| 蔡泽丰,祖庆泉,周春高,施海彬,王 杰.TACE联合MWA治疗肝切除术后复发性肝癌的疗效及预后分析[J].,2023,(23):4578-4583 |
| TACE联合MWA治疗肝切除术后复发性肝癌的疗效及预后分析 |
| Effect and Prognosis of TACE Combined with MWA in the Treatment of Recurrent Hepatocellular Carcinoma after Hepatectomy |
| 投稿时间：2023-05-28 修订日期：2023-06-23 |
| DOI：10.13241/j.cnki.pmb.2023.23.036 |
| 中文关键词: TACE MWA 术后复发性肝癌 预后分析 |
| 英文关键词: TACE MWA Postoperative recurrent hepatocellular carcinoma Prognosis analysis |
| 基金项目:江苏省卫生健康委医学科研立项项目（S2020091） |
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| 中文摘要: |
| 摘要 目的：探讨经肝动脉化疗栓塞术（TACE）联合微波消融（MWA）治疗肝切除术后复发性肝癌（RHCC）的临床疗效及预后分析。方法：选取2012年2月-2020年6月医院介入放射科就诊的224例肝切除术后复发性肝癌患者作为研究对象，其中联合组44例，TACE组180例，使用倾向评分匹配（PSM）按1：1匹配分为联合组40例和TACE组40例。联合组使用TACE联合MWA（TACE-MWA）治疗，TACE组使用TACE治疗，比较两组患者匹配后肿瘤应答与不良反应，使用Logrank进行生存分析，使用Logisitic回归分析预后影响因素。结果：PSM匹配后，术后1月、3月联合组的客观缓解率（60.00%、77.50%）高于TACE组（37.50%、40.00%），术后3月联合组的疾病控制率（92.50%）高于TACE组（65.00%）（P＜0.05）；联合组3年的生存率（45.00%）高于TACE组（20.00%）（P＜0.05）；两组患者在恶心呕吐、发热、腹痛方面均无统计学差异（P＞0.05）；RHCC患者术后的3年生存率与年龄、乙型肝炎（HBV）感染、甲胎蛋白（AFP）水平、肿瘤直径、TACE次数、治疗方法有关，多因素Logisitic回归分析显示年龄≥60岁、HBV感染、TACE次数≥3次是3年生存率的独立危险因素，TACE-MWA是独立保护因素（P＜0.05）。结论：TACE联合MWA治疗肝切除术后复发性肝癌可显著改善RHCC患者的病情，具有良好的疗效，且患者术后3年生存率受年龄≥60岁、HBV感染、TACE次数≥3次、治疗方法4种因素的影响。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the clinical effect and prognosis of transarterial chemoembolization (TACE) combined with microwave ablation (MWA) in the treatment of recurrent hepatocellular carcinoma (RHCC) after hepatectomy. Methods: A total of 224 patients with RHCC after hepatectomy in interventional radiology department of the hospital were enrolled as the research objects between February 2012 and June 2020, including 44 cases in combination group and 180 cases in TACE group. According to propensity score matching (PSM), there were 40 cases in combination group (TACE-MWA) and 40 cases in TACE group (TACE) finally. The tumor response and adverse reactions were compared between the two groups after matching. The survival analysis was performed by Logrank, and the influencing factors of prognosis were analyzed by Logisitic regression analysis. Results: At 1 month and 3 months after surgery, objective remission rates in combination group were higher than those in TACE group (60.00%, 77.50% vs 37.50%, 40.00%), and disease control rate was higher than that in TACE group at 3 months after surgery (92.50% vs 65.00%, P<0.05). The 3-year survival rate in combination group was higher than that in TACE group (45.00% vs 20.00%, P<0.05). There was no significant difference in nausea and vomiting, fever or abdominal pain between the two groups (P>0.05). The 3-year survival rate in RHCC patients after surgery was related to age, hepatitis B virus (HBV) infection, alpha-fetoprotein (AFP), tumor diameter, TACE frequency and treatment methods. Multivariate Logisitic regression analysis showed that age ≥60 years, HBV infection and TACE frequency ≥3 times were independent risk factors of 3-year survival, while TACE-MWA was an independent protective factor (P<0.05). Conclusion: TACE combined with MWA can significantly improve the condition of RHCC patients after hepatectomy, with good curative effect. There are many influencing factors of 3-year survival rate, including age ≥60 years, HBV infection, TACE frequency ≥3 times and treatment methods. |
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