172例肝癌射频消融治疗预后因素分析

Prognostic factors on outcome of radiofrequency ablation of 172 primary hepatic tumors

目的探讨原发性肝癌射频消融(RFA)治疗的生存期及影响因素,进行单因素及多因素分析,以指导RFA消融治疗。方法1999至2004年172例原发性肝癌行RFA治疗,其中150例(87.2%)不能或不宜手术治疗。分析24项与生存期可能相关的因素,探讨与生存期的相关性。随访时间4～51个月,随访率94.8%(163例)。单因素分析采用KaplanMeier模型及Logrank检验,多因素分析采用COX比例风险模型。结果原发性肝癌RFA治疗后半年、1年、2年、3年的生存率分别为:91.5%、77.4%、55.7%、51.2%。分析可能影响生存期的24项单因素中8项有统计学意义,分别为:肝功能ChildPugh分级、肿瘤国际抗癌联盟(UICC)分期、初次RFA前甲胎蛋白(AFP)值、门静脉高压、肿瘤复发性、病理分级、治疗目的方案、消融安全范围。根据UICC分期标准,首发癌116例半年、1年、2年、3年的生存率分别为:Ⅰ期和Ⅱ期(33例)达96.7%、92.3%、81.6%、65.3%;Ⅲ期和Ⅳ期(83例)为91.2%、76.3%、56.6%、51.4%;Ⅰ和Ⅱ期与Ⅲ和Ⅳ期之间差异有统计学意义。复发癌56例的生存率分别为88.5%、70.2%、41.4%、24.5%,与首发癌Ⅲ和Ⅳ期差异无统计学意义。与生存率相关的多因素有3项,分别为:ChildPugh分级、门脉高压、治疗目的方案。结论影响原发性肝癌RFA治疗预后的因素可分为两个方面:患者因素为肝功能ChildPugh分级、门脉高压程度;治疗方面因素为治疗目的方案;此结果有助于指导RFA治疗。

Objective To investigate the prognostic factors affecting outcome in Radiofrequency （RF） ablation of primary hepatic tumors by univariate and multivariate analyses, and to assess the therapeutic efficacy of Radio-frequency ablation. Methods A total of 172 patients with primary hepatic tumors underwent RF treatment in our department between 1999 and 2004. Among them, 150 patients were not the surgery candidates. The follow-up period ranged from 4 to 51 months and follow-up rate was 94. 8% （ 163 patients）. Kaplan-Meier model and log-rank test were used in univariate analyses and COX regression model was used in multivariate analyses, to identify prognostic factors for survival. Results The survival rates at half a year, 1 year, 2 year and 3 year were 91.5% ,77.4% ,55.7% and 51.2% respectively. Using univariate analyses, 24 potential factors were analyzed and 8 of them were found significant for survival. These 8 factors were Child-Pugh grade, UICC stage, AFP value before first RF, Portal hypertension, first treatment or treatment for recurrence, pathological grade, treatment purpose and method, ablative safe margin. For 116 patients who underwent RF when first diagnosis, the survival rates in patients with different tumor stage （UICC standard of hepatocellular carcinoma） at half a year, 1 year, 2 year and 3 year were estimated as follows： 96.7%, 92.3%, 81.6% and 65.5% in 33 patients of stage Ⅰ-Ⅱ ; 91.2%, 76. 3%, 56. 6% and 51.4% in 83 patients of stage Ⅲ-Ⅳ ;There was significant difference in survival rates between patients of stage Ⅰ - Ⅱ and patients of stage Ⅲ -Ⅳ. For 56 patients suffered from recurrent hepatic tumors, the survival rates at half a year, 1 year, 2 year and 3 year were 88.5%, 70. 2%, 41.4% and 24.5%, being similar to those of stage Ⅲ-Ⅳ. The 8 factors mentioned above were further analyzed by multivariate model and 3 of them were identified as prognostic factors for survival. These 3 factors included Child-Pugh grade, Portal hypertension, treatment purpose and method. Conclusion Based on our statistical analysis, the prognostic factors on outcome in Radio-frequency ablation of hepatic tumors were grouped into two categories. Child-Pugh grade, and Portal hypertension were the characteristics of patients and uncontrollable. While treatment purpose and method also had significant impact on survival and was controllable during RF procedure. This information might be useful to improve treatment level of Radiofrequency ablation of hepatic tumors.