PDF下载 ( 2502 KB)
Clinical effect of transcatheter arterial chemoembolization combined with radiofrequency ablation in treatment of Barcelona Clinical Liver Cancer stage B primary liver cancer and influencing factors for prognosis
-
摘要: 目的探讨经肝动脉化疗栓塞术（TACE）联合肝癌射频消融（RFA）治疗巴塞罗那（BCLC） B期原发性肝癌患者的疗效及其预后影响因素。方法选择2007年1月-2012年1月在首都医科大学附属北京佑安医院住院行TACE联合RFA治疗的BCLC-B期原发性肝癌患者154例。收集所有患者基线实验室及影像检查资料,通过门诊、住院或电话随访所有病例。采用KaplanMeier法绘制生存曲线,采用log-rank检验生存曲线,将单因素分析中P <0. 05的指标纳入多因素Cox回归分析。结果 154例BCLC-B期肝癌患者,中位生存期37个月,1、2、3、5年生存率分别为82. 5%、59. 7%、50. 6%和36. 1%。将患者按照BCLC-B期亚分期分为B1、B2、B3、B4期,B1期患者生存率明显高于B2～B4期,差异有统计学意义（χ2=16. 881,P=0. 001）; RFA后1个月达到完全消融、年龄<60岁、术前AFP <400 ng/ml、胆碱酯酶≥4000 U/L、TBil≤21μmol/L、Child-Pugh A级,肿瘤数目≤3个、肿瘤...Abstract: Objective To investigate the clinical effect of transcatheter arterial chemoembolization ( TACE) combined with radiofrequency ablation ( RFA) in the treatment of Barcelona Clinical Liver Cancer ( BCLC) stage B primary liver cancer and influencing factors for prognosis. Methods A total of 154 patients with BCLC stage B primary liver cancer who were admitted to Beijing YouAn Hospital, Capital Medical University, from January 2007 to January 2012 and underwent TACE combined with RFA were enrolled. Baseline laboratory data and imaging findings were collected for all patients, and all patients were followed up by the outpatient service, hospitalization, or telephone. The Kaplan-Meier method was used to plot survival curves and the log-rank test was used for the analysis of survival curves. The indicators with P < 0. 05 in the univariate analysis were included in multivariate Cox regression analysis. Results The 154 patients with BCLC stage B liver cancer had a median survival time of 37 months and the 1-, 2-, 3-, and 5-year survival rates were 82. 5%, 59. 7%, 50. 6%, and 36. 1%, respectively. The patients were divided into B1, B2, B3, and B4 groups according to the BCLC substage, and the B1 group had a significantly higher survival rate than the B2, B3, and B4 groups ( χ2= 16. 881, P = 0. 001) . The patients with complete ablation at one month after RFA, an age of < 60 years, an alpha-fetoprotein ( AFP) level of < 400 ng/ml, a cholinesterase ( ChE) level of ≥4000 U/L, a total bilirubin ( TBil) level of ≤21 μmol/L, a Child-Pugh class A disease, a number of tumors of ≤3, or a maximum tumor diameter of < 3 cm had a significantly higher survival rate than those with incomplete ablation ( χ2= 173. 002, P < 0. 001) , an age of ≥60 years ( χ2= 6. 336, P = 0. 012) , an AFP level of ≥400 ng/ml ( χ2= 10. 765, P = 0. 001) , a ChE level of < 4000 U/L ( χ2= 6. 933, P =0. 008) , a TBil level of > 21 μmol/L ( χ2= 4. 624, P = 0. 032) , a Child-Pugh class B disease ( χ2= 5. 570, P = 0. 018) , a number of tumors of > 3 ( χ2= 6. 761, P = 0. 009) , or a maximum tumor diameter of > 5 cm ( χ2= 7. 430, P = 0. 024) . The multivariate Cox regression analysis showed that ablation assessment ( odds ratio [OR]= 21. 950, 95% confidence interval [CI]: 11. 817-40. 772, P < 0. 001) , Child-Pugh class ( OR = 2. 190, 95% CI: 1. 329-3. 609, P = 0. 002) , AFP level ( OR = 1. 760, 95% CI: 1. 122-2. 760, P = 0. 014) , and BCLC B substage ( OR = 2. 178, 95% CI: 1. 284-3. 694, P = 0. 004) were influencing factors for survival time after RFA in patients with BCLC stage B liver cancer. Conclusion TACE combined with RFA is safe and effective in the treatment of BCLC stage B liver cancer.Incomplete ablation, a AFP level of ≥400 ng/ml, Child-Pugh class B, and late substage of BCLC stage B are independent risk factors for survival time after RFA in patients with BCLC stage B liver cancer.
