肝细胞癌射频消融后局部肿瘤进展多因素分析

Analysis of risk factors for local tumor progression after radiofrequency ablation of hepatocellular carcinoma

目的 探讨射频消融（ radiofrequency ablation,RFA）治疗肝细胞癌（hepatocellular carcinoma,HCC）后局部肿瘤进展的危险因素,为进一步优化治疗提供依据.方法 回顾性分析246例患者343个肿瘤病灶行RFA规范化治疗的临床及随访资料,统计分析影响RFA局部疗效的相关因素.结果 肝细胞癌RFA治疗后局部肿瘤进展发生率为11.4％（39/343病灶）,局部肿瘤进展发生的平均时间为12.0个月（3～28个月）.单因素分析显示肿瘤大小、边界是否清晰、是否邻近血管、RFA前是否行超声造影（contrast-enhanced ultrasound,CEUS）与射频后局部肿瘤进展相关；COX多因素分析获得的独立影响因素是：肿瘤大小（P＜0.001）、是否邻近血管（P ＜0.001）和RFA前是否CEUS（P=0.018）.结论 肿瘤大小、是否邻近血管和RFA前是否CEUS是局部肿瘤进展的独立影响因素,此结果有助于采取相应措施和策略,提高RFA疗效.

Objective To evaluate prognostic factors affecting local tumor progression after radiofrequency ablation （RFA） of hepatocellular carcinoma （HCC）.Methods A total of 246 HCC patients （343 lesions） underwent RFA treatment in our department and were enrolled into this study.The average tumor size was 3.7 cm （ range 0.9 ～ 3.7 cm）.Regular follow-up with enhanced CT was performed to evalutate the treatment results.Kaplan-Meier model and log-rank test were used in univariate analysis and COX regression model was used in multivariate analysis to identify risk factors for local tumor progression.Results The local tumor progression rate was 11.4% （39/343 lesions）,and the average time from initial RFA to local tumor progression was 12.0 months.Univariate analysis indicated tumor size （ P 〈0.001 ）,close to intrahepatic vessels （ P 〈0.001）,tumor boundary （ P =0.020）,pathological grade（ P =0.010） and CEUS before RFA （ P =0.001） as risk factors for local progression.The following factors were identified as independent prognostic factors for local tumor progression by multivariate model：tumor size （P 〈 0.001）,isolated or close to intrahepatic vessels（ P 〈0.001） and CEUS before RFA（P =0.018）.Conclusions Tumor size,CEUS before RFA and close to intrahepatic vessels are the most important factors for local progression after RFA.Being awaring of possible risk factors for local tumor progression may increase the treatment efficacy and help to promote the use of RFA technique.