1、癌症进展2023 年 2 月第 21 卷第 3 期ONCOLOGY PROGRESS,Feb 2023 V ol.21,No.3*论著*射频消融术联合经导管动脉栓塞化疗治疗原发性大肝癌的疗效射频消融术联合经导管动脉栓塞化疗治疗原发性大肝癌的疗效程海燕#，董刚，刘佳，刘晓婉郑州大学第一附属医院超声介入室，郑州 4500000摘要摘要：目的目的探讨射频消融术（RFA）联合经导管动脉栓塞化疗（TACE）治疗原发性大肝癌的疗效。方法方法根据治疗方式的不同将96例原发性大肝癌患者分为对照组和观察组，每组48例，对照组患者给予TACE治疗，观察组患者给予TACE联合RFA治疗，两组患者均给予综合干预。比较
2、两组患者肝功能指标总胆红素（TBIL）、丙氨酸转氨酶（ALT）、甲胎蛋白（AFP）、免疫功能指标CD3+、CD4+、CD8+、自然杀伤（NK）细胞、生活质量欧洲癌症研究与治疗组织生命质量测定量表（EORTC QLQ-C30）、并发症发生情况、随访 2 年生存情况和肿瘤直径。结果结果治疗后1个月，两组患者TBIL、ALT、AFP、CD8+水平均低于本组治疗前，CD3+、CD4+、NK细胞水平均高于本组治疗前，且观察组患者TBIL、ALT、AFP、CD8+水平均低于对照组，CD3+、CD4+、NK细胞水平均高于对照组，差异均有统计学意义（P0.05）。治疗后1个月，两组患者EORTC QLQ-C3
3、0量表各维度评分均高于本组治疗前，且观察组患者EORTC QLQ-C30量表各维度评分均高于对照组，差异均有统计学意义（P0.05）。随访1、2年，观察组患者的总生存率均高于对照组，差异均有统计学意义（P0.05）。治疗后1个月，两组患者的肿瘤直径均小于本组治疗前，且观察组患者的肿瘤直径小于对照组，差异均有统计学意义（P0.05）。结论结论RFA联合TACE治疗原发性大肝癌的效果明显优于TACE单独治疗，能够明显改善患者的肝功能及免疫功能指标，且不增加并发症发生风险，有助于提高生活质量及生存率。关键词关键词：原发性大肝癌；经导管动脉栓塞化疗；射频消融术；免疫功能中图分类号中图分类号：R R73
4、5735.7 7文献标志码文献标志码：AdoiAdoi：10.11877/j.issn.1672-1535.2023.21.03.19Efficacy of radiofrequency ablation combined with transcatheter arterialEfficacy of radiofrequency ablation combined with transcatheter arterialchemoembolization in the treatment of primary large liver cancerchemoembolization in the
5、treatment of primary large liver cancerCHENG Haiyan#,DONG Gang,LIU Jia,LIU XiaowanUltrasonic Intervention Room,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,He nan,ChinaAbstractAbstract:ObjectiveObjectiveTo investigate the efficacy of radiofrequency ablation(RFA)combined wit
6、h transcatheter arterial chemoembolization(TACE)in the treatment of primary large liver cancer.MethodMethodA total of 96 patients with primary large liver cancer were collected and divided into control group and observation group according to different treatmentmethods,with 48 cases in each group.Th
7、e patients in the control group were treated with TACE,and the patients in theobservation group were treated with TACE combined with RFA.Both groups were given comprehensive intervention.Liver function indexes total bilirubin(TBIL),alanine aminotransferase(ALT),alpha-fetoprotein(AFP),immune function
8、 indexes CD3+,CD4+,CD8+,natural killer(NK)cell,quality of life European Organization for Research and Treatment of Cancer quality of life questionnaire core 30(EORTC QLQ-C30),complications,2-year follow-up survival,andtumor diameter were compared between the two groups.ResultResultOne month after tr
9、eatment,the levels of TBIL,ALT,AFP and CD8+in the two groups were lower than those before the treatment,and the levels of CD3+,CD4+and NK cellwere higher than those before the treatment,and the levels of TBIL,ALT,AFP and CD8+in the observation group werelower than those in the control group,the leve
10、ls of CD3+,CD4+and NK cell were higher than those in the control group,with differences were statistically significant(P0.05).One month after treatment,the scores of each dimension ofEORTC QLQ-C30 scale in the two groups were higher than those before treatment,and the scores of each dimension ofEORT
11、C QLQ-C30 scale in the observation group were higher than those in the control group,with differences were statistically significant(P0.05).After 1 and 2 years of follow-up,the overall survival of the observation group were higherthan those of the control group,and the differences were statistically
12、 significant(P0.05).One month after the treatment,the tumor diameters of the two groups were smaller than those before the treatment,and the tumor diameters of the observation group was smaller than that of the control group,and the differences were statistically significant(P0.05).ConcluConclu sion
13、sionThe effect of RFA combined with TACE in the treatment of primary large liver cancer is significantly better thanthat of TACE alone,and it can significantly improve the liver function and immune function indicators of patients withoutincreasing the risk of adverse events.Therefore,it does help im
14、proving patients quality of life and survival.#通信作者（corresponding author），邮箱：309癌症进展2023年2月第21卷第3期Key wordsKey words:primary large liver cancer;transcatheter arterial chemoembolization;radiofrequency ablation;immunefunctionOncol Prog,2023,21(3)原发性肝癌是常见的恶性肿瘤之一，近年来其发病率呈上升趋势1。原发性大肝癌是指肿瘤直径5 cm 的肝癌，手术切除是
15、大肝癌的主要治疗手段，但早期肝癌往往缺乏特异性症状，多数患者确诊时已进展至中晚期，错过了手术治疗的最佳时机2。经导管动脉栓塞化疗（transcatheter arterialchemoembolization，TACE）是失去手术机会或复发性肝癌的常用治疗方法，但部分患者TACE术后肝功能恢复较慢，且肿瘤完全坏死率较低，影响患者的预后及生活质量3。射频消融术（radiofrequencyablation，RFA）创伤小、并发症少，对于肿瘤直径3 cm的肝癌效果显著4-5。RFA治疗小肝癌的疗效较为明确，但对大肝癌的疗效尚不确定，本研究旨在探讨 TACE 联合 RFA 治疗原发性大肝癌的临床疗效
16、，现报道如下。1 1资料与方法资料与方法1 1.1 1 一般资料一般资料选取 2018 年 1 月至 2020 年 6 月郑州大学第一附属医院收治的原发性大肝癌患者。纳入标准：符合 原发性肝癌规范化病理诊断指南（2015 年版）6中关于大肝癌的诊断标准，并经病理学检查确诊；未发生远处转移；符合手术指征。排除标准：近期放化疗史；不能耐受化疗；合并精神、意识功能障碍；合并其他部位恶性肿瘤。依据纳入和排除标准，本研究共纳入 96 例原发性大肝癌患者，根据治疗方式的不同分为对照组和观察组，每组 48 例，对照组患者给予 TACE 治疗，观察组患者给予TACE联合RFA治疗，两组患者均给予综合干预。对照组中，男 29例，女 19例；年龄4275 岁，平均（61.824.33）岁；肿瘤直径 5.189.23 cm，平均（7.471.34）cm；肝功能 Child-Pugh分级：A级42例，B级6例。观察组中，男30例，女18例；年龄 4276 岁，平均（61.854.31）岁；肿瘤直径5.199.25 cm，平均（7.491.31）cm；肝功能 Child-Pugh分级：A级42例，B级6例。两组