近日，由山东大学齐鲁医院消化内科副教授程宝泉作为第一作者及通讯作者撰写的论文“Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3 cm”在世界著名杂志《美国医学协会期刊》（JAMA）299卷14期发表，是该杂志此期第一篇论文。
程宝泉利用医院丰富的临床资料，结合国外在该研究领域的先进技术、科学思维和临床治疗经验，探讨原发性肝癌治疗新方法。该研究对肝癌肿瘤大于3cm的肝癌患者，分别选择结合治疗（transarterial chemoembolization combined with radiofrequency ablation therapy）和单独TACE或RFA治疗，通过首要观察点生存期（survival）和次要观察点肿瘤反应率（objective response rate），发现结合治疗优于单独治疗。原发性肝细胞肝癌（hepatocellular carcinoma, HCC）在我国为第二位癌症死亡病因，尽管包括手术等综合治疗发展迅猛，但HCC五年生存率仍很低。因此，寻找HCC的治疗新方法十分必要。程宝泉的研究结果为治疗原发性肝癌提供了新思维，具有较高的学术价值和临床应用前景。哈佛大学医学院教授Andrew X.Zhu 和Ghassan K.Abou-Alfa为该论文撰写了Editorial。哈佛大学的两位教授在长达三页的editorial paper中高度赞扬了该论文的学术和临床应用价值。（来源：山东大学 赵永鑫）
生物谷推荐原始出处：
（JAMA），299(14):1669-1677，Bao-Quan Cheng，Cui-Hua Yi
Chemoembolization Combined With Radiofrequency Ablation for Patients With Hepatocellular Carcinoma Larger Than 3 cm
A Randomized Controlled Trial
Bao-Quan Cheng, MD, PhD; Chong-Qi Jia, PhD; Chun-Tao Liu, MD; Wei Fan, MD; Qing-Liang Wang, MD; Zong-Li Zhang, MD, PhD; Cui-Hua Yi, MD, PhD
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.
