原发性肝癌合并肝动静脉瘘患者经导管动脉化疗栓塞后早期联合射频消融治疗的临床研究

Efficacy of transcatheter arterial chemoembolization combined with early radiofrequency ablation for hepatocellular carcinoma patients with hepatic arteriovenous fistula

摘要:

目的 分析原发性肝癌合并肝动静脉瘘（HCC-AVF）患者经导管动脉化疗栓塞（TACE）后早期（1周内）联合射频消融（RFA）治疗的效果。方法 选取2018年10月—2020年6月在温州医科大学附属第二医院首次TACE造影发现HCC-AVF的60例患者，随机分为TACE组和TACE + eRFA组，每组30例。TACE组患者行≥ 2次TACE治疗，TACE+eRFA组患者在TACE治疗后1周内行RFA治疗，联合治疗直至肝动静脉瘘（AVF）消失。分析两组临床疗效、AVF闭合情况、血清AFP水平的变化及治疗后1年和2年的生存率。结果 TACE+eRFA组治疗有效率为83.3%（25/30），高于TACE组的60.0%（18/30）（P <0.05）。ACE+eRFA组CR为60.0%（18/30），高于TACE组的33.3%（10/30）（P <0.05）。TACE+eRFA组治疗后AVF闭合、血清AFP水平降低情况优于TACE组（P <0.05）。TACE+eRFA组1年、2年生存率分别为76.7%（23/30）和46.7%（14/30），高于TACE组的50.0%（15/30）和20.0%（6/30）（P <0.05）。结论 TACE治疗后1周内行eRFA治疗相比单纯TACE治疗能一定程度上提高临床疗效、肿瘤坏死率、AVF闭合率和AFP转阴率，延长HCC-AVF患者生存时间。

Abstract:

Objective To explore the efficacy of transcatheter arterial chemoembolization (TACE) combined with early (within 1 week) radiofrequency ablation (eRFA) for hepatocellular carcinoma patients with hepatic arteriovenous fistula (HCC-AVF).Methods The 60 patients diagnosed as HCC-AVF during the first TACE in the Second Affiliated Hospital of Wenzhou Medical University from October 2018 to June 2020 were selected, and they were randomly divided into TACE group (30 cases) and TACE + eRFA group (30 cases). Patients in the TACE group received two or more sessions of TACE, while patients in the TACE + eRFA group received RFA within 1 week after the TACE treatment until the AVF closed. The therapeutic efficacy, AVF closure, changes of serum levels of alpha-fetoprotein (AFP), and 1-year and 2-year survival rates after the treatment in the two groups were analyzed.Results The overall response rate (complete response and partial response) of the TACE + eRFA group was 83.3% (25/30), which was higher than 60.0% (18/30) in the TACE group (P < 0.05). The complete response rate of the TACE + eRFA group was 60.0% (18/30), which was higher than 33.3% (10/30) in the TACE group (P < 0.05). The incidence of AVF closure and the decrease in the serum level of AFP were higher in the TACE + eRFA group than those in the TACE group (P < 0.05). The 1-year and 2-year survival rates in the TACE + eRFA group were 76.7% (23/30) and 46.7% (14/30), which were higher than 50.0% (15/30) and 20.0% (6/30) in the TACE group (P < 0.05).Conclusions Compared with TACE treatment alone, TACE combined with eRFA may improve the clinical response, the tumor necrosis rate, the incidence of AVF closure, and negative conversion ratio of AFP, and prolong the survival time of HCC-AVF patients.