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| 化疗栓塞联合射频消融治疗大于3cm的肝细胞癌：一项随机对照试验 |
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| Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3 cm: A randomized controlled trial |
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| Cheng B.-Q., Jia C.-Q., Liu C.-T., Fan W., Wang Q.-L., Zhang Z.-L., Yi C.-H. 2009/5/29 18:39:20 |
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JAMA - Journal of the American Medical Association, 2008, Volume 299, Issue 14
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| Context: Transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) therapy has been used for patients with large hepatocellular carcinoma tumors, but the survival benefits of combined treatment are not known. Objective: To compare rates of survival of patients with large hepatocellular carcinoma tumors who received treatment with TACE combined with RFA therapy (TACE-RFA), TACE alone, and RFA alone. Design, Setting, and Patients: Randomized controlled trial conducted from January 2001 to May 2004 among 291 consecutive patients with hepatocellular carcinoma larger than 3 cm at a single center in China. Intervention: Patients were randomly assigned to treatment with combined TACE-RFA (n=96), TACE alone (n=95), or RFA alone (n=100). Main Outcome Measures: The primary end point was survival and the secondary end point was objective response rate. Results: During a median 28.5 months of follow-up, median survival times were 24 months in the TACE group (3.4 courses), 22 months in the RFA group (3.6 courses), and 37 months in the TACE-RFA group (4.4 courses). Patients treated with TACE-RFA had better overall survival than those treated with TACE alone (hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.33-2.63; P<.001) or RFA (HR, 1.88; 95% CI, 1.34-2.65; P<.001). In a preplanned substratification analysis, survival was also better in the TACE-RFA group than in the RFA group for patients with uninodular hepatocellular carcinoma (HR, 2.50; 95% CI, 1.42-4.42; P=.001) and in the TACE-RFA group than the TACE group for patients with multinodular hepatocellular carcinoma (HR, 1.99; 95% CI, 1.31-3.00; P<.001). The rate of objective response sustained for at least 6 months was higher in the TACE-RFA group (54%) than with either TACE (35%; rate difference, 0.19; 95% CI, 0.06-0.33; P=.009) or RFA (36%; rate difference, 0.18; 95% CI, 0.05-0.32; P=.01) treatment alone. Conclusion: In this patient group, TACE-RFA was superior to TACE alone or RFA alone in improving survival for patients with hepatocellular carcinoma larger than 3 cm. Trial Registration: clinicaltrials.gov Identifier: NCT00479050. ©2008 American Medical Association. All rights reserved. |
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| Correspondence Address: Cheng, B.-Q.; Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan 250012, China; email: dcbq@sohu.com |
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 疾病资源中心
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
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