手术联合术中射频消融治疗结直肠癌肝转移的预后分析

Prognostic analysis of colorectal liver metastases treated by surgery combined with intraoperative radiofrequency ablation

目的 探讨手术联合术中射频消融治疗结直肠癌肝转移的临床价值.方法 回顾性分析2009年1月至2016年8月于中国医学科学院肿瘤医院肝胆外科行根治手术的187例结直肠癌肝转移患者的临床资料,根据是否联合术中射频消融分为手术组和联合治疗组,分析两组患者的临床病理资料,探讨生存和复发的影响因素.并通过倾向得分匹配验证手术联合射频消融与单纯手术远期疗效的差异.结果 联合治疗组患者的肝转移灶数目（267个）、同时性肝转移（100%）、同时累及左右半肝（73.3%）和术前化疗（93.3%）的比例均明显高于手术组（471个、74.7%、42.0%和63.1%）（P值均〈0.05）.联合治疗组的中位生存时间为25.7个月,3年和5年总生存率分别为47.9%和28.8%.手术组中位生存时间为46.9个月,3年和5年总生存率分别为59.1%和42.4%,优于联合治疗组（x2=4.579,P=0.034）.联合治疗组中位无病生存时间为5.4个月,短于手术组的10.1个月（x2=5.399,P=0.023）.多因素分析结果显示,联合射频消融不是生存和复发的独立预后因素（HR=0.98,95%CI：0.47～2.08,P=0.965;HR=1.21,95%CI：0.71～2.07,P=0.465）.经倾向得分匹配后,手术组的中位生存时间为30.2个月,中位无病生存时间为5.3个月,联合治疗组中位生存时间为25.7个月,中位无病生存时间为4.2个月,差异均无统计学意义（x2=0.876,P=0.350;x2=0.199,P=0.650）.结论 在相似肿瘤负荷的情况下,手术联合术中射频消融治疗不可切除的结直肠癌肝转移可取得与可切除患者行单纯手术相似的远期疗效.

Objective To investigate the clinical value of intraoperative radiofrequency ablation （RFA） in the treatment of colorectal liver metastasis （CLM）. Methods A retrospectively analysis of 187 patients with CLM who underwent liver resection with or without RFA from January 2009 to August 2016 in Department of Hepatobiliary Surgery,Cancer Hospital,Chinese Academy of Medical Sciences was performed. According to whether RFA was used intraoperatively,patients were divided into resection only group and combined treatment group. The clinical and pathological characteristics of the two groups were compared to explore factors influencing survival and recurrence. Imbalance of background characteristics between the two groups was further overcome by propensity score matching method （PSM）. Results The number of liver metastases （267）,simultaneous liver metastases （100%）,bilobar involvement （73.3%） and preoperative chemotherapy （93.3%） rates were significantly higher in the combined treatment group than those in the resection only group（471,74.7%,42.0% and 63.1%）（all P〈0.05）. In the combined treatment group,median overall survival （OS） was 25.7 months;and 3-year and 5-year OS were 47.9% and 28.8%,respectively. In the resection only group,the median survival time was 46.9 months;and 3-year and 5-year OS rate was 59.1% and 42.4%,respectively （x2=4.579,P=0.034）. Median disease-free survival （DFS） was 5.4 months in the combined treatment group,and 10.1 months in the resection only group （x2=5.399,P=0.023）. In multivariate analysis,intraoperative RFA was not an independent prognostic factor for OS and DFS （HR=0.98,95%CI： 0.47-2.08,P=0.965;HR=1.21,95%CI： 0.71-2.07,P=0.465）. After PSM,the median OS of the resection only and the combined treatment groups were 30.2 and 25.7 months （x2=0.876,P=0.350）. The median DFS in the two groups was 5.3 and 4.2 months,respectively （x2=0.199,P=0.650）. Conclusion In patients with similar tumor burden,liver resection combined with intraoperative RFA for unresectable CLM can achieve long-term outcomes similar to hepatectomy alone for resectable CLM.