Effect and prognostic analysis of radiofrequency ablation in treating advanced hepatocellular carcinoma

目的 评价超声引导经皮射频消融(RFA)治疗中晚期肝细胞癌(HCC)的疗效,并分析影响预后因素.方法 2000年7月至2011年6月在北京大学肿瘤医院行超声引导下RFA并长期随访的90例非手术适应期中晚期HCC患者为对象,男78例,女12例,年龄24 ～87(59±12)岁,Ⅲ期80例,Ⅳ期10例.肿瘤大小(直径)1.5 ～8.0(4.5±1.4) cm; ＞3.0 cm肿瘤73例(81.1％)；多发(2～4灶)肿瘤31例(34.4％)；肝功能Child-Pugh B、C级32例(35.6％).RFA后规律随访,用增强CT结合甲胎蛋白(AFP)评价疗效.影响预后的单因素分析采用Kaplan-Meier方法及Log-rank检验,多因素分析采用Cox逐步回归方法.P＜0.05为差异有统计学意义.结果 肿瘤彻底灭活率90.9％(120/132灶),严重并发症2例(2.2％),无相关死亡病例.随访3～129个月,局部复发率15.2％(20/132灶),1、3、5年总生存率分别为83.3％、48.3％、21.9％,中位生存期35个月,平均(46±6)个月.单因素分析显示Child-Pugh A级、肿瘤≤3.0 cm、应用超声造影(CEUS)、行规范化治疗、初次治疗获彻底灭活、肿瘤无复发新生的患者生存率更高,差异有统计学意义(P＜0.05)；多因素分析肝功能分级及规范化治疗为独立预后因素(P=0.001,P＜0.001).结论 中晚期HCC RFA治疗需重视CEUS检查指导并采取规范化治疗,初次治疗使肿瘤彻底灭活,重视保肝治疗等因素有助于延长生存期.Objective To evaluate the effect of ultrasound-guided percutaneous radiofrequency ablation (RFA) in treating advanced hepatocellular carcinoma (HCC) and to analyze the prognostic factors.Methods A total of 90 patients with unresectablely advanced HCC underwent percuatenous RFA therapy between July 2000 and June 2011 were enrolled into the study.According to the 6th UICC/AJCCTNM system,80 and 10 patients were in stage Ⅲ and Ⅳ,respectively.78 patients were men and 12 patients were women.Ages ranged from 24 to 87 years old (mean ±SD,59 ± 12 years).The tumor size ranged from 1.5 to 8.0 cm ( mean ± SD,4.5 ± 1.4 cm).The maximum tumor of 73 patients ( 81.1％ ) was larger than 3.0 cm.31 patients (34.4％ ) had 2 -4 tumors.The Child-Pugh classification of B and C were 32 patients (35.6％) altogether.By regular follow-up,enhanced CT combined with AFP was used to evaluate the effect after RFA.Kapian-Meier model and Log-rank test were used in univariate analysis and Cox regression model was used in multivariate analysis to identify prognostic factors for survival.P ＜ 0.05 was considered statistically significant difference.Results Complete tumor necrosis rate after initial RFA was 90.9％ ( 120/132 tumors).Serious complications were developed in two patients (2.2％ ) and no treatment-related death occurred.3 - 129 months were followed up.Local recurrence rate was 15.2％ (20/132 tumors).The 1-,3-,5-year overall survival rates were 83.3％,48.3％,21.9％,respectively,and the median survival time was 35 months.The univariate analyses showed that patients with Child-Pugh classification of A,tumor less than 3.0 cm,applying CEUS,using standard treatment protocols,achieving complete tumor necrosis and without tumor recurrence survived longer ( P ＜ 0.05 ).Child-Pugh classification and the standard treatment protocols were identified as independent prognostic factors for survival by multivariate model ( P =0.001,P ＜0.001 ).Conclusion Paying attention to the following factors of CEUS,standard treatment protocols,initially complete tumor necrosis and liver protection therapy for patients with advanced HCC is helpful to improve the patients' survival.PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)011735-7389