Objective: To investigate the clinical efficacy radiofrequency ablation (RFA) combined with (125)I radioactive seed implantation in treatment of hepatocellular carcinoma HCC with the tumor diameter 3-5 cm. Methods: One hundred patients with HCC diagnosed clinically or pathologically with Barcelona staging of B or C in Lishui Central Hospital from February 2012 to September 2017 were retrospectively analyzed. Of the included 100 cases, 89 were males and 11 were females with the mean age of 18-80 (57±11) years old.According to the treatment modality, the subjects were divided into control group (RFA, n=67) and combined group (RFA+(125)I, n=33). Patients in control group were only received RFA and cases in combined group received RFA plus sequenced with (125)I implantation therapy. The prognosis of progression free survival (PFS) and overall survival (OS) between the two groups were compared through the Kaplan-Meier curve and Log-rank test. Results: The median follow-up time period was 6-55 months in the last follow-up time point of Dec 30, 2017. The median PFS were 4-55 (23.0±4.7) and 1-53 (12.0±1.6) months for combined and control groups respectively with significant statistical difference (P=0.015). The median OS were 6-55 (42.0±7.9) and 2-55 (38.0±2.8) months for combined and control groups with the trend of improvement in combined group, but without statistical difference (P=0.444). Subgroup analysis further indicated that the PFS was significant improved in patients with residual tumor lesions who received the combined treatment (PFS: 18 vs 9 months, P=0.025). However, there was no statistical difference for PFS between the control and combined treatment groups for cases without residual tumor lesions after RAF treatment(P=0.685). Conclusions: PFS was obviously increased in HCC patients(tumor diameter 3-5 cm) who received(125)I implantation after radiofrequency ablation, especially for cases with residual tumor lesions.
目的： 探讨病灶直径在3~5 cm的原发性肝癌（HCC）射频消融（RFA）后联合(125)I放射性粒子植入治疗的临床价值及适合人群。 方法： 回顾性分析2012年2月至2017年9月丽水市中心医院100例临床或病理诊断HCC患者的临床资料，其中男89例、女11例，年龄18~80（57±11）岁，巴塞罗那（BCLC）分期为B期及部分C期患者，所有患者均行RFA治疗，对照组（RFA，n=67）根据影像学检查予随访观察；联合组（RFA+(125)I，n=33）序贯行(125)I放射性粒子植入治疗，主要研究终点是肿瘤无进展生存期（PFS），次要研究终点为总生存（OS）与治疗相关的不良事件。采用Kaplan-Meier方法进行生存分析，Log-rank检验比较生存曲线差异。 结果： 末次随访时间为2017年12月30日，两组资料中位随访时间38（6~55）个月。联合组PFS明显长于对照组[（23.0±4.7）比（12.0±1.6）个月]，差异有统计学意义（P=0.015）。联合组中位生存时间较对照组有延长趋势[（42.0±7.9）比（38.0±2.8）个月]，但差异无统计学意义（P=0.444）。进一步亚组分析提示，RFA后有残留存活病灶联合粒子治疗组和对照组中位PFS时间分别为18和9个月（P=0.025），而消融后病灶坏死组两组差异无统计学意义（P=0.685），两组中位OS差异均无统计学意义。 结论： 病灶直径在3~5 cm的HCC RFA后联合粒子植入可延长PFS。.
Keywords: Brachytherapy; Hepatocellular carcinoma; Iodine-125; Radiofrequency ablation.