小肝癌射频消融与手术切除的疗效分析

COMPARING THE EFFECT OF RADIOFREQUENCY ABLATION AND SURGICAL RESECTION FOR THE TREATMENT OF SMALL HEPATOCELLULAR

目的通过对比研究,评价直径小于5 cm的肝细胞性肝癌（简称小肝癌）射频消融与手术切除治疗的临床疗效。方法选择2001年1月-2006年6月间87例临床诊断为小肝癌患者的资料。根据治疗方法分为射频组和手术组。随访时间6-71个月,采用Kap lan-Meier模型进行生存分析,Log-Rank试验被用来估计生存曲线的不同。结果本研究结束后,共有67例患者存活,20例患者死亡。射频组1、2、3年累积生存率分别为91%、76.7%、69.7%,手术组1、2、3年累积生存率分别为90%、82.9%、75.4%,两者生存曲线的差异经Log-Rank检验无统计学意义（χ^2=0.99,P=0.32）。全组共有43例肿瘤复发,射频组25例,手术组18例。两组间的复发构成比有显著性差异（χ^2=6.47,P=0.01）。射频组与手术组1、2、3年的无瘤生存率分别为57.3%、40.3%、35.3%与71.1%、45.7%、、30.9%,两组的无瘤生存率经Log-Rank检验无统计学差异（χ^2=0.06,P=0.80）。结论对于小肝癌而言,射频消融与手术切除有相近的疗效。射频治疗创伤小、可重复性强,在小肝癌的治疗中有重要的临床应用价值。

Objective To compare the effect of radiofrequency ablation （RFA） and surgical resection for the treatment of small hepatocellular carcinoma （SHCC）. Methods From January 2001 to June 2006, eighty-seven SHCC patients who had undergone RFA treatment or surgical resection were analyzed retrospectively. This group incuded the patients who had Child-Pugh class A or B cirrhosis with a tumor size less than5 cm in diameter, while tumor noudles less than 3 , and no evidence of extrahepatic tumor metastasis or macrovascular invasion. Follow - up ranged from 6 to 69 months. Survival probabilities were estimated with the Kaplan- Meier method, and differences between survival curves were evaluated with the Log-Rank test. Results At the end of the study, 67 patients were alive, and 20 were dead. The 1 - , 2 - and 3-year overall cumulative survival rates after radiofrequency ablation and surgical resection were 91.0% ,76.7% ,69.7% and 90.0% ,82.9% ,75.4% , respectively. The difference between the two survival curves was not statistically significant （χ^2 = 0. 99,P = 0. 32）. Forty-three patients suffered intrahepatie recurrence after treatment, ineluding 25 eases after radiofrequency ablation and 18 cases after surgical resection. The intrahepatic recurrence between the two groups had significant difference （χ^2 = 6.47 ,P = 0.01 ）. The 1 - , 2 - , and 3-year disease -free survival rates after radiofrequency ablation and surgical resection were 57. 3% versus 71.1% , 40. 3% versus 45.7% , and 35.3% versus 30.9%. The difference between the two groups was not statistically significant （χ^2 = 0. 06 ,P = 0. 80）. Conclusion Radiofrequency ablation shows comparable results to surgical resection for the treatment of SHCC. Therefore, RFA with the advantage of mininvasive, repeatability should be considered as one valuable treatment of small hepatocellular carcinoma.