老年肝癌患者的射频消融治疗

Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma in Elderly Patients

目的比较射频消融治疗老年和非老年肝癌患者的临床疗效。方法回顾性分析比较2004年3月～2007年8月77例老年和非老年肝癌患者射频消融的治疗效果,年龄≥60岁者为老年组(n=31),<60岁者为非老年组(n=46)。结果老年组与非老年组比较,肿瘤完全清除率87.1%vs82.6%(P=0.832),1～3年复发率分别为44.4%、59.8%、71.3%vs56.4%、70.7%、78.1%(P=0.464)。1～3年生存率分别为89.6%、63.8%、35.9%vs78.9%、46.6%、20.1%(P=0.114)。并发症的发生比率分别为29.0%vs26.1%(P=0.776)。肿瘤个数、初治时是否复发及治疗后是否再复发是影响预后的危险因素,而年龄、肿瘤直径不是预后的影响因素。结论对于老年肝癌患者PRFA治疗可以获得与非老年患者相当的长期生存率,而其微创、重复性好的优势更适合老年肝癌患者,尤其是复发癌患者。

Objective To compare the clinical effect of percutaneous radiofrequency ablation（PRFA） for hepatocellular carcinoma in elderly patients and in non-elderly patients. Methods We reviewed the clinical data of 77 HCC patients undergone PRFA from March, 2004 to August, 2007. Patients were categorized into two groups by their age： the elderly group （n= 31）, aged 60 and above, and the non-elderly group （n= 46）, younger than 60 years old. Survival time, treatment-related complications were compared between the two groups. Factors that may influence the outcome were also determined using a multivariate analysis with Cox regress model. Results Results The tumor complete elimination rate was similar （87. 1% vs 82. 6%, P = 0. 832）. The 1, 2 and 3 year recurrence rates were 44. 4%, 59. 8%,71.3% respectively in the elderly group, and were 56. 4%, 70. 7%, 78. 1% respectively in the non-elderly group. There was no significant difference between the two groups （P = 0. 464）. The 1, 2 and 3 year survival rates for the elderly group and the non-elderly group were 89. 6%,63. 8%,35.9% vs 78. 9%,46. 6%, 20. 1%, respectively （P = 0. 114）. Regarding the rate of treatment-related complication, no significant difference was found between the two groups （29. 0% vs 26. 1%, P = 0. 776）. Recurrence tumor, nonsolitary tumor and recurrence after PRFA except tumor size and age were found to be the prognostic factors. Conclusion PRFA had the advantage of less invasiveness and the survival rate in the elderly patients was as comparable as that in the non-elderly patients. PRFA may be more suitable to elderly patients as one of the treatment modality for hepatocellular carcinoma, especially to those who with recurrence tumor.