-
Key words:
- liver neoplasms /
- chemoembolization, therapeutic /
- catheter ablation /
- treatment outcome /
- prognosis /
- risk factors
-
[1]European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASLEORTC clinical practice guidelines:Management of hepatocellular carcinoma[J]. J Hepatol, 2012, 56 (4) :908-943. [2]BRUIX J, SHERMAN M, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma:An update[J]. Hepatology, 2011, 53 (3) :1020-1022. [3]LI X. Short-and long-term efficacy of transarterial chemoembolization versus liver resection in treatment of patients with Barcelona stage B multiple hepatocellular carcinoma[J]. J Clin Hepatol, 2017, 33 (7) :1296-1300. (in Chinese) 黎昕.经肝动脉化疗栓塞术与肝切除术治疗巴塞罗那B期多发性肝细胞癌的近远期效果比较[J].临床肝胆病杂志, 2017, 33 (7) :1296-1300. [4]LLOVET JM, PAVEL M, RIMOLA J, et al. Pilot study of living donor liver transplantation for patients with hepatocellular carcinoma exceeding Milan Criteria (Barcelona Clinic Liver Cancer extended criteria) [J]. Liver Transpl, 2018, 24 (3) :369-379. [5]National Health and Family Planning Commission of the People's Republic of China. Diagnosis, management, and treatment of hepatocellular carcinoma (V2017) [J]. J Clin Hepatol, 2017, 33 (8) :1419-1431. (in Chinese) 中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范 (2017年版) [J].临床肝胆病杂志, 2017, 33 (8) :1419-1431. [6]BOLONDI L, BURROUGHS A, DUFOUR JF, et al. Heterogeneity of patients with intermediate (BCLC B) Hepatocellular Carcinoma:Proposal for a subclassification to facilitate treatment decisions[J]. Semin Liver Dis, 2012, 32 (4) :348-359. [7]BIOLATO M, GALLUSI G, IAVARONE M, et al. Prognostic ability of BCLC-B subclassification in patients with hepatocellular carcinoma undergoing transarterial chemoembolization[J].Ann Hepatol, 2018, 17 (1) :110-118. [8]YANG B, ZHENG B, YANG M, et al. Liver resection versus transarterial chemoembolization for the initial treatment of Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma[J]. Hepatol Int, 2018, 12 (5) :417-428. [9]LI YM, MA Z, CHEN H. Radiofrequency ablation for primary liver cancer[J/CD]. Chin J Hepatic Surg:Electronic Edition, 2017, 6 (5) :337-342. (in Chinese) 李玉民, 马臻, 陈昊.原发性肝癌射频消融治疗[J/CD].中华肝脏外科手术学电子杂志, 2017, 6 (5) :337-342. [10]YIN X, ZHANG L, WANG YH, et al. Transcatheter arterial chemoembolization combined with radiofrequency ablation delays tumor progression and prolongs overall survival in patients with intermediate (BCLC B) hepatocellular carcinoma[J]. BMC Cancer, 2014, 14:849. [11]HIROOKA M, HIRAOKA A, OCHI H, et al. Transcatheter arterial chemoembolization with or without radiofrequency ablation:Outcomes in patients with Barcelona Clinic Liver Cancer Stage B hepatocellular carcinoma[J]. AJR Am J Roentgenol, 2018, 210 (4) :891-898. [12]HA Y, SHIM JH, KIM SO, et al. Clinical appraisal of the recently proposed Barcelona Clinic Liver