Objective: To investigate the prognostic factors of primary liver cancer treated with transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA), and then to establish a prognostic model. Methods: Clinicopathological and follow-up data of 145 patients who underwent TACE combined with RFA from January 2010 to December 2012 were retrospectively analyzed. Univariate and multivariate survival analyses were performed using the Cox proportional hazards model, and the prognostic model was established. Results: The 1, 2, and 3-year survival rates were 92.6%, 81.4% and 66.2%, respectively. The 3-year recurrence and metastasis rate was 64.8%.Multivariate analysis showed that female cases and higher serum albumin levels were the protective factors for the 3-year overall and relapse-free survival of patients(P<0.05 for all). High levels of alpha-fetoprotein (AFP), alanine aminotransferase (ALT), total bilirubin (TBIL), portal vein thrombosis and higher Child Pugh stages were the independent risk factors for the 3-year overall survival(P<0.05 for all). High levels of AFP, TBIL, portal vein thrombosis and advanced stages of BCLC staging (B and C) were the independent risk factors for tumor recurrence and metastasis(P<0.05 for all). The predictive model established based on the multivariate analysis showed good sensitivity and specificity. The area under ROC curve were higher than 0.90. Conclusions: The prognosis of liver cancer patients treated with TACE combined with RFA is affected by various clinicopathological factors. The systematic evaluation of the relevant factors before treatment may help to select proper patients and improve prognosis.
目的： 探讨经肝动脉化疗栓塞(TACE)联合射频消融(RFA)治疗原发性肝癌的预后影响因素。 方法： 回顾性分析2010年1月1日至2012年12月31日间行TACE联合RFA治疗的145例患者的临床资料，单因素和Cox比例风险模型分析患者的临床病理特征与预后的关系。 结果： 145例患者的1、2、3年生存率分别为92.6%、81.4%和66.2%，3年肿瘤转移复发率为64.8%。Cox多因素分析显示，女性和血清白蛋白水平升高均为患者3年生存和复发转移的保护性因素(均P<0.05)，术前甲胎蛋白(AFP)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)水平升高和肝功能Child Pugh分级B级均为患者3年生存的独立危险因素(均P<0.05)，AFP、TBIL水平升高、门静脉癌栓、巴塞罗那临床肝癌(BCLC)分期B期和BCLC分期C期均为患者复发转移的独立危险因素(均P<0.05)。Cox比例风险模型预测TACE联合RFA治疗后原发性肝癌患者3年生存和复发转移的效能良好，受试者工作特征曲线下面积>0.90。 结论： TACE联合RFA疗法是治疗肝癌的重要手段，患者的预后受到多种因素的影响，对患者治疗前的相关因素进行评价，可以更好地选择治疗的适应证和评价预后，提高肝癌患者的疗效。.
Keywords: Liver neoplasms; Predictive model; Prognosis; Radio-frequency ablation; Transcatheter arterial chemoembolization.