探讨超声引导下微波消融联合肝动脉化疗栓塞（TACE）在不同直径结直肠癌肝转移中的疗效及影响预后的因素。

回顾性分析2016年1月至2019年1月在甘肃省人民医院行TACE、超声引导下微波消融以及二者联合治疗的结直肠癌肝转移患者共122例，根据转移灶最大径分为≤3 cm组（A组）57例，＞3，≤5 cm组（B组）65例，观察3种治疗方法在A组及B组中的疗效，采用χ²检验或Fisher确切概率检验比较3种治疗方法间治疗有效率、疾病控制率的差异，采用Kaplan-Meier法绘制3种治疗方法的生存曲线并计算治疗后1、2、3年累积生存率，采用Log-rank检验比较3种治疗方式间累积生存率的差异，并采用COX回归模型分析影响结直肠癌肝转移预后的因素。

A组中，联合治疗与微波消融治疗的治疗有效率、疾病控制率、累积生存率及复发率相似，差异均无统计学意义（P均＞0.05），联合治疗、微波消融治疗的治疗有效率、疾病控制率、累积生存率明显高于TACE治疗［95.2% vs 91.3% vs 64.0%；100% vs 95.7% vs 72.0%；（100%、95.6%、55.7%） vs （100%、92.3%、24.2%） vs （95.1%、59.5%、0%）］，复发率低于TACE治疗（21.1% vs 22.2% vs 65.0%），差异均有统计学意义（有效率：χ²=6.546、5.056，P=0.013、0.039；疾病控制率：P均=0.011；累积生存率：χ²=19.256、7.651，P＜0.001、=0.006；复发率：P=0.006、0.008）。B组中，联合治疗的治疗有效率、疾病控制率、累积生存率分别高于微波消融治疗、TACE治疗［94.4% vs 70.9% vs 38.5%；97.2% vs 80.6% vs 57.7%；（100%、91.3%、11.7%） vs （95.5%、71.1%、4.5%） vs （91.5%、34.0%、0%）］，复发率低于微波消融治疗、TACE治疗（36.0% vs 68.2% vs 94.4%），差异均有统计学意义（有效率：χ²=6.690、22.964，P=0.018、＜0.001；疾病控制率：P=0.043、＜0.001；累积生存率：χ²=5.511、24.469，P=0.019、＜0.001；复发率：P=0.028、＜0.001），且微波消融治疗的治疗有效率、疾病控制率、累积生存率高于TACE治疗，复发率低于TACE治疗，差异均有统计学意义（有效率：χ²=6.068，P=0.020；疾病控制率：χ²=3.159，P=0.046；累积生存率：χ²=5.429，P=0.020；复发率：P=0.039）。COX回归多因素分析提示转移灶最大径（RR=3.360，Ρ＜0.001）、数目（RR=2.210，Ρ=0.022）、治疗前化疗（RR=0.979，Ρ=0.001）、分化程度（高分化：RR=0.103，Ρ＜0.001）、治疗方式（联合治疗、微波消融治疗：RR=0.044、0.174，Ρ均＜0.001）为影响结直肠癌肝转移预后的独立因素。

超声引导下微波消融联合TACE在＞3~5 cm结直肠癌肝转移治疗中有明显优势，能显著延长生存期；患者转移灶直径越大、数目越多，预后越差，采用联合治疗、超声引导下微波消融治疗、且结合治疗前化疗可提高生存率，改善预后。

To evaluate the efficacy of ultrasound-guided microwave ablation combined with hepatic artery chemoembolization (TACE) in the treatment of liver metastases from colorectal cancer with different diameters and identify the factors affecting the prognosis.

A retrospective analysis was performed on 122 patients with liver metastases from colorectal cancer who underwent TACE, ultrasound-guided microwave ablation, or the combination of the two at Gansu Provincial Hospital from January 2016 to January 2019. According to the maximum diameter of the metastasis, the patients were divided into either a ≤3 cm group (group A; 57 cases) or a ＞3, ≤5 cm group (group B; 65 cases). The efficacy of the three treatment methods in group A and group B was observed. The chi-square test or Fisher's exact probability test was used to compare the difference in treatment efficiency and disease control rate among the three treatment methods. The Kaplan-Meier method was used to plot the survival curves of the three treatment methods and calculate the cumulative survival at 1, 2, and 3 years after treatment. The log-rank test was used to compare the difference in cumulative survival rate among the three treatments, and the COX regression model was used to analyze the factors affecting the prognosis of colorectal cancer liver metastasis.

In group A, the treatment efficiency, disease control rate, cumulative survival rate, and recurrence rate were comparable between patients receiving combination therapy and those receiving microwave ablation therapy (P＞0.05). The treatment effective rate, disease control rate, and cumulative survival rate associated with combination therapy and microwave ablation therapy were significantly higher [95.2% vs 91.3% vs 64.0%; 100% vs 95.7% vs 72.0%; (100%, 95.6%, 55.7%) vs (100%, 92.3%, 24.2%) vs (95.1%, 59.5%, 0%)], and the recurrence rate (21.1% vs 22.2% vs 65.0%) was significantly lower than those with TACE treatment (effective rate: χ²=6.546, 5.056, P=0.013, 0.039; disease control rate: both P=0.011; cumulative survival rate: χ²=19.256, 7.651, P＜0.001,=0.006; recurrence rate: P=0.006, 0.008). In group B, the effective rate, disease control rate, and cumulative survival rate associated with combination therapy were significantly higher [94.4% vs 70.9% vs 38.5%; 97.2% vs 80.6% vs 57.7%; (100%, 91.3%, 11.7%) vs (95.5%, 71.1%, 4.5%) vs (91.5%, 34.0%, 0%)], and the recurrence rate (36.0% vs 68.2% vs 94.4%) was significantly lower than those with microwave ablation therapy or TACE therapy (effective rate: χ²=6.690, 22.964, P=0.018, ＜0.001; disease control rate: P=0.043, ＜0.001; cumulative survival rate: χ²=5.511, 24.469, P=0.019, ＜0.001; recurrence rate: P=0.028, ＜0.001). The effective rate, disease control rate, and cumulative survival rate associated with microwave ablation therapy were significantly higher, and the recurrence rate was significantly lower than those with TACE therapy (effective rate: χ²=6.068, P=0.020; disease control rate: χ²=3.159, P=0.046; cumulative survival rate: χ²=5.429, P=0.020; recurrence rate: P=0.039). Multivariate COX regression analysis showed that the maximum diameter of metastases (RR=3.360, Ρ＜0.001), lesion number (RR=2.210, Ρ=0.022), pre-treatment chemotherapy (RR=0.979, Ρ=0.001), degree of differentiation (highly differentiated: RR=0.103, Ρ＜0.001), and treatment methods (combination therapy or microwave ablation treatment: RR=0.044, 0.174, Ρ＜0.001) were independent factors affecting the prognosis of liver metastases from colorectal cancer.

Microwave ablation combined with TACE under ultrasound guidance has obvious advantages in the treatment of ＞3-5 cm colorectal cancer liver metastasis, which can significantly prolong the survival time. The larger the diameter and number of the metastatic foci, the worse the prognosis of the patients. Combination therapy or ultrasound-guided microwave ablation therapy, combined with pre-treatment chemotherapy, can increase survival rate and improve prognosis.