TACE联合射频消融治疗结肠癌肝转移患者的临床疗效

doi:10.3877/cma.j.issn.2095-3232.2015.01.009

中华肝脏外科手术学电子杂志 ›› 2015, Vol. 04 ›› Issue (01) : 31 -34. doi: 10.3877/cma.j.issn.2095-3232.2015.01.009

所属专题：文献；

临床研究

TACE联合射频消融治疗结肠癌肝转移患者的临床疗效

何科¹, 王晶¹, 徐丽南², 瞿虎²^,^†(

), 江春强², 柯嘉², 俞建东², 苏中振³, 尧冰⁴

^1. 510080　广州，中山大学附属第一医院妇产科
^2. 510655　广州，中山大学附属第六医院外一科
^3. 510630　广州，中山大学附属第三医院超声科

收稿日期:2014-11-12 出版日期:2015-02-10
通信作者: 瞿虎
基金资助:
广东省科技计划项目(2011B031300016)

Clinical efficacy of TACE combined with radiofrequency ablation in the treatment of liver metastasis of colon cancer

Ke He¹, Jing Wang¹, Linan Xu², Hu Qu²^,^†(), Chunqiang Jiang², Jia Ke², Jiandong Yu², Zhongzhen Su³, Bing Yao⁴

^1. Department of Obstetrics and Gynecology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
^2. First Department of Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
^4. Department of Ultrasonography, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China

Received:2014-11-12 Published:2015-02-10
Corresponding author: Hu Qu
About author:
Corresponding author: Qu Hu, Email: quhu74@hotmail.com

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引用本文：

何科, 王晶, 徐丽南, 瞿虎, 江春强, 柯嘉, 俞建东, 苏中振, 尧冰. TACE联合射频消融治疗结肠癌肝转移患者的临床疗效[J]. 中华肝脏外科手术学电子杂志, 2015, 04(01): 31-34.

Ke He, Jing Wang, Linan Xu, Hu Qu, Chunqiang Jiang, Jia Ke, Jiandong Yu, Zhongzhen Su, Bing Yao. Clinical efficacy of TACE combined with radiofrequency ablation in the treatment of liver metastasis of colon cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2015, 04(01): 31-34.

目的

探讨TACE联合射频消融（RFA）治疗结肠癌肝转移的临床疗效。

方法

本前瞻性研究对象为2007年6月至2011年5月中山大学附属第六医院收治的68例结肠癌肝转移患者。所有患者均签署知情同意书，符合医学伦理学规定。其中男43例，女25例；平均年龄（59±4）岁。按随机数字表法将患者分为RFA组和对照（Control）组，每组34例。两组患者均先进行TACE，RFA组在TACE治疗3周后行RFA。两组均于治疗前后采用流式细胞术检测CD3⁺、CD4⁺、CD8⁺阳性细胞百分率和CD4⁺/CD8⁺比值。观察两组患者治疗后肿瘤直径及总体疗效。患者接受随访，观察肿瘤复发和患者存活情况。两组患者肿瘤直径及免疫功能检测数据比较采用t检验，两组疗效比较采用秩和检验，生存分析采用Log-rank法和Z检验。

结果

治疗后RFA组CD4⁺、CD8⁺及CD4⁺/CD8⁺比值分别为（42±4）%、（13±3）%、2.9±0.9，与Control组的（33±4）%、（17±3）%、2.3±0.9比较差异有统计学意义（t=5.483，-6.488，9.321；P<0.05）。治疗后RFA组肿瘤直径为（0.9±0.1） cm，明显小于Control组的（1.9±0.2） cm （t=-4.573，P<0.05）。RFA组术后总有效率为62%（21/34），Control组为35%（12/34），RFA组治疗效果优于Control组（Z=4.769，P<0.05）。RFA组2、3年生存率分别为38.2%、23.5%，明显高于Control组的14.7%、5.9%（Z=4.836，4.221；P<0.05）。

结论

TACE联合RFA治疗结肠癌肝转移是一种安全、有效的治疗方案,其疗效可能与改善机体免疫功能有关。

关键词: 结肠肿瘤, 肝肿瘤, 肿瘤转移, 消融技术, 化学栓塞，治疗性

Objective

To investigate the clinical efficacy of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in treatment of liver metastasis of colon cancer.

Methods

A total of 68 patients with liver metastasis of colon cancer in the Sixth Affiliated Hospital of Sun Yat-sen University from June 2007 to May 2011 were enrolled in this prospective study. The informed consents of all patients were obtained and local ethical committee approval had been received. There were 43 males and 25 females with a mean age of (59±4) years old. The patients were divided into RFA group and Control group with 34 cases in each group according to random number table method. Patients in both groups underwent TACE firstly and patients in RFA group underwent RFA 3 weeks after TACE treatment. Cluster of differentiation (CD) 3⁺, CD4⁺, CD8⁺ positive cell percentage and CD4⁺/CD8⁺ ratio were defined by flow cytometry before and after treatments in two groups. The tumor diameter after treatments and general efficacy were observed. The patients were followed up and the tumor recurrence and survival of the patients were observed. The comparisons of tumor diameter and immune function between two groups were conducted using t test. The comparison of efficacy between two groups was conducted using rank sum test. The survival analysis was conducted using Log-rank test and Z test.

