TACE联合RFA治疗不同BCLC分期原发性肝癌的疗效及安全性研究-东南大学学报医学版

TACE联合RFA治疗不同BCLC分期原发性肝癌的疗效及安全性研究

单位：郑州大学第一附属医院感染科一病区, 河南郑州 450052

分类号：R735.7

出版年·卷·期（页码）：2021·40·第三期（353-359）

摘要：

目的：观察肝动脉化疗栓塞（TACE）联合射频消融（RFA）在不同巴塞罗那临床肝癌（BCLC）分期原发性肝癌（HCC）中的治疗价值。方法：前瞻性纳入我院2017年4月至2019年4月收治的HCC患者118例。根据随机数字表法分成观察组与对照组各59例。观察组采用TACE联合RFA治疗，对照组单纯行TACE治疗。比较两组治疗效果，分别在治疗前后检测血清高尔基体糖蛋白73（GP73）、α-L-岩藻糖苷酶（AFU）、肿瘤特异性生长因子、可溶性白细胞介素-2受体（sIL-2R）水平，分析两组不良事件发生率，经COX多因素模型分析预后危险因素。结果：观察组总缓解率为81.36%，高于对照组的64.41%，其中观察组B期总缓解率（80.65%）高于对照组（56.00%）（P<0.05）。观察组B期血清GP73、AFU、sIL-2R水平低于对照组B期（P<0.05）。两组A、B期不良事件发生率比较差异均无统计学意义（P>0.05）。观察组总生存率为88.14%，高于对照组的72.88%（P<0.05）。COX多因素分析显示BCLC B期是患者预后的危险因素，而RFA治疗是改善预后的保护性因素（P<0.05）。结论：TACE联合RFA对BCLC A期HCC患者的近期疗效与单用TACE接近，但能提高B期患者的近期疗效，这可能与其进一步下调血清GP73、AFU、sIL-2R水平有关，治疗安全性较高。

Objective: To observe the therapeutic value of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in different (Barcelona Clinic Liver Cancer, BCLC) stages of primary hepatocellular carcinoma(HCC). Methods: Prospectively enrolled 118 HCC patients were admitted to our hospital from April 2017 to April 2019. According to the random number table method, they were divided into the observation group and the control group(59 cases in each group). The observation group was treated with TACE combined with RFA, and the control group was treated with TACE alone. The treatment effects of the two groups were compared, and serum Golgi glycoprotein 73(GP73), α-L-Fucosidase(AFU), tumor-specific growth factor, and soluble interleukin-2 receptor(SIL-2R) levels were detected before and after treatment. The incidence rate of adverse events in the two groups was analyzed, and the prognostic risk factors were analyzed by COX multivariate model. Results: The total remission rate of the observation group was 81.36%, which was higher than 64.41% of the control group. The total remission rate of phase B in the observation group(80.65%) was higher than that of the control group(56.00%) (P<0.05). Serum levels of GP73, AFU and sIL-2R in the observation group of stage B were lower than those in the control group of B stage(P<0.05). There were no differences in the incidence rates of adverse events between the two groups in stages A and B(P>0.05). The overall survival rate of the observation group was 88.14%, which was higher than 72.88% of the control group(P<0.05). COX multivariate analysis showed that BCLC stage B was a risk factor for the prognosis of patients, and RFA treatment was a protective factor for improving the prognosis(P<0.05). Conclusion: The short-term efficacy of TACE combined with RFA for HCC patients with BCLC stage A is similar to that of TACE alone, but it can improve the short-term efficacy of patients with stage B. This may be related to the further down-regulation of serum GP73, AFU, and sIL-2R levels, and the treatment is safer.

