经皮热消融治疗极早期肝癌的疗效及预后因素分析

Percutaneous thermal ablation for very early stage hepatocellular carcinoma: efficacy and prognostic factors

目的:探讨超声引导下经皮热消融治疗极早期肝癌的临床疗效及预后相关因素。方法:回顾性分析2007年1月—2010年1月139例极早期肝癌行超声引导下经皮热消融治疗患者资料,计算肿瘤完全消融率、总体生存率、无瘤生存率并分析预后相关影响因素。结果:全组肿瘤完全消融率97.84%;平均生存时间(70.10±28.87)个月,1、3、5年总体生存率分别为94.90%、87.70%、73.10%;平均无瘤生存时间(44.70±24.21)个月,1、3、5年无瘤生存率分别为90.60%、61.90%、43.20%。单因素分析和多因素分析显示,年龄≥60岁、治疗后无瘤生存时间<2年和肝外转移是影响总体生存时间的独立危险因素(均P<0.05);患有丙型肝炎和术前高AFP水平是无瘤生存时间的不良影响因素(均P<0.05)。结论:超声引导下经皮热消融治疗是极早期肝癌安全、有效的治疗方式,但高龄、术后早期复发、肝外转移、丙型肝炎和术前高AFP患者预后不良。

Objective： To evaluate the efficacy of percutaneous thermal ablation in treatment of very early stage hepatocellular carcinoma （HCC） and the prognostic factors. Methods： The clinical data of 139 patients with very early stage HCC undergoing ultrasound-guided percutaneous thermal ablation from January 2007 to January 2010 were reviewed. Tae complete ablation rate, overall survival rate and disease-free survival rate were determined and the influential prognostoic factors were analyzed. Results： In whole group of patients, the complete ablation rate was 97.84%; the average survival time was （70.10±28.87） months, and the 1-, 3-, and 5-year overall survival rates was 94.90%, 87.70% and 73.10%, respectively; the average disease-flee survival time was （44.70±24.21） months, and the 1-, 3-, and 5-year disease free survival rate was 90.60%, 61.90% and 43.20%, respectively. The results of univariate and multivariate analysis showed that age more than 60 years, disease-free survival time less than 2 years and extrahepatic metastases were independent risk factors for overall survival （all P〈0.05）; hepatitis C infection and preoperative high ATP level were unfavorable factors for disease-free survival （all P〈0.05）. Conclusion： Percutaneous thermal ablation is a safe and effective treatment modality for very early stage HCC. However, patients with an old age, short-term recurrence after operation, extrahepatic metastases, high preoperative AFP level and hepatitis C infection may face poor outcomes.