原发性肝癌194例患者射频消融术后临床预后因素分析

Clinical prognostic factors analysis of radiofrequency ablation on 194 cases of primary hepatocellular carcinoma

目的探讨原发性肝细胞肝癌患者接受射频消融术后的生存期及相关预后因素。方法回顾性分析经射频消融治疗194例肝细胞性肝癌的临床资料,采用Kaplan-Meier法绘制生存曲线,采用COX比例风险模型进行多因素生存分析。结果射频消融术后肝细胞性肝癌的1年、3年、5年累积生存率分别为81.42%、52.65%和41.20%。其中小肝癌(肿瘤≤3 cm)的患者1年、3年、5年累积生存率分别为88.47%、59.04%和42.35%。COX多因素生存分析显示肝功能分级、肿瘤个数、肿瘤大小和血管癌栓等因素与生存率相关(RR分别=0.59、0.52、0.49、1.79,P均<0.05)。射频消融术后主要有发热、疼痛、胸腹水和皮肤灼伤等并发症,但未发生射频消融治疗相关性死亡。结论射频消融术是一种安全有效的肝癌治疗方法,尤其针对小肝癌,其生存率较高。肝功能分级、肿瘤个数、肿瘤大小和血管癌栓等因素与射频治疗后生存率相关。

Objective To investigate the survival time and prognostic factors of radiofrequency ablation （RFA）-treated hepatocellular carcinoma （HCC） patients. Methods A total of 194 HCC cases treated by RFA were retrospectively ana-lyzed. Potential prognostic factors were analyzed by Kaplan-Meier model, Log-rank test of univariate analysis and Cox re-gression model of multivariate analysis. Results The cumulative survival rates of RFA-treated HCC at 1, 3 and 5 years were 81.42%,52.65% and 41.20%, respectively. And the survival rates of small hepatocellular carcinoma that tumor size smaller than 3 cm at 1, 3 and 5 years achieved 88.47%,59.04% and 42.35%, respectively. Cox regression analysis re-vealed that child-pugh, tumor number, size, vascular tumor embolus were related to survival rate（RR=0.59,0.52,0.49, 1.79,P〈0.05）. The main complications included fever, abdominal pain, ascites, pleural effusion, skin burn. No RFA-related death happened. Conclusions RFA is a safe and effective treatment for HCC, especially for small ones which could achieve higher survival rate. And child-pugh, tumor number, size and vascular tumor embolus were related inde-pendently to the survival rate treating with RFA.