参考文献：

[1] PAOLA B, FEDERICA T, GRETA C, et al. Global trends and predictions in hepatocellular carcinoma mortality[J]. J Hepatol, 2017, 67(2):302-309.
[2] LAURA K, HASHEM B E.Epidemiology and management of hepatocellular carcinoma[J]. Gastroenterology, 2019, 156(2):477-491.
[3] LI C, SHEN J Y, ZHANG X Y, et al. Predictors of futile liver resection for patients with barcelona clinic liver cancer stage B/C hepatocellular carcinoma[J]. J Gastrointest Surg, 2017, 22(3):496-502.
[4] HALAZUN K J, NAJJAR M, ABDELMESSIH R M, et al. Liver transplantation for hepatocellular carcinoma[J]. Ann Surg, 2017, 265(3):557-564.
[5] WANG Y Y, WANG L J, XU D, et al. Postoperative adjuvant transcatheter arterial chemoembolization should be considered selectively in patients who have hepatocellular carcinoma with microvascular invasion[J]. HPB, 2019, 21(4):425-433.
[6] 任衍乔, 郑传胜.肝癌射频消融术后各种影像学评价应用与进展[J]. 介入放射学杂志, 2018, 27(10):89-92.
[7] 侯帅, 樊琳琳.非手术治疗原发性肝癌研究进展[J]. 实用肝脏病杂志, 2016, 19(2):249-252.
[8] ADHOUTE X, PENARANDA G, RAOUL J L, et al. Nomogram of the barcelona clinic liver cancer system:external validation in european patients[J]. Liver Int, 2016, 36(11):1716-1717.
[9] 陈焕朝, 李宏.肝癌的治疗与康复[M]. 武汉:湖北科学技术出版社, 2016:55.
[10] 朱笑生, 刘文超.原发性肝癌全球流行情况和危险因素的新进展[J]. 现代肿瘤医学, 2018, 26(14):163-167.
[11] 王辉, 潘裕国, 夏金堂, 等. 经肝动脉化疗栓塞术在原发性肝癌治疗中的应用[J]. 临床肝胆病杂志, 2018, 34(2):414-418.
[12] 刘勤, 周少波.小肝癌射频消融与经腹腔镜切除治疗的近期疗效及成本效果分析[J]. 中国普通外科杂志, 2020, 29(5):88-94.
[13] 刘向玲, 王剑飞, 丰玉荣, 等. 临床常用分期标准对原发性肝癌术后三年生存率的预测价值比较[J]. 临床肝胆病杂志, 2012, 28(12):948-951.
[14] YANG D J, LUO K L, LIU H, et al. Meta-analysis of transcatheter arterial chemoembolization plus radiofrequency ablation versus transcatheter arterial chemoembolization alone for hepatocellular carcinoma[J]. Oncotarget, 2017, 8(2):2960-2970.
[15] PENG Z, WEI M, CHEN S, et al. Combined transcatheter arterial chemoembolization and radiofrequency ablation versus hepatectomy for recurrent hepatocellular carcinoma after initial surgery:a propensity score matching study[J]. Eur Radiol, 2018, 28(8):3522-3531.
[16] 袁广庆, 莫灿均, 张志成.肝动脉化疗栓塞联合射频消融治疗原发性肝癌临床疗效观察[J]. 临床军医杂志, 2019, 47(10):1126-1127.
[17] 孙振宇, 袁旦平, 徐力善.GP73与肝癌临床诊断和治疗的研究进展[J]. 肝脏, 2020, 25(2):214-216.
[18] 杨训俊, 陈小童, 倪莉, 等. 尿素、α-L-岩藻糖苷酶、甲胎蛋白联合检测在慢性乙型肝炎-肝硬化-肝癌发展中的应用价值[J]. 中国卫生检验杂志, 2020, 30(17):2095-2098.
[19] 南君, 许春进.香菇多糖配合化疗对肝癌患者肝功能、T细胞亚群及IL-12、sIL-2R的影响[J]. 中西医结合肝病杂志, 2018, 28(3):153-155.
[20] 何健, 陈晓明.2018年肝癌TACE治疗研究进展[J]. 循证医学, 2019, 19(1):21-22.
[21] 张浩, 仲富瑞, 程宦立, 等. 肝动脉灌注化疗栓塞联合射频消融治疗中晚期肝癌的疗效分析[J]. 中国普通外科杂志, 2020, 29(1):35-42.
[22] 郭伟昌, 彭翼, 李昭辉, 等. 动脉化疗栓塞联合射频消融与手术切除对早期HCC患者生存率影响的Meta分析[J]. 重庆医学, 2018, 47(4):508-511.

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