| Objective:To investigate the safety and effectiveness of the TACE synchronous or sequential combined with MWA in the treatment of primary large and huge hepatocellular carcinoma.By clinical comparison and analysis of treatment with a single TACE large primary and huge hepatocellular carcinoma and transcatheter hepatic artery chemoembolization(Transcatheter arterial,chemoembolization,TACE)simultaneous or sequential combined percutaneous microwave ablation(Microwave,ablation,MWA).Materials and methods:Patients which were involved in the diagnosis and treatment department in the Inner Mongolia Autonomous Region people’s hospital were selected from 150 patients with primary large hepatocellular carcinoma and huge hepatocellular carcinoma.The patients They were treated from March 2014 to March 2017.The patients treated with TACE were treated as the control group,and the patients treated with microwave ablation for 1—2 weeks after TACE treatment were sequential group.The microwave ablation immediately after TACE therapy for patients with synchronous group,the basic data of the three groups were comparable(P>0.05).the control group adopted the single TACE treatment,sequential group treated with TACE 1—2 weeks after MWA treatment,The synchronous group was treated with TACE immediately after the treatment of MWA.Reexamination of liver and kidney function and blood routine seventh days after intervention.The liver and kidney function and alpha fetoprotein were reexamined after a months of the operation.At the same time,we observed whether there were nausea,vomiting,fever,abdominal pain,liver failure,gallbladder infarction,liver abscess,cholesteatoma,bleeding and skin burns.CT was performed on the abdomen 3—7 days after operation,and the extent of ablation and complications were evaluated.6-8 weeks after the first treatment,abdominal enhancement CT or MRI was performed to observe the tumor necrosis and the deposition of lipiodol.The recent evaluation of the effectiveness of the modified solid tumor efficacy evaluation criteria for the evaluation of the curative effect of liver cancer.If complete remission is achieved,there is no need for retreatment temporarily.The interval between prolonged reexamination and treatment is 3 months,and no complete remission is achieved.TACE or TACE combined with MWA is applied again.Kaplan—Meier survival curve analysis compared the three groups of patients in sixth months,December,18 months of disease progression rate and survival rate.The effects of the factors on the survival and prognosis were analyzed by single factor and multi factor analysis.Results:The success rate of the three groups was 100%.(1)safety:three groups of patients were able to tolerate surgery.Different degrees of abdominal pain,fever,nausea,vomiting and constipation occurred in some patients after surgery,the control group and sequential group patients with nausea and vomiting and fever symptoms than synchronous group,and sequential group and concurrent group of patients with abdominal pain than the control group,the control group of patients with constipation than the sequential group and synchronous group,The difference is obvious(P<0.05).Synchronous sequential group and group 1 weeks after operation were compared with the preoperative postoperative transient elevation of transaminase decreased in January,at 1 weeks after operation showed blood leukocyte count and neutrophil percentage increased compared with the preoperative,postoperative decline in January,the difference is obvious.There was no significant change in renal function in the three groups of patients within 1 weeks after operation and 1 months after the operation,and had no significant influence on the renal function.30 days after the operation,there were no deaths in three groups.(2)the frequency of interventional therapy and interval,lipiodol dosage:average treatment group and the group of patients with synchronous sequential number less than the control group,and the difference is obvious(P<0.05),there is no obvious difference between the sequential group and synchronous group;The interval time compared between control group with sequential group and synchronous group was significantly shorter,the difference was statistically significant(P<0.05),Sequential and synchronous group were no significant differences between the control group and sequential group;The lipiodol dose of the control group and the sequential group were higher than that of synchronous group,with statistical significance,the control group and the sequential group had no significant difference.(3)tumor response rate:CT/MRI examination for hepatic enhancement 6—8 weeks after operation in each group were,According to mRECIST standard and preoperative imaging results,sequential group and synchronous group had higher objective remission rate compared with control group.There was no difference in objective remission rate between sequential group and synchronous group.4)AFP:the operation of three groups of patients with AFP were significantly decreased one month after compared with the preoperative,There was no difference in the preoperative AFP value between the three groups.One months after operation,the difference between the control group and the sequential group and the synchronous group was statistically significant.There was no difference between the sequential group and the synchronous group,indicating that the decrease of AFP in the sequential group and the synchronous group was obviously higher than the other group(5)transaminase changes:three groups of patients after treatment will appear aminotransferase flares in sequential group relatively long duration,elevated transaminase 1 weeks after operation in the three groups of control group respectively than the sequential group than synchronous group,among them,only the sequential group and synchronization between group comparison was statistically significant,three groups of patients after treatment,the basic recovery in 1 months after the next course of transaminase,before the patients were lower than the transaminase before treatment to reduce.(6)between the three groups:after 1 weeks Shengong,WBC and NP showed no significant difference.(7)in the synchronous group and the sequential group were significantly higher than those in the control group,The difference is obvious,the synchronous group and the sequential group.The survival rate and progression free rate at 6 months,12 months and 18 months in the synchronous group and the sequential group were significantly higher than those in the control group,The difference is obvious,but there was no significant difference between the synchronous group and the sequential group.Univariate analysis:ECOG score,liver function Child—pugh grading,portal invasion,tumor type and size,treatment modalities and tumor remission were correlated with prognosis(P<0.05,table 11).Multivariate analysis was conducted by Cox risk regression analysis.Results showed that liver function Child—pugh grading,ECOG score,treatment modalities and tumor remission were the main factors influencing the prognosis of patients.Conclusion:1,TACE+MWA and MWA+TACE combined with sequential simultaneous treatment of large hepatocellular carcinoma and huge liver cancer,compared with the single TACE treatment,increased tumor necrosis rate,reduce the AFP value,the effective control of the tumor progression,so as to prolong the median survival of patients and the average survival,progression free survival and survival rate.The results show that the two regimens in addition pain of postoperative complication probability is slightly higher than the single TACE treatment,the treatment interval is longer,less number of treatment,complementary advantages,high safety and efficacy characteristics,has important clinical significance in improving prognosis of hepatocellular carcinoma and the level of long—term huge liver cancer patients,it is worthy of clinical the development and application of.2,TACE+MWA sequential treatment group compared with MWA+TACE synchronous treatment group,although the two combination therapy in the short一term and long—term curative effect has no obvious difference,but the synchronous treatment of chemotherapy and lipiodol dosage less than sequential group,The postoperative fever and nausea and vomiting and other complications were lower than that of sequential therapy and single TACE treatment,Besides,it can expand the indications and deal with complications such as bleeding and arteriovenous fistulas caused by MWA treatment.Therefore,MWA+TACE synchronic combined treatment of large liver cancer and huge liver cancer is more advantageous. |
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