微波消融治疗696例米兰标准内肝细胞癌的疗效分析

Efficacy of microwave ablation in treatment of hepatoceUular carcinoma within the Milan criteria： a report of 696 cases

目的进一步明确米兰标准内肝细胞癌行微波消融治疗的疗效，亚组分析不同大小肿瘤行微波消融治疗的疗效区别。方法回顾性分析2011年1月至2013年1月行微波消融治疗的米兰标准内肝细胞癌病例资料，分析微波消融治疗的完全消融率、严重并发症发生率、复发率及总生存率，比较不同大小肿瘤行微波消融治疗后总生存率等的差异，随访时间3．4～61．8个月。各组率的比较采用χ2检验；总体生存率、局部复发率及远处复发率等采用Kaplan-Meier法计算，各组生存率的比较采用Log—rank检验。结果共纳入696例，消融治疗801处病灶，完全消融率为93．8％（653／696），严重并发症发生率为1．7％（12／696）。中位生存期为59．6个月，1、2、3年总生存率分别为94．8％、82．2％、71．7％；局部复发率为13．4%（93／696），肝内远处转移率为40．1％（279／696），肝内总复发率为48．1％（335／696），1、2、3年复发率分别为22．9%、38．4%、46．8％。亚组分析表明，肿瘤最大直径3～5cm组及≤3cm组，在完全消融率、严重并发症发生率及总生存率方面差异无明显统计学意义垆值分别为0．12、0．61、0．61）。结论对于米兰标准内肝细胞癌，微波消融是一种安全有效的治疗方式，而对于直径≤3cm及3～5cm的肿瘤，微波消融的安全性、有效性及远期疗效并无明显区别；但如果消融治疗经验不丰富，不能准确运用适形消融及把握个体消融策略，对于治疗直径3～5cm的肿瘤，应该谨慎处理，避免治疗后肿瘤残留等情况发生。

Objective To investigate the efficacy of microwave ablation in the treatment of hepatocellular carcinoma （HCC） within the Milan criteria and to investigate the differences in clinical efficacy of microwave ablation in tumors with different sizes. Methods A retrospective analysis was performed on the clinical data of the patients with HCC within the Milan criteria who received microwave ablation in our hospital from January 2011 to January 2013. The complete ablation rate, incidence rate of major complications, recurrence rate, and overall survival rate were analyzed and the treatment outcomes were compared between two groups with different tumors sizes. The patients were followed up for 3.4-61.8 months. The Kaplan-Meier method was used to calculate overall survival rate, local recurrence rate, and distant recurrence rate. Comparison of rates between groups was made by the chi-square test and comparison of survival rates between groups was made by the log-rank test. Results A total of 696 patients with HCC within the Milan criteria involving 801 tumors were included in this study. The complete ablation rate was 93.8% （653/696） and the incidence rate of major complications was 1.7% （12/696）. The median survival time was 59.6 months and the 1-, 2-, and 3-year overall survival rates were 94.8%, 82.2%, and 71.7%, respectively. The local recurrence rate was 13.4% （93/696） and the rate of intrahepatic distant metastasis was 40.1% （279/696）. The overall intrahepatic recurrence rate was 48.1% （335/696）, and the 1-, 2-, and 3-year recurrence rates were 22.9%, 38.4%, and 46.8%, respectively. There were no significant differences in complete ablation rate, incidence rate of major complications, and overall survival rate between the two groups with different tumor sizes （diameters ≤ 3 cm and 3-5 cm） （P = 0.12;P=0.61;P=0.61）. Conclusion Microwave ablation is a safe and effective lreamaent modality for HCC within the Milan criteria. And there are no significant differences in safety, effectiveness, and long-term efficacy of microwave ablation between the two groups with different tumor sizes （diameters ≤ 3 cm and 3-5 cm）. However, if the operator＇s experience is not rich and cannot accurately use conformal ablation and make an individualized treatment, the tumors with a diameter of 3-5 cm should be carefully treated using microwave ablation to avoid residual tumor after treatment.