Cancer stage B subclassification by survival analysis[J]. J Gastroenterol Hepatol, 2014, 29 (4) :787-793. [13]SCAFFARO LA, STELLA SF, ALVARES-DA-SILVA MR, et al. Survival rates according to barcelona clinic liver cancer sub-staging system after transarterial embolization for intermediate hepatocellular carcinoma[J]. World J Hepatol, 2015, 7 (3) :628-632. [14]XU HX, LU MD, XIE XY, et al. Prognostic factors for longterm outcome after percutaneous thermal ablation for hepatocellular carcinoma:A survival analysis of 137 consecutive patients[J]. Clin Radiol, 2005, 60 (9) :1018-1025. [15]YIN XY, XIE XY, LU MD, et al. Percutaneous thermal ablation of medium and large hepatocellular carcinoma:Long-term outcome and prognostic factors[J]. Cancer, 2009, 115 (9) :1914-1923. [16]LI J, ZHU WL, KANG XX, et al. Prognostic factors and model of primary liver cancer treated with transcatheter arterial chemoembolization combined with radiofrequency ablation[J].Chin J Oncol, 2017, 39 (10) :787-791. (in Chinese) 李靖, 朱文良, 康鑫鑫, 等.经肝动脉化疗栓塞联合射频消融治疗原发性肝癌的预后影响因素及预测模型[J].中华肿瘤杂志, 2017, 39 (10) :787-791. [17]HENG-JUN G, YAO-JUN Z, MIN-SHAN C, et al. Rationality and effectiveness of transarterial chemoembolization as an initial treatment for BCLC B stage HBV-related hepatocellular carcinoma[J]. Liver Int, 2014, 34 (4) :612-620. [18]TAKADA H, KUROSAKI M, NAKANISHI H, et al. Impact of pre-sarcopenia in sorafenib treatment for advanced hepatocellular carcinoma[J]. PLo S One, 2018, 13 (6) :e0198812. [19]GUO XD, SUN SS, LI WD, et al. Clinical features of patients with Barcelona Clinic Liver Cancer stage C primary liver cancer and related prognostic factors:An analysis of 140 cases[J].J Clin Hepatol, 2018, 34 (7) :1456-1461. (in Chinese) 郭晓笛, 孙莎莎, 李文东, 等. 140例BCLC分期C期原发性肝癌患者的临床特征及预后影响因素分析[J].临床肝胆病杂志, 2018, 34 (7) :1456-1461. [20]XU XF, XING H, HAN J, et al. Risk factors, patterns, and outcomes of late recurrence after liver resection for hepatocellular carcinoma:A multicenter study from China[J]. JAMA Surg, 2018.[Epub ahead of print] [21]KIM CJ, KIM HJ, PARK JH, et al. Radiologic response to transcatheter hepatic arterial chemoembolization and clinical outcomes in patients with hepatocellular carcinoma[J]. Liver Int, 2014, 34 (2) :305-312. [22]YIN L, LI H, LI AJ, et al. Partial hepatectomy vs. transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan Criteria:A RCT[J]. J Hepatol, 2014, 61 (1) :82-88. [23]ZHAO YN, ZHANG YQ, YE JZ, et al. Hepatic resection versus transarterial chemoembolization for patients with Barcelona Clinic Liver Cancer intermediate stage Child-Pugh A hepatocellular carcinoma[J]. Exp Ther Med, 2016, 12 (6) :3813-3819. [24]DONADON M, CIMINO M, PROCOPIO F, et al. Potential role of cholinesterases to predict short-term outcome after hepatic resection for hepatocellular carcinoma[J]. Updates Surg, 2013, 65 (1) :11-18. [25]YAO Q, BAO X, XUE R, et al. Prognostic value of immunoscore to identify mortality outcomes in adults with HBV-related primary hepatocellular carcinoma[J]. Medicine (Baltimore) , 2017, 96 (17) :e6735. 期刊类型引用(30)
