射频消融及手术治疗不同大小小肝癌的无瘤生存率及复发转移率

Analysis of tumor-free survival rate and recurrence rate of radiofrequency ablation versus surgical resection for small hepatocellular carcinoma

目的：研究射频消融及手术治疗不同大小小肝癌的无瘤生存率及复发转移率。方法：回顾性分析我院2008年10月至2010年10月64例肝癌患者的临床资料，均为单发肿瘤且肿瘤大小≤5cm，根据首次治疗方法分组，射频消融29例（射频组），手术切除35例（手术组），再根据肿瘤大小将两组分为〈3cm组及3～5cm组，观察两组手术清除率、并发症发生率．随访比较两组治疗后不同大小肝癌的复发转移率及1、3、5年无瘤生存率，同时对两组1、3、5年累积生存率进行比较。结果：射频组肿瘤清除率、并发症发生率分别为89．66％、6．9％与手术组（100％、14．29％）比较差异无统计学意义（P〉0．05）。对于〈3cm肝癌患者，射频组复发转移率及1、3、5年无瘤生存率分别为60．00％、80．00％、40．00％、30．00％与手术组（38．46％、84．62％、61．54％、38．46％）比较差异无统计学意义（P〉0．05）；对于3～5cm的肝癌患者，射频组及手术组以上指标比较差异也无统计学意义（P〉0．05）。射频组及手术组组内比较，〈3cm与3～5cm患者无瘤生存率无明显差异（P〉0．05），但复发转移率以〈3cm显著较低（P〈0．05）。射频组1、3、5年累积生存率分别为100．00％、62．07％、37．93％与手术组（100．00％、62．86％、48．57％）比较差异无统计学意义（P〉0．05）。结论：当肝癌患者肿瘤大小≤5cm时，射频消融、局部手术有基本一致的中远期疗效．肿瘤体积越大的小肝癌患者术后复发及转移率更高，同时射频消融因微创性可避免手术所致一系列并发症．故将射频消融术作为≤5cm小肝癌外科手术的替代疗法具有可行性。

Objective To analyze tumor-free survival rate and recurrence rate of radiofrequency ablation （RFA） versus surgical resection （SR） for small hepatocellular carcinoma. Methods Clinical data of 64 patients （hospitalized from October 2008 to October 2010） with small hepatocellular carcinoma（ ≤ 5 cm） in our hospital were retrospectively analyzed. 29 cases among them underwent RFA, and the 35 cases underwent SR, then they were further divided into two groups according to the tumor diameter （≤ 3 cm vs.≤ 3 - 5 cm）. The rate of complete elimination of tumor, complications, recurrence and metastasis, and survival rate out of tumor-free at year 1, 3, and 5 were compared. Accumulated survival rate of the two groups at year 1, 3, and 5 were compared. Results The rate of complete elimination of tumor, and complications in the RFA group were 89.66% and 6.9% respectively, and no statistically significant difference was found compared with the SR group （100% and 14.29%, respectively） . The rate of recurrence and metastasis and 1, 3, 5- year tumor-free rate in RFA and SR group with tumor diameter 〈 3 cm were 60.00%, 80.00%, 40.00%, 30.00% and 38.46%, 84.62%, 61.54%, 38.46% （P 〉 0.05） respectively, and for the cases with tumor diameter in 3 - 5 cm, these data showed no significant difference between groups （P 〉 0.05）. No significant difference were found in tumor-free survival rate within groups, while rate of recurrence and metastasis was significantly lower in the 〈 3 cm group （P 〈 0.05）. The accumulated survival rate in RFA at year 1, 3 and 5 were 100%, 62.07%, 37.93% and 100%, 62.86%, 48.57% in SR group （P 〉 0.05）. Conclusions RFA and SR had similar medium and long term clinical effect for small hepatocellular carcinoma with tumor diameter≤ 5 cm. The larger in size of the tumor, the higher rate of recurrence and metastasis. RFA is less invasive and can avoid complications and should be considered an eligible treatment for small hepatocellular carcinoma with tumor diameter ≤ 5 cm.