| Objective: To investigate the safety and efficacy of transcatheter arterial chemoembolization(TACE)combined with CT-guided percutaneous transhepatic radiofrequency ablation(RFA)in accordance with Milan standard primary hepatic carcinoma(PHC),and to analyze the risk of recurrence by univariate and multivariate analysis.Factors provide a reasonable theoretical support for reducing the recurrence of liver cancer after intervention.And summarize the complications and liver function changes after radiofrequency ablation.Methods: This study retrospectively analyzed 132 cases of primary hepatic carcinoma patients who met the Milan standard from January 2014 to June 2018 in the Department of Interventional Diseases of the Union Hospital of Fujian Medical University.102 cases were followed up.For the purpose of complete ablation of liver cancer tissue,CTguided single-electrode radiofrequency ablation,TACE combined with RFA group were treated with TACE within 1-4 weeks before radiofrequency ablation.The tumor ablation rate was evaluated according to the imaging examination 1 month after the ablation and the 1 year,2 years,and 3 years survival rates were calculated.KaplanMeier method was used to analyze the factors and clinical factors of suspicious patients.The Log-Rank test was used to calculate the cumulative event rate of each group.The Cox regression model was used to analyze the multivariate analysis of recurrence after interventional comprehensive treatment.Results: Transcatheter arterial chemoembolization combined with radiofrequency ablation is consistent with Milan standard primary liver cancer with a complete response rate(CR)of 75%,partial response rate(PR)of 16%,stable diseases rate(SD)of 4%,progressive disease(PD)rate of 5%;objective response rate is 91% in total,and disease control rate is 95% in total.The 1 year,2 years,and 3 years cumulative survival rates of patients were 93.1%,81.4%,and 61.8%.The 1 year,2 years,and 3 years cumulative survival rates of 3cm tumors were 94.6%,83.9%,and 69.6%.The effects of preoperative TACE on the recurrence rate of ≤3 cm and 3-5 cm tumor RFA were compared.The results showed that the 3-5 cm tumor TACE-RFA combination group was better than the RFA group alone,which could effectively reduce the recurrence rate;while the ≤3 cm tumor group had no statistical difference.The effect of sequential treatment interval in the TACE-RFA combination group on recurrence rate was compared.The results suggest that the difference is not statistically significant.At the same time,by comparing the effects of different radiofrequency ablation edges and radiofrequency ablation needle length on the patient’s recurrence rate,the results showed that the difference was not statistically significant.Analysis of sixteen factors that may affect recurrence rate,seven of which were statistically significant: tumor number,specific location tumor,HBV-DNA quantification,prothrombin time(PT),platelet count(PLT),Child-Pugh grade,and alpha fetoprotein(AFP).There are four factors associated with recurrence rate: number of tumors,tumors at specific locations,PLT and AFP.Complications after radiofrequency ablation include fever,pain,vomiting,and puncture bleeding,with no surgery-related deaths.Conclusion: The development and application of transcatheter arterial chemoembolization and radiofrequency ablation techniques provide a new therapeutic approach for primary liver cancer that cannot be treated surgically.The effect of TACE combined with RFA in the treatment of moderate liver cancer is better than that of radiofrequency ablation alone,which can effectively reduce the recurrence rate after surgery.At the same time,ensuring adequate radiofrequency ablation cauterization margin is of great significance in preventing tumor recurrence.Multiple tumors,special tumors,platelet counts below the lower limit of normal values and high serum AFP values should be alert to the risk of recurrence when interventional therapy for liver cancer patients.Pay attention to regular follow-up. |
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