肝动脉灌注化疗与TACE在巨块型肝癌中的应用疗效对比

Comparison of the Efficacy of Hepatic Artery Infusion Chemotherapy and TACE in Bulky Liver Cancer

摘要: 目的：探究肝动脉灌注化疗(HAIC)与肝动脉化疗栓塞术(TACE)在原发性巨块型肝癌治疗中的应用疗效。方法：选择2020年1月至2021年12月在广西中医药大学第一附属医院肝胆外科收治的巨块型肝癌患者的资料，根据患者介入治疗手段的不同将患者分为HAIC治疗组(研究组)和TACE治疗组(对照组)，并采用倾向得分匹配法对两组基线资料进行1:1匹配，配对后比较两组在总治疗有效率、并发症发生率等方面的差异。结果：本研究共收集到符合条件的114例原发性巨块型肝癌患者，其中研究组54例，对照组60例，采用倾向得分匹配法完成匹配60例，每组30例，配对后两组基线资料比较无显著差异(P > 0.05)；HAIC组与TACE组比较：两组术后AFP指数均较术前明显降低，HAIC组术后AFP指数较TACE组明显低下(P < 0.05)，术后CD4⁺指数较TACE组明显高出(P < 0.05)。HAIC组总治疗有效率明显高于TACE组(P < 0.05)。两组患者术后发生的发热、白细胞减少、恶心呕吐等并发症发生率比较无明显差异(P > 0.05)。结论：肝动脉灌注化疗和TACE对原发性巨块型肝癌均有疗效，并发症少，但肝动脉灌注化疗能够更快有效控制肿瘤进展，可使肿瘤尽快降期，近期疗效较高，可改善患者预后。

Abstract: Objective: To investigate the therapeutic efficacy of hepatic artery infusion chemotherapy (HAIC) and transarterial chemoembolization (TACE) in the treatment of primary massive hepatocellular carcinoma (HCC). Methods: Data from patients with massive HCC admitted to the Hepatobiliary Surgery Department of the First Affiliated Hospital of Guangxi University of Chinese Medicine between January 2020 and December 2021 were selected. Patients were divided into the HAIC treatment group (study group) and the TACE treatment group (control group) based on their interventional treatment methods. Propensity score matching (PSM) was used to perform 1:1 matching of baseline data between the two groups. After matching, differences in total treatment efficacy rate, complication incidence rate, and other aspects were compared between the two groups. Results: A total of 114 eligible patients with primary massive HCC were included in this study, with 54 in the study group and 60 in the control group. After PSM, 60 patients were matched, with 30 in each group. There were no significant differences in baseline data between the two groups after matching (P > 0.05). Comparison between the HAIC group and the TACE group: The AFP index was significantly lower after surgery compared to before surgery in both groups, and the AFP index was significantly lower in the HAIC group than in the TACE group (P < 0.05). The CD4⁺ index was significantly higher in the HAIC group than in the TACE group after surgery (P < 0.05). The total treatment efficacy rate was significantly higher in the HAIC group than in the TACE group (P < 0.05). There were no significant differences in the incidence rates of postoperative complications such as fever, leukopenia, nausea, and vomiting between the two groups (P > 0.05). Conclusion: Both HAIC and TACE are effective in the treatment of primary massive HCC with few complications. However, HAIC can more rapidly and effectively control tumor progression, enable rapid tumor downstaging, demonstrate higher short-term efficacy, and improve patient prognosis.