微创医学

目的探讨载药微球肝动脉化疗栓塞术（DEB-TACE）治疗大肝癌的有效性、安全性以及影响近期疗效和预后的因素。方法回顾性分析71例接受DEB-TACE治疗的大肝癌患者的临床资料及随访数据，评估患者术后1个月的客观缓解率（ORR），随访并记录患者的术后不良反应、无进展生存期（PFS），并采用Logistics回归模型分析影响治疗效果的相关因素及Cox回归模型分析影响PFS的相关因素。结果71例患者术后1个月的疗效为完全缓解（CR）1例、部分缓解（PR）48例、疾病稳定（SD）13例、疾病进展（PD）9例，ORR为69.0%（49/71），疾病控制率（DCR）为87.3%（62/71）。全组DEB-TACE治疗大肝癌患者的中位PFS为5.00个月；治疗有效（CR+PR）患者的中位PFS明显长于无效（SD+PD）患者(P＜0.05)。6例患者出现Ⅲ级腹痛；17例患者出现Ⅲ级肝功能损害（Ⅲ级总胆红素升高3例，Ⅲ级丙氨酸转氨酶升高11例，Ⅲ级天冬氨酸转氨酶升高3例），未出现Ⅳ级以上不良反应。Logistics回归分析结果显示，肝内肿瘤单发是治疗效果的独立保护因素（OR=3.792，95% CI:1.023～14.057，P=0.046）。Cox回归分析结果显示，治疗有效（CR或PR）是PFS的独立保护因素（HR=0.332，95% CI: 0.159～0.691，P=0.003）。结论DEB-TACE治疗大肝癌的近期疗效确切、安全性高，肝内肿瘤单发是治疗效果的独立保护因素，而治疗有效是PFS的独立保护因素。

ObjectiveTo explore the effectiveness, safety and factors affecting the short-term efficacy and prognosis of drug-eluting bead transarterial chemoembolization (DEB-TACE) in the treatment of large hepatocellular carcinoma. MethodsThe clinical and follow-up data of 71 patients with large hepatocellular carcinoma received the treatment of DEB-TACE were analyzed retrospectively. The objective response rate (ORR) one month after operation was evaluated, postoperative adverse reactions and the progression free survival (PFS) were followed up and recorded, the related factors affecting the therapeutic effects were analyzed by the logistic regression model, and the related factors affecting PFS were analyzed by the Cox regression model. ResultsOne case was complete response (CR), 48 were partial response (PR), 13 were stable disease (SD), and 9 were progressive disease (PD) in the efficacy of the 71 patients after a month of operation, with the ORR of 69.0% (49/71) and the disease control rate (DCR) of 87.3% (62/71). The median PFS of patients with large hepatocellular carcinoma treated with DEB-TACE was 5.00 months, the median PFS of patients with effective treatment (CR + PR) was significantly longer than that of patients with ineffective treatment (SD + PD) (P＜0.05). Six cases occurred grade Ⅲ abdominal pain, 17 patients had grade Ⅲ liver function damage (3 cases expressed as the increase of grade Ⅲ total bilirubin, 11 cases in the increase of grade Ⅲ alanine aminotransferase, and 3 cases in the increase of grade Ⅲ aspartate aminotransferase), and there were no adverse reactions in grade Ⅳ above. The logistic regression analysis showed that single intrahepatic tumor was an independent protective factor for the therapeutic effect (OR=3.792, 95% CI: 1.023～14.057, P=0.046). The Cox regression analysis revealed that effective treatment (CR or PR) was an independent protective factor for PFS (HR=0.332, 95% CI: 0.159～0.691, P=0.003). ConclusionDEB-TACE has a definite short-term efficacy and high safety in the treatment of large hepatocellular carcinoma. Single intrahepatic tumor is an independent protective factor for the therapeutic effect, and the effective treatment is an independent protective factor for PFS.