Clinical Efficacy And Long-term Survival Of TACE Combined With MWA Regimen In The Treatment Of Large Hepatocellular Carcinoma

Objective: To investigate the clinical efficacy of transcatheter arterial chemoembolization(TACE)combined with microwave ablation(MWA)and TACE alone in the treatment of large hepatocellular carcinoma(LHC),analyze the long-term survival,and further study the prognostic factors of patients,so as to provide more reference for clinical treatment.Methods: 78 patients with LHC admitted to our hospital from August 2014 to August 2016 were selected as the study subjects,and randomly divided into study group and control group.There was no significant difference in general data between the two groups,which was comparable(P > 0.05).The patients in the control group were treated with TACE regimen alone.The femoral artery was punctured by Seldinger method.After successful diagnosis,hepatic arteriography was performed to determine the location,size,number and blood supply of the tumors.The tumors were selectively intubated by the guide wire catheter until they reached the blood supply artery of the tumors,and then the tumors were embolized with lipiodol emulsion.Tumor peripheral blood vessels were injected with a large amount of chemotherapeutic drugs,and finally the proximal end of the tumor feeding artery was embolized with gelatin sponge to prolong the time of chemotherapy;once every 28-40 days,no more than three times.The patients in the study group were treated with TACE and MWA on the basis of the control group,and then treated with MWA 30 days after the operation.The patients were given ECG monitoring and oxygen inhalation through intravenous channels.The patients were taken supine position.After routine disinfection and towel laying,local infiltration anesthesia was carried out.Ultrasound-guided puncture and introduction of microwave electrodes into the predetermined tumors.Location,turn on microwave machine to adjust power,action time and needle insertion times according to the size of mass and patient's condition.Common power is 40-60 W,action time is 300-1800 s.Needles are arranged according to the shape and size of tumors.Large tumors are coagulated in different directions,in different parts and in different combinations.Needles are withdrawn and coagulated at the end of ablation.Needle passage prevents needle passage metastasis and bleeding.General data of patients were recorded and compared,including gender,age,body mass index(BMI),smoking history,drinking history,portal vein branch tumor thrombus,lymphatic metastasis,maximum diameter of tumors,liver function classification,Barcelona staging(BCLC).After treatment,all patients were followed up for 3 years.The follow-up date was up to August 2019.The survival time was from the first treatment to death for any reason or follow-up deadline.The survival curve was drawn and the median survival time(MST)was calculated and compared.The proximity of 1 month and 3 months after treatment was observed and compared between the two groups.The long-term effect was 1,2 and 3 years after treatment.The changes of serum AFP,AFU,CA19-9,gamma-glutamyltransferase(gamma-GGT)and alkaline phosphatase(ALP)levels were observed and compared before and after treatment.According to the prognosis,the subjects were divided into good prognosis group and bad prognosis group,and the influencing factors of prognosis were analyzed.Results:(1)The proportion of complete remission(CR)and partial remission(PR)in the study group was significantly higher than that in the control group one month after operation(P < 0.05);the proportion of SD and PD in the study group one month after operation was significantly lower than that in the control group(P < 0.05).The ORR and DCR in the study group were significantly higher than those in the control group(P < 0.05);the number of PD in the study group was significantly lower than that in the control group(P < 0.05);and the ORR and DCR in the study group were significantly higher than those in the control group(P < 0.05)at 3 months after the operation.(2)After treatment,the serum levels of AFP,AFU,CA19-9,gamma-GGT and ALP in the two groups were significantly lower than those before treatment,and those in the study group were lower than those in the control group(P < 0.05).(3)Serum levels of AFU,CA19-9,gamma-GGT and ALP were positively correlated with serum levels of AFP(P < 0.05).(4)After treatment,the maximum diameter of tumors in the two groups was significantly smaller than that before treatment,and that in the study group was smaller than that in the control group(P < 0.05).(5)MST was 23.24 months in the study group and 13.58 months in the control group.The 1-year,2-year and 3-year survival rates in the study group were significantly higher than those in the control group(P < 0.05).(6)During the treatment,the two groups of patients had different degrees of adverse reactions,after intervention,the symptoms of patients were alleviated.There was no significant difference in the incidence of adverse reactions between the two groups(P > 0.05).(7)The prognosis of patients with different BMI,preoperative AFP level,age,sex,BCLC stage,Child-Pugh grade,portal vein branch tumor thrombus,drinking history,smoking history,lymphatic metastasis and treatment times were different(P < 0.05).(8)Preoperative AFP level,Child-Pugh classification,portal vein branch tumor thrombus and treatment times were risk factors for prognosis(P < 0.05).CONCLUSION:(1)TACE combined with MWA regimen can effectively reduce the maximum diameter of tumors and promote disease rehabilitation.(2)TACE combined with MWA regimen can effectively reduce serum markers in patients with LHC and improve liver function.With the increase of serum levels of AFU,CA19-9,gamma-GGT and ALP,serum AFP levels also increase.(3)The incidence of adverse reactions of TACE combined with MWA was significantly lower than that of TACE alone,with higher safety.(4)The proportion of CR and PR in TACE combined with MWA regimen was significantly higher than that in TACE alone,with higher objective remission rate and control rate.(5)In the long-term efficacy,the 1-year and 3-year survival rates of patients with TACE combined with MWA regimen were significantly higher than those of patients with TACE alone,and had a longer median survival time,which had a positive effect on prolonging the survival of patients.(6)BMI,preoperative AFP level,age,sex,BCLC stage,Child-Pugh grade,portal vein branch tumor thrombus,drinking history,smoking history,lymphatic metastasis and treatment times were the factors influencing the prognosis of patients with LHC.Among them,preoperative AFP level,Child-Pugh grade,portal vein branch tumor thrombus and treatment times were the factors influencing the prognosis of patients with LHC.Risk factors.