大功率微波消融治疗肝癌临床疗效及其复发危险因素分析

High-powered microwave ablation in treating patients with hepatocellular carcinoma and the risk factors of recurrence

目的比较大功率微波消融治疗小肝癌和大肝癌的疗效,分析大功率微波治疗肝癌的安全性及与术后肿瘤复发相关的危险因素。方法对45例未行其它治疗的乙型肝炎相关性原发性肝癌患者共60个肿瘤病灶行80～100 W大功率和（2450±10）MHz微波频率消融治疗,肿瘤直径范围为3～8 cm,肿瘤直径3～5 cm（小肝癌46个）和肿瘤直径5～8 cm（大肝癌14个）。比较消融治疗后两组肿瘤完全消融率,分析影响大功率微波消融治疗后复发、并发症发生和疗效的相关危险因素。结果在微波消融后1个月行超声造影、增强CT或MRI检查,发现小肝癌组一次性完全灭活率为82.6%（38/46）,显著高于大肝癌组的64.3%（9/14,P=0.037）;小肝癌组和大肝癌组二次完全灭活率分别为100.0%（46/46）和85.7%（12/14,P〉0.05）;术后4例患者发生右侧少量胸腔积液;大功率微波消融术后局部复发率为22.2%（10/45）;1 a和2 a生存率分别为95.6%（43/45）和86.7（39/45）;单因素分析显示肿瘤复发与肿瘤病灶临近危险区域（P=0.017）、血清HBV DNA阳性（P=0.027）、病灶数目（P=0.022）和术前AFP水平（P=0.025）有关,多因素分析结果提示HBV DNA阳性（P=0.031）和肿瘤病灶临近危险区域（P=0.039）为原发性肝癌在微波消融治疗后肿瘤复发的独立危险因素。结论大功率微波对于小肝癌完全消融率高于大肝癌,是安全的、高效的;推测乙型肝炎病毒载量与肿瘤病灶临近危险区域是大功率微波消融术后复发的独立危险因素。

Objective To investigate the efficacy of high-powered microwave ablation（MWA） in treating patients with small and large hepatocellular carcinoma（HCC） and to clarify the safety and the risk factors of recurrence after percutaneous MWA. Methods A total of 45 patients with hepatitis B virus（HBV） associated HCC,who had not received any treatment before percutaneous MWA,were enrolled in this study. All patients received MWA by using high power[（80-100 W） and（2450±10） MHz] through percutaneous approach. The procedure was carried out for a total of 60 lesions with the diameter of 3 to 8 cm. The patients were divided into two groups,e.g. 46 in small tumor group（3-5 cm） and 14 in big tumor group（5-8 cm）. The local tumor ablation rates between the two groups were compared. The recurrence,complications and the therapeutic efficacy were recorded. The contrast enhanced ultrasound and the contrast enhanced CT or MRI was performed one month after microwave ablation.The factors related to HCC recurrence were analyzed by using univariate analysis and multivariate analysis. Result The complete ablation rates for the first ablation in the small tumor group was significantly higher than in the big tumor group（82.6% vs. 64.3%,P=0.037）,and the complete ablation rates for the second ablation were 100.0% in the small tumor group and 85.7% in the big tumor group（P〉0.05）;After the MWA,no skin burn or death occurred;Ten（22.2%） of 45 patients developed recurrence after ablation and the one-year and two-year survival rates were 95.6%（43/45） and 86.7（39/45）;Univariate analysis showed that a positive correlation existed between the lesion＇s number,proximity to a major bile duct,pre-ablation serum α-fetoprotein（AFP） levels,serum HBV DNA positive and early recurrence and multivariate analysis identified HBV DNA（P=0.031） and proximity to a major bile duct（P=0.039） as the independent prognosis factors causing postoperative HCC recurrence. Conclusion The complete ablation rate of high-powered percutaneous MWA in the small tumor group is higher than in the big tumor group and high-powered percutaneous MWA appears to be a safe and effective treatment with fewer complications for patients with HCC. HBV DNA and proximity to risk area are the independent prognosis factors causing postoperative HCC recurrence.