射频消融治疗小肝癌疗效及预后因素分析

Radiofrequency ablation for small hepatocellular carcinoma: efficacy and prognostic factors

目的：探讨射频消融治疗小肝癌的疗效及预后影响因素。方法：回顾中南大学湘雅医院2006年1月—2013年6月行射频消融治疗98例小肝癌患者临床资料,分析患者的局部肿瘤进展率、复发率、生存率及预后影响因素。结果：98例患者随访2~92个月,平均34.8个月。1、3、5年累积分别为17.3%、27.4%、30.9%;1、3、5年累积肝内远处复发率分别为25.7%、62.1%,77.3%;1、2、3、4、5年累积总体生存率分别为95.4%、85.4%、65.9%、54.7%、39.9%;1、2、3、4、5年累积无瘤生存率分别为74.0%、52.7%、45.0%、37.0%、25.3%。多因素分析显示,白蛋白≤35 g/L（P=0.001）、首次复发时间≤1年（P=0.002）或首次复发为不同肝段肝内远处复发（P=0.004）是影响患者总体生存的危险因素。结论：射频消融治疗小肝癌安全、有效,对于早期肝内复发的病灶具有很高的可重复操作性。术前低血清白蛋白水平、首次复发时间短以及首次不同肝段肝内远处复发是影响患者预后的重要因素。

Objective： To assess the efficacy of radiofrequency ablation （RFA） in the treatment of small hepatocellular carcinoma （HCC） and analyze the prognostic factors. Methods： The clinical data of 98 patients with small HCC undergoing RFA from January 2006 to June 2013 in Xiangya Hospital of Central South University were reviewed. The rate of local tumor progression, recurrence, and survival, as well as the factors affecting prognosis were analyzed. Results： The 98 patients were followed-up for 2 to 29 months, and their 1-, 3- and 5-year cumulative local tumor progression rate was 17.3%, 27.4% and 30.9%, 1-, 3- and 5-year cumulative intrahepatic distant recurrence rate was 25.7%, 62.1% and 77.3%, 1-, 2-, 3-, 4- and 5-year cumulative survival rate was 95.4%, 85.4%, 65.9%, 54.7% and 39.9%, and 1-, 2-, 3-, 4- and 5-year cumulative tumor-free survival rate was 74.0%, 52.7%, 45.0%, 37.0% and 25.3%, respectively. Multivariate analysis revealed that serum albumin≤35 g/L （P=0.001）, time to first recurrence ≤1 year （P=0.002）, and the first recurrence located in a different distant hepatic segment （P=0.004） were risk factors for the overall survival of the patients. Conclusion： RFA is safe and effective in treatment of small HCC, and is of high repeatability for early intrahepatic HCC recurrence. Low preoperative serum albumin level, short time interval to first recurrence, and first recurrence located in a different distant hepatic segment are important factors affecting the prognosis of thepatients.