超声引导肝细胞癌射频消融术后局部肿瘤进展的危险因素分析

Local tumor progression after ultrasound-guided radiofrequency ablation for hepatocellular carcinoma:risk factors analysis

目的研究超声引导肝细胞癌(HCC)射频消融术后影响局部肿瘤进展的危险因素。方法对99例患者107个病灶行超声引导经皮射频消融治疗,所有患者均进行超声造影血流灌注、肝组织硬度等检查,平均随访时间10.6个月。采用单因素分析和Cox多因素分析方法,研究HCC患者射频消融治疗后局部肿瘤进展的危险因素。结果肿瘤大小、是否邻近较大血管、血流灌注程度和肝组织硬度是HCC射频消融治疗后局部肿瘤进展独立危险因素,其风险比分别为1.12、1.38、1.59和1.77;HCC射频消融前行肝动脉化疗栓塞是局部肿瘤进展的保护因素,风险比为0.52。结论肿瘤大小、是否邻近较大血管、肿瘤血流灌注程度和肝组织硬度是HCC射频消融后局部肿瘤进展的独立影响因素,射频消融前行肝动脉化疗栓塞可有效降低局部肿瘤进展发生率。

Objective To investigate the risk factors for local tumor progression（LTP）after ultrasound-guided radiofrequency ablation（RFA）in treatment of hepatocellular carcinoma（HCC）.Methods Ninety-nine patients with 107 lesions involved in this study received RFA for HCC.Contrast-enhanced ultrasound（CEUS）perfusion parameters,liver stiffness measurement（LSM）and other examinations in all those patients were collected at a mean follow-up of 10.6months.Kaplan-Meier model,log-rank test and Cox proportional hazard model was applied for survival analysis and identifying risk factors for LTP in HCC patients after RFA.Results Tumor size,distance to large vessels,tumor perfusion and LSM were independent risk factors for LTP with the hazard ratios（HR）as 1.12,1.38,1.59 and 1.77,respectively.Additionally,transarterial chemoembolization（TACE）before RFA treatment was a protective factor for LTP（HR0.52）.Conclusion Tumor size,distance to large vessels,tumor perfusion and LSM are the most important risk factors for LTP after RFA.Besides,using TACE before RFA treatment can effectively improve LTP.