肝细胞癌射频消融治疗后肿瘤残留的危险因素及预后分析

Risk factors and prognosis for patients with residual tumor after radiofrequency ablation of hepatocellular carcinoma

目的探讨肝细胞癌（HCC）射频消融（RFA）治疗后肿瘤残留的危险因素及预后。方法回顾性分析2001年5月至2007年3月114例经RFA治疗的HCC患者临床资料，分析可能与RFA后肿瘤残留有关的临床因素以及残髓HCC的预后。结果114例HCC患者经RFA治疗一次后，完全消融90例，肿瘤残留24例。90例肿瘤完全消融患者的中位生存期为40个月，24例肿瘤残留患者的中位生存期为29个月，二者差异无统计学意义（P=0．242）。在24例肿瘤残留患者中，经再次治疗后达到无肿瘤残留者11例，其中位生存期为53个月；经再次治疗后仍有残留者13例，其中位生存期为28个月。RFA治疗一次后肿瘤完全消融患者与再次治疗后达到无肿瘤残留患者的中位生存期比较，差异无统计学意义（P=0．658）；与再次治疗后仍有肿瘤残留患者的中位生存期比较，差异有统计学意义（P=0．012）。多因素分析表明，肿瘤〉3cm（P=0．007）和靠近大血管（P=0．042）是HCC经RFA治疗后肿瘤残留的独立危险因素。结论肿瘤〉3cm和靠近大血管是HCC行RFA治疗后肿瘤残留的独立危险因素。对未能达到完全消融的HCC患者，应积极采取进一步治疗措施，争取达到完令根治肿瘤，以改善预后。

Objective To investigate the risk factors and prognosis of patients with residual tumor after radiofreqnency ablation （ RFA ） for bepatocellular carcinoma （ HCC ）. Methods The clinicopathological data of 114 patients with HCC undergoing RFA in our hospital from May 2000 to March 2007 were retrospectively studied, and the prognostic factors of residual tumor were analyzed. Results After one session of RFA, 90 patients had complete ablation and 24 had residual tumor. The median overall survivals in the complete ablation group and residual tumor group were 40 and 29 months, respectively. There was no statistically significant difference between those two groups （P =0.242）. 24 patients with residual tumor were re-treated by RFA or hepatectomy or TACE. Among them 11 patients achieved complete response and 13 incomplete response, their median overall survival were 53 and 28 months, respectively. There was no significant difference between first complete ablation group and second complete response group （P = 0. 658）. However, compared with the first complete ablation group, the incomplete response group had poor prognosis （ P = 0.012）. Multivariate analysis showed that tumor size 〉 3 cm （ P = 0. 007） and proximity to a large vessel （ P = 0. 042 ） were independent risk factors for residual tumor after RFA. Conclusion Tumor size 〉 3 cm and proximity to a large vessel are independent risk factors for residual tumor after RFA. Further treatment of residual tumor is necessaary to eliminate the tumor and improve prognosis.