Results

The CD4⁺, CD8⁺ percentage and CD4⁺/CD8⁺ ratio were (42±4)%, (13±3)%, 2.9±0.9 in RFA group after treatment and were (33±4)%, (17±3)%, 2.3±0.9 in Control group, where significant differences were observed (t=5.483, -6.488, 9.321; P<0.05). The tumor diameter in RFA group after treatment [(0.9±0.1) cm] was significantly smaller than that in Control group [(1.9±0.2) cm] (t=-4.573, P<0.05). The total effective rate in RFA group was 62%(21/34) and was 35%(12/34) in Control group. The treatment efficacy of RFA group was better than that of Control group (Z=4.769, P<0.05). The 2-, 3-year survival rates in RFA group (38.2%, 23.5%) were significantly higher than those in Control group (14.7%, 5.9%) (Z=4.836, 4.221; P<0.05).

Conclusions

TACE combined with RFA is a safe and effective regimen in treating liver metastasis of colon cancer. The efficacy may be associated with the improvement of the body’s immune function.

Key words: Colonic neoplasms, Liver neoplasms, Neoplasm metastasis, Ablation techniques, Chemoembolization, therapeutic

表1 两组结肠癌肝转移患者一般资料比较

组别	例数	性别（例）		年龄（岁，±s）	肿瘤直径（cm，±s）
组别	例数	男	女	年龄（岁，±s）	肿瘤直径（cm，±s）
RFA组	34	21	13	60±4	2.8±0.6
Control组	34	22	12	59±4	2.9±0.5
统计值	?	χ²=0.237		t=0.731	t=-0.231
P值	?	>0.05		>0.05	>0.05

表1 两组结肠癌肝转移患者一般资料比较

组别	例数	性别（例）		年龄（岁，±s）	肿瘤直径（cm，±s）
组别	例数	男	女	年龄（岁，±s）	肿瘤直径（cm，±s）
RFA组	34	21	13	60±4	2.8±0.6
Control组	34	22	12	59±4	2.9±0.5
统计值	?	χ²=0.237		t=0.731	t=-0.231
P值	?	>0.05		>0.05	>0.05

表2 两组结肠癌肝转移患者治疗前后免疫功能比较（±s）

组别	例数	CD3⁺（%）		CD4⁺（%）		CD8⁺（%）		CD4⁺/CD8⁺
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
RFA组	34	43±4	70±4	26±3	42±4	20±4	13±3	1.8±0.7	2.9±0.9
Control组	34	41±3	52±4	27±4	33±4	20±3	17±3	1.8±0.8	2.3±0.9
t值	?	0.731	7.548	-0.361	5.483	-0.773	-6.488	-0.361	9.321
P值	?	>0.05	<0.05	>0.05	<0.05	>0.05	<0.05	>0.05	<0.05

表2 两组结肠癌肝转移患者治疗前后免疫功能比较（±s）

组别	例数	CD3⁺（%）		CD4⁺（%）		CD8⁺（%）		CD4⁺/CD8⁺
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
RFA组	34	43±4	70±4	26±3	42±4	20±4	13±3	1.8±0.7	2.9±0.9
Control组	34	41±3	52±4	27±4	33±4	20±3	17±3	1.8±0.8	2.3±0.9
t值	?	0.731	7.548	-0.361	5.483	-0.773	-6.488	-0.361	9.321
P值	?	>0.05	<0.05	>0.05	<0.05	>0.05	<0.05	>0.05	<0.05

表3 两组结肠癌肝转移患者治疗效果比较

组别	例数	完全缓解（例）	部分缓解（例）	稳定（例）	进展（例）	总有效率（%）
RFA组	34	6	15	7	6	63
Control组	34	2	10	10	12	35
Z值	?	?	?	4.769	?	?
P值	?	?	?	<0.05	?	?

表3 两组结肠癌肝转移患者治疗效果比较

组别	例数	完全缓解（例）	部分缓解（例）	稳定（例）	进展（例）	总有效率（%）
RFA组	34	6	15	7	6	63
Control组	34	2	10	10	12	35
Z值	?	?	?	4.769	?	?
P值	?	?	?	<0.05	?	?

表4 两组结肠癌肝转移患者治疗后生存率比较（%）

组别	例数	1年	2年	3年
RFA组	34	67.6	38.2	23.5
Control组	34	50.0	14.7	5.9
Z值	?	2.186	4.836	4.221
P值	?	>0.05	<0.05	<0.05

表4 两组结肠癌肝转移患者治疗后生存率比较（%）

组别	例数	1年	2年	3年
RFA组	34	67.6	38.2	23.5
Control组	34	50.0	14.7	5.9
Z值	?	2.186	4.836	4.221
P值	?	>0.05	<0.05	<0.05

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