手术切除和射频消融治疗转移瘤直径≤5cm转移性肝癌的疗效比较

Comparing the therapeutic efficacy of surgical resection and radio frequency ablation to treat metastatic liver cancer within 5 cm

目的比较手术切除(surgical resection,RES)和射频消融(radio frequency ablation,RFA)治疗转移瘤直径≤5 cm转移性肝癌的临床疗效,并分析手术切除组患者预后的影响因素。方法回顾性分析广西医科大学附属肿瘤医院2008年1月至2012年12月收治的转移瘤直径≤5 cm的转移性肝癌患者行手术切除治疗(n=49,RES组)和射频消融治疗(n=33,RFA组)的临床疗效,选择可能对转移性肝癌手术切除治疗预后有影响的因素进行单因素分析和多因素分析。结果 RES组和RFA组患者1年、2年、3年生存率分别为81.6%、68.5%、50.4%和84.8%、69.4%、50.7%,两组差异均无统计学意义(P均>0.05);两组患者1年、2年、3年术后再次复发转移率分别为28.8%、54.2%、68.3%和34.9%、50.5%、69.2%,差异亦均无统计学意义(P均>0.05)。单因素分析显示转移瘤数目、肿瘤的分化程度及淋巴结转移影响RES组患者预后(P<0.05),Cox回归模型多因素分析显示淋巴结转移是影响RES组患者预后的独立影响因素(P<0.05)。结论对于转移瘤直径≤5 cm的转移性肝癌患者,射频消融与手术切除治疗的近期疗效相当,但射频消融较手术切除创伤性小,可优先考虑。转移瘤数目、肿瘤的分化程度及淋巴结转移影响RES组患者预后,淋巴结转移是预后的独立危险因素。

Objective To compare the therapeutic efficacy of Surgical Resection （RES） and Radio Frequency Ablation （RFA） for treating patients baring metastatic liver cancer within 5 cm, and analysis the prognostic factors of RES group. Methods Records were retrospectively reviewed for 88 patients with metastatic liver cancer, who has been admitted by the Affiliated Tumor Hospital of Guangxi Medical University from January 2008 to December 2012.49 cases received Surgical Resection treatment （RES group） and 33 cases were underwent Radio Frequency Ablation treatment （RFA group） . The potentially prognostic factors of RES group were examined by univariate and multivariate analyses. Results （1）The 1,2 and 3-year survival rates were 81.6%,68.5% and 50.4% in RES group, respectively,and 84.8% ,69.4% and 50.7% in RFA group, respectively,then there were no statistical significance between these two groups （P〉O.05）. The 1,2 and 3-year rates of recurrence and metastasis in RES group were 28.8%,54.2% and 68.3%,and showed in 34.9%,50.5% and 69.2% in RFA group （P〉0.05）. （2）The univariate analysis showed that the number of the liver metastases,degree of differentiation of the primary tumor and lymph node metastasis were associated with the prognosis of the patients（P〈0.05）. The Cox multivariate analysis showed lymph node metastasis is an independent prognostic factor affecting the patients of metastatic liver cancer（P〈0.05 ）. Conclusion （1） The short-term therapeutic effect in metastatic liver cancer patients, whose lesion is up to 5 cm, seems not to differ in RFA and RES. But from the point of the treatment,RFA,which has a lower trauma than RES,might be a prior selection for metastatic liver cancer patients. （2） the number of the liver metastases,the degree of differentiation of the primary tumor and lymph node metastasis are associated with the prognosis of the patients. Lymph node metastasis is an independent prognostic factor affecting the patients of metastatic liver cancer.