1. 邹暾，龙文兴，周定中，周忠威，彭俊. 原发性肝癌采用肝动脉化疗栓塞术联合RFA的疗效及对血清miR-202、FHIT和P16蛋白水平的影响. 湘南学院学报(医学版). 2024(01): 27-29+78 . 
百度学术2. 余令兵. TACE中灌注吡柔比星治疗原发性肝癌的临床疗效及对免疫功能、血清肿瘤标志物水平的影响. 中国卫生工程学. 2024(02): 238-240+243 . 百度学术3. 王娟，田宁，刘超，张山燕，周远. 肝动脉化疗栓塞联合靶向药物及免疫检查点抑制剂治疗中晚期肝癌的效果及对患者生存时间的影响. 大医生. 2024(07): 36-39 . 百度学术4. 胡迎超. 血清甲胎蛋白和巨噬细胞移动抑制因子水平与原发性肝癌肝动脉化疗栓塞术患者预后的关系. 慢性病学杂志. 2023(01): 116-118 . 百度学术5. 周菲菲，黄荣，蒋军，毛晓帆. 平均血小板体积/淋巴细胞比值对原发性肝癌SBRT治疗预后的评估价值. 西部医学. 2023(04): 563-567 . 百度学术6. 何翠瑛，苏贞栋，陈燕红，周林荣，杨宇，姚清深. 阿帕替尼联合TACE治疗原发性肝癌复发生存的影响因素分析. 中西医结合肝病杂志. 2023(04): 298-302 . 百度学术7. 张栋华，宋爱军，胡海军，刘朝阳. 经导管动脉化疗栓塞联合射频消融术治疗原发性肝癌患者的临床疗效. 癌症进展. 2023(08): 858-861 . 百度学术8. 王如芹，高振东，高宗毅. 影响立体定向放射治疗原发性肝癌效果的相关因素分析. 中国基层医药. 2022(02): 285-290 . 百度学术9. 刘爽. 基于聚焦解决模式的放松训练干预在肝癌射频消融术围术期护理中的应用效果评估. 黑龙江医学. 2022(01): 76-78 . 百度学术10. 兰海涛，黄真婷，王小星. 超选择性肝动脉化疗栓塞术联合阿帕替尼对中晚期原发性肝癌患者血清MMP表达的影响. 数理医药学杂志. 2022(04): 597-599 . 百度学术11. 张雪婷，周祖邦，薛亚娥，张明华，杜学晴. TACE联合热消融与单独TACE治疗结直肠癌肝转移疗效：Meta分析. 中国介入影像与治疗学. 2022(05): 278-283 . 百度学术12. 杜炜玮，段铮，胡斌. 经皮RFA治疗原发性肝癌的效果及对血清TGF-β1、EGR2水平的影响. 分子诊断与治疗杂志. 2022(04): 635-638 . 百度学术13. 武文华，冯秦辉，蔡芝芳，贾晓黎，杨锐华，党双锁. 经导管动脉化疗栓塞术联合超声引导射频消融术治疗原发性肝癌对疗效及免疫功能的影响. 中国医师进修杂志. 2022(05): 459-464 . 百度学术14. 王瑛，袁鹤立，赵利，张亚丽，马向明. 伴营养不良风险的原发性肝癌患者临床特征及预后因素分析. 中西医结合肝病杂志. 2022(06): 494-498 . 百度学术15. 柯映平，叶绍光，卢舜彬. 肝动脉化疗栓塞术联合FOLFOX方案持续性动脉灌注化疗在巴塞罗那B期原发性肝癌患者中的应用效果. 中国当代医药. 2022(18): 73-76 . 百度学术16. 张贻庆，崔贵医，杨磊，刘刚，冯世杰，王劲. 肝肿瘤切除术与射频消融术治疗原发性肝癌的疗效及其对血清AFP、CEA、CA125水平的影响. 实用癌症杂志. 2022(08): 1316-1319 . 百度学术17. 孙玉，张洪海，袁春旺，龙江，郑加生，张永宏. C反应蛋白/白蛋白比值影响肝动脉栓塞联合微波消融治疗中期肝细胞癌的预后. 肝胆胰外科杂志. 2022(10): 587-592 . 百度学术18. 郝晓光，李伟靖，朱丽娜，史博，艾宁，吴勇超，李智岗. 中晚期肝癌患者经导管化疗栓塞治疗后序贯射频消融手术治疗时机的选择. 介入放射学杂志. 2022(09): 908-912 . 百度学术19. 章甜，贾思静，孙冬雪，龙奉玺，唐东昕，杨柱. 拉米夫定联合TACE治疗HBV相关性中晚期肝癌的Meta分析. 临床医学研究与实践. 2021(13): 36-41+47 . 百度学术20. 付卫东，尚靖智. 肝动脉化疗栓塞术联合经皮射频消融术治疗中晚期肝癌的临床疗效评价. 吉林医学. 2021(05): 1095-1098 . 百度学术21. 谷涛，于经瀛. 肝动脉化疗栓塞术治疗原发性进展性肝细胞癌新进展. 协和医学杂志. 2021(03): 380-385 . 百度学术22. 刘人杰. 索拉菲尼治疗原发性肝癌的效果及对患者血清HSP90α、VEGF水平的影响. 中国医学创新. 2021(14): 15-19 . 百度学术23. 高磊磊，秦帅鑫，陈威，候振国. TACE联合RFA治疗中期原发性肝癌的疗效及对患者血清GP73、AFP和AFP-L3水平的影响. 临床和实验医学杂志. 2021(13): 1388-1391 . 百度学术24. 金文彪. 肝动脉化疗栓塞联合射频消融在原发性肝癌中的价值. 中国卫生标准管理. 2021(17): 48-51 . 百度学术25. 范隼，钟鹏，巫兆国. 经肝动脉化疗栓塞联合同步射频消融术治疗肝癌的初步临床研究. 吉林医学. 2021(10): 2389-2390 . 百度学术26. 曹昆昆，李晓伟，付志刚，翟健，曲增强，丁宁. 微波消融同步联合经导管动脉化疗栓塞治疗膈下肝细胞癌. 中国介入影像与治疗学. 2021(11): 659-662 . 百度学术27. 卢毅，周任. 肝动脉化疗栓塞联合射频消融治疗原发性小肝癌的临床效果及对患者免疫功能的影响. 广西医学. 2021(18): 2161-2165 . 百度学术28. 何勇. 肝动脉介入化疗栓塞术联合阿帕替尼在晚期肝癌中的应用. 临床医药实践. 2020(03): 181-183 . 百度学术29. 徐蓉，华忠. 肝硬化并发原发性肝癌的流行病学特征、危险因素及相关预防干预对策研究. 中西医结合肝病杂志. 2020(04): 357-359+366 . 百度学术30. 刘峥嵘，俞巍. 肝动脉化疗栓塞术和肝动脉栓塞术治疗肝细胞癌的疗效. 血管与腔内血管外科杂志. 2019(02): 139-143 . 百度学术其他类型引用(2)
-
百度学术
下载:
