射频消融与手术切除治疗小肝癌的效果观察

Comparison the treatment effects of radiofrequency ablation and surgical resection for small primary liver carcinoma

目的:比较手术切除与射频消融(RFA)治疗小肝癌(≤5 cm)的临床疗效。方法:对116例手术切除和100例RFA治疗的小肝癌患者的临床随访资料进行分析。结果:2组随访1～72个月,平均34.36个月。手术切除组与RFA组的1、3、5年无瘤生存率分别为85.4%、40.9%、29.2%与82.6%、27.7%、16.4%,平均无瘤生存时间32.78个月与29.39个月(P=0.51);总累积生存率分别为96.0%、73.2%、63.1%与98.3%、67.1%、51.0%,平均总累积生存时间46.91个月与46.68个月(P=0.67)。肿瘤长径≤3 cm的手术切除组与RFA组患者1、3、5年无瘤生存率分别为85.7%、62.5%、37.5%与85.0%、37.4%、29.9%(P=0.50),累积生存率分别为97.1%、70.9%、64.2%与100.0%、69.3%、59.9%(P=0.87)。肿瘤长径3～5 cm的手术切除组与RFA组患者1、3、5年无瘤生存率分别为85.7%、30.6%、30.0%与80.8%、21.8%、10.9%(P=0.58),累积生存率分别为97.1%、74.9%、50.1%与96.9%、64.1%、47.2%(P=0.41)。Cox多因素分析显示,消除各因素可能引起的影响后,手术切除组与RFA组总体无瘤生存期和总体生存期差异均无统计学意义。结论:对直径≤5 cm的小肝癌RFA安全、疗效确切,近远期疗效与手术切除相近,可以考虑作为小肝癌的首选治疗手段之一。

Objective：To compare clinical results of surgical resection （SR） and radiofrequency ablation （RFA） for small primary liver carcinoma（ ~〈 5 cm）. Methods：The follow-up results of 116 small primary liver carcinoma cases treated with surgical resection and 110 small primary liver carcinoma cases treated with radio frequency ablation were analyzed. Results：The mean follow-up time was up to 34.36（ 1 -72） months. The 1,3,5-year disease free survival rates in SR and RFA group were 85.4% ,40.9% ,29.2% and 82.6% , 27.7%, 16.4% and the mean disease free survival time were 32.78 -29.39 months（ P = 0.51 ）, and the mean cumulative survival time were 46.91 and 46.68 months （ P = 0. 67 ） respectively. The 1,3,5-year disease free survival rates in SR and RFA group with tumor diameter ≤ 3 cm were 85.7% ,62.5 %, 37.5% and 85.0%, 37.4% ,29.9% （P = 0.50 ） and the mean cumulative survival time were 97.1% ,70.9% ,64.2% and 100.0% , 69.3 %, 59.9% （P = O. 87 ） respectively, but for the cases with tumor diameter in 3 -5 cm, these data were 85.7% ,30.6% , 30.0% and 80.8%, 21.8%, 10.9% （P = 0. 58 ）, and 97.1% , 74.9%, 50. 1% and 96.9% , 64.1% ,47.2% （P = 0.41 ）respectively. Cox results without multiple factors showed no significant difference in disease free survival rate and cumulative survival rate of SR and RFA group. Conclusions：Radio freqency ablation is a safe and satisfactory treatment for small liver carcinoma（ ≤5 cm）, and its immediate and long-term outcomes is similar to surgical resection, which can be selected the first choice of treatment for small lliver carcinoma.