高龄原发性肝癌射频治疗疗效分析

The efficacy of radiofrequency ablation in treatment of hepatocellular carcinoma in aged patients

目的 观察高龄原发性肝细胞癌(HCC)患者射频消融治疗(RFA)疗效及RFA对肝功能及生命质量的影响。方法 超声引导RFA治疗的225例HCC患者为本文研究对象；非老年组(年龄≤60岁)109例；老年组(年龄＞60岁)116例中，年龄≥70岁者50例，52．6％(61人)合并其他疾病。治疗前两组病灶大小，肝功能分级均无显著差异。比较两组RFA疗效、生存期、生存率、生命质量变化及对肝功能的影响。结果 两组消融成功率，局部肿瘤进展率均无明显差异。平均生存期非老年组为(43．31±3．16)个月，老年组为(41．07±2．50)个月，两组无统计学差异。老年组RFA治疗前后生命质量得分无显著差异；治疗后，老年组社会功能领域得分高于非老年组，两组生命质量总得分及其他领域得分均无显著差异。两组患者治疗前与治疗后1个月的谷丙转氨酶、谷草转氨酶、总胆红素水平均无明显差异。结论 RFA对不适合手术治疗的高龄HCC患者，可获得良好疗效，并保持患者较高的生命质量；对高龄患者可作为首选治疗方法之一。

Objective To investigate the efficacy of radiofrequency ablation （RFA） in treatment of hepatocellular carcinoma （HCC） and its effect on the quality of life and liver function in aged patients. Methods Two hundreds and twenty five HCC patients undergoing ultrasound-guided RFA were allocated into the young group （with the age no more than 60 years, 109 cases） and the aged group （with the age more than 60 years, 116 cases）, in which 50 cases （43.1% ） were in age more than 70 years and 52.6% （61 cases） had concomitant cerebrovascular and cardiovascular diseases or diabetes mellitus and so on. There were no statistical differences between two groups in tumour sizes and Child-Pugh stages. Indexes including ablation success rate, local tumor progression rate, survival rate and the quality of life were obtained for analysis and comparison. Results There was no statistically significant difference between the aged group and the young group in the ablation success rate （95.5 % vs 93.9%） and the local tumor progression rate （ 14.7% vs 9.2%）. The mean cumulative survival time was （41.07 ±2.50） months in aged group and （43.31 ± 3.16） months in young group, with no statistically significant difference between them （ P 〉 0.05）. There was no statistically significant difference between the two groups in quality of life after RFA treatment except the social functions （32.9 ± 10.2 in aged group and 25.8 ± 9.4 in young group, P = 0.048）. The ALT, AST and the total bilirubin level before and one month after RFA treatment had no statistically significant differecne between the two groups. Conclusion RFA is generally effective and safe in treating aged HCC patients who are not the candidates for surgery.