经皮微波消融治疗较大原发性肝癌的可行性及疗效研究

Efficacy and feasibility of percutaneous microwave ablation for relatively large hepatocellular carcinoma

目的：评估经皮微波消融（PMWA）治疗较大原发肝癌（HCC）的可行性和疗效。方法：回顾性收集2007年1月—2010年1月49例接受了超声引导下PMWA手术不可行的较大HCC（5~6 cm）患者的临床与随访资料。分析患者肿瘤完全消融率、严重并发症发生率,治疗后的总体生存（OS）和无瘤生存（DFS）情况,以及OS影响因素。结果：49例患者中首次肿瘤完全消融率为85.7%,二次消融后所有患者均达到完全消融率。严重并发症发生率为8.1%。截至随访结束（中位随访时间48个月）,41例（87.5%）出现了肝内复发;平均生存时间（54.4±32.0）个月;1、3、5年OS分别为87.8%、63.3%、39.1%。平均DFS时间为（35.8±30.6）个月,1、3、5年DFS率分别为69.4%、40.9%、21.8%。单因素分析显示术前乙肝病毒定量阳性和甲胎蛋白（AFP）高水平是影响OS的不良因素（均P〈0.05）,多因素分析显示术前AFP高水平是OS的独立影响因素（HR=1.730,95%CI=1.135~2.635,P=0.011）。结论：PMWA是较大肝癌安全可行且有效的治疗方式,但术后复发的治疗仍需探索。术前AFP高水平是PMWA术后OS的独立影响因素。

Objective： To investigate the efficacy and feasibility of percutaneous microwave ablation （PMWA） in treatment of relatively large hepatocellular carcinoma （HCC）. Methods： The clinical and follow-up data of 49 patients with unresectable and relatively large （5-6 cm） HCC who underwent ultrasound-guided PMWA from January 2007 to January 2010 were reviewed. The complete ablation （CA） rate, incidence of severe complications, overall survival rate （OS）, and disease-free survival rate （DFS） as well as prognostic factors for OS of the patients were analyzed. Results： Of the 49 patients, the CA rate after initial PMWA was 85.7%, and CA was achieved in all cases after a second session of PM-WA. R-he incidence of severe complications was 8.1%. At the end of follow-up （median follow-up time was 48 months）, intrahepatic recurrence occurred in 41 cases （87.5%）, the average survival time was （54.4＋32.0） months, and the 1-, 3- and 5-year OS was 87.8%, 63.3% and 39.1%, respectively; the average DFS time was （35.8＋30.6） months and the 1-, 3- and 5-year DFS was 69.4%, 40.9% and 21.8%, respectively. Univariate analysis showed that preoperative positive quantitative HBV DNA and high level of alpha fetoprotein （AFP） were unfavorable factors for OS （both P〈0.05）, and multivariate analysis showed that preoperative high AFP level was independent influential factor for OS （HR=I.730, 95% CI=1.135-2.635, P=0.011）. Condasion： PMWA is a safe, feasible and effective treatment for relatively large HCC. However, the treatment of recurrence remains a challenge. High preoperative AFP level is independent factor of the OS after PMWA.