射频消融治疗符合米兰标准的老年肝癌患者疗效分析

Clinical efficiency of radiofrequency ablation for elderly hepatocellular carcinoma patients conforming to the Milan criteria

目的评估射频消融术(radiofrequency ablation,RFA)治疗符合米兰标准的老年肝癌患者的疗效。方法回顾性分析1999年6月至2011年6月我院行射频消融治疗的90例≥70岁符合米兰标准的原发性肝细胞癌(Hepatocellular carcinoma,HCC)病例,进行随访观察,评价其疗效,统计初次RFA术后1、2、3、4、5年无瘤生存率及总生存率,同时分析影响预后的相关因素。结果共90例病例纳入本研究。术后出现并发症31例(34.44%),无严重并发症病例及死亡病例。RFA术后中位无瘤生存时间21个月,1、2、3、4、5年无瘤生存率分别为65.56%、46.67%、33.33%、24.44%、17.78%。中位总生存时间49个月,1、2、3、4、5年总生存率分别为91.11%、80.00%、67.78%、52.22%、35.56%。在多因素分析中长期饮酒史、肝炎病毒感染、肝硬化、Child-Pugh B级、AFP>20 ng/mL、HBV-DNA>1 000 cps/mL、Cr>88.4μmol/L、合并症是影响生存率的显著危险因素。对于单发病灶,病灶直径大于3 cm者,无瘤生存率及总生存率明显较低。结论 RFA治疗符合米兰标准的老年肝癌患者,安全性高、并发症少、疗效满意;肝癌直径大于3 cm者行RFA治疗预后较差;但RFA仍是老年早期肝癌患者较好的选择。

Objective To evaluate the efficiency of radiofrequency ablation（ RFA） for elderly hepatocellular carcinoma（ HCC） patients conforming to the Milan criteria. Methods A retrospective study was adopted to analyze the clinical data of 90 cases of HCC patients,aged ≥70 years and conforming to the Milan criteria,treated with RFA initially. All patients were followed up for once per 1 to 3 months,for an average time of 37. 63 months. The rate of overall survival（ OS） and disease free survival（ DFS） in 1,2,3,4 and 5 years after initial RFA were statistically analyzed. Then the factors contributing to overall survival and recurrence-free survival after initial RFA were analyzed. Results In the cohort of 90 patients,31（ 34. 44%） had complications after RFA,and no severe complication or death was observed. The median of DFS was 21 months. The DFS rates of 1,2,3,4 and 5 years after initial RFA were 65. 56%,46. 67%,33. 33%,24. 44% and 17. 78%,respectively. The median of OS was 49 months. The OS rates of 1,2,3,4 and 5 years after initial RFA were 91. 11%,80. 00%,67. 78%,52. 22%,and 35. 56%,respectively. In the multivariate analysis,long-term drinking,hepatoviral infection,cirrhosis,Child-Pugh grade B,alpha fetoprotein（ AFP） 20 ng / ml,HBV-DNA 1 000 copies / mL,serum creatinine 88. 4 μmol / L,and comorbid diseases were significant risk factors influencing survival rate. For the patients with single focus with size larger than 3 cm,their DFS and OS rates were significant lower. Conclusion RFA is safe,effective and of less complication for elderly HCC patients confirming to the Milan criteria. The patients with tumor size 3 cm have poor prognosis after RFA. However,RFA is a good option for elderly patients.