经皮射频消融与再手术治疗单个直径≤3 cm的复发性肝癌的疗效比较

Effects of percutaneous radiofrequency ablation and repeat hepatectomy for the treatment of solitary recurrent hepatocellular carcinoma with the diameter no more than 3 cm

目的 比较经皮射频消融（PRFA）与再手术切除治疗单个直径≤3 cm的复发性肝癌的疗效.方法 回顾性分析1999年1月至2009年12月中山大学肿瘤防治中心收治的151例复发性肝癌（单个肿瘤直径≤3 cm）患者的临床资料,其中79例患者行PRFA（PRFA组）,72例行肿瘤再手术切除（再手术切除组）.比较两组患者的生存率、并发症发生率及肿瘤复发情况.计量资料比较采用t检验,计数资料比较采用x^2检验,生存率计算采用寿命表法,生存曲线采用Kaplan-Meier法绘制,组间比较采用Log-rank检验.结果 PRFA组和再手术切除组并发症发生率分别为13%（10/79）和36%（26/72）,两组比较,差异有统计学意义（x^2=11.411,P＜0.05）.PRFA组和再手术切除组1～5年累积生存率分别为89.7%、75.2%、67.1%、61.5%、56.6%和86.0%、67.6%、53.6%、44.1%、40.2%,两组总体生存曲线比较,差异无统计学意义（x^2=1.610,P＞0.05）.PRFA组4、5年累积生存率显著高于再手术切除组（x^2=4.682,4.196,P＜0.05）.PRFA组肿瘤局部复发率为5%（4/79）,再手术切除组切缘复发率为3%（2/72）,两组比较,差异无统计学意义（x^2=0.565,P＞0.05）.结论 PRFA治疗单个直径≤3 cm的复发性肝癌的长期疗效优于再手术切除,且具有微创的优势.

Objective To compare the efficacy of percutaneous radiofrequency ablation （PRFA） and repeat hepatectomy for solitary recurrent hepatocellular carcinoma （HCC） with the diameter≤3 cm. Methods The clinical data of 151 patients with recurrent HCC （diameter≤3 cm） who were admitted to the Cancer Center of Sun Yat-Sen University from January 1999 to December 2009 were retrospectively analyzed. Of all the patients, 79received PRFA （PRFA group） and 72 received repeat hepatectomy （repeat hepatectomy group）. The survival rate, morbidity and recurrence of the tumor between the two groups were compared. All data were analyzed using t test, chi-square test or Log-rank test, and the survival of the patients were analyzed using the Kaplan-Meier method. Results The mobidities of the PRFA group and repeat hepatectomy group were 13% （10/79） and 36%（26/72）, respectively, with a significant difference between the two groups （x^2=11.411, P〈0.05）. The cumulative 1-, 2-, 3-, 4-, 5-year survival rates were 89.7%, 75.2%, 67.1%, 61.5%, 56.6% in the PRFA group, and 86.0%, 67.6%, 53.6%, 44.1%, 40.2% in the repeat hepatectomy group, with no significant difference between the two groups （x^2=1.610, P〉0.05）. The cumulative 4-, 5-year survival rates of the PRFA group were significant higher than those in the repeat hepatectomy group （x^2=4.682, 4. 196, P 〈 0.05）. The local tumor recurrence rate of the PRFA group was 5% （4/79）, and the incisal margin recurrence rate was 3% （2/72） in the repeat hepatectomy group, with no significant difference between the two groups （x^2=0.565, P〉0.05）. Conclusion As a less invasive treatment method, PRFA is superior to repeat hepatectomy for solitary recurrent HCC with the diameter≤3 cm.