经皮微波消融治疗术后复发性肝癌的长期生存影响因素分析

Long term prognosis and risk factors of percutaneous microwave ablation treatment of recurrence hepatocellular carcinoma after hepatectomy

目的研究超声引导下经皮微波消融治疗术后复发性肝癌的疗效和临床因素对生存率的影响。方法1998年4月至2010年12月原发性肝癌手术切除患者102例，术后复发选择经皮微波消融，分析微波消融术后患者生存预后及影响因素。结果微波消融治疗后患者1、3、5、7年总体生存率分别为73．5％、53．5％、40．5％、17．7％；手术后≤1年（早期）及〉1年（晚期）复发组微波消融后1、3、5年总体生存率分别为63．3％、38．9％、27．1％和86．3％、72．3％、63．0％，组间比较差异有统计学意义（P=0．003）。单因素分析示复发灶直径、数目、肝功能分级及甲胎蛋白水平是影响微波消融后患者生存时间的危险因素，多因素分析示复发灶数目、肝功能分级及甲胎蛋白水平是影响微波消融后患者生存时间的危险因素。结论微波消融治疗术后复发性肝癌应用价值高、疗效显著。手术后晚期复发、单发、直径≤3cm病灶微波消融治疗效果好。

Objective To explore the therapeutic results of percutaneous microwave ablation for patients with recurrence primary liver cancer after surgery and the factors influencing the survival after ablation therapy. Methods 102 patients who underwent hepatectomy for primary liver cancer in April 1998 to December 2010, and subsequent microwave ablation for recurrence hepatocellular carcinoma, were enrolled. Long term survival rates and prognostic factors after ablation were analyzed. Results The 1,3,5, and 7 year overall survival rates after ablation were 73.5 %, 53.5 ~,40.5 % and 17. 7 %. The 1,3, and 5 year overall survival rates for patients within one year recurrence after hepatectomy were 63.3% ,38.9%, and 27.1 ~,respectively,which was significantly lower than that for patients after this time period in which the 1,3 ,and 5 year overall survival rates were 86.3~~ ,72.3% and 63.0% ,respectively （ P = 0. 003）. Univariate analysis revealed that recurrence tumor size more than 3 cm, multiple tumors, poor Child-Pugh score, and AFP level ~100 /~g/L were risk prognostic factors of overall survival for patients who underwent ablation. Multivariate analysis identified multiple tumors, poor Child-Pugh score,and AFP level 〉 100μg/L were the factors affecting overall survival. Conclusions Microwave ablation is of high clinical application value and is an effective minimally invasive treatment for recurrence hepatocellular carcinoma. Microwave ablation is equally effective when used in late recurrence, single tumor and tumor size〈3 cm.