经皮超声引导下射频消融治疗胃癌肝转移疗效分析

Outcome of percutaneous ultrasound-guided radiofrequency ablation for liver metastases from gastric cancer

目的探讨经皮超声引导下射频消融(RFA)治疗胃癌肝转移的疗效及预后因素。方法回顾性分析55例接受经皮超声引导下RFA治疗的胃癌肝转移患者临床及影像学资料,观察评价患者总体生存率及预后影响因素。结果55例(102个病灶)胃癌肝转移患者1、2、3、5年总体生存率分别为70.45%、42.90%、20.32%及10.16%。RFA治疗后1个月,肿瘤灭活率94.12%(96/102),肿瘤局部复发率15.69%(16/102),肝内新生转移灶发生率52.73%(29/55)。单因素分析示年龄(P=0.015)、肿瘤数目(P=0.011)、RFA前是否有肝外转移(P=0.026)、RFA后是否化疗(P=0.031)是影响患者生存的重要因素。多因素分析示年龄(P=0.033)、肿瘤数目(P=0.004)、RFA后是否化疗(P=0.001)是独立预后因素。RFA治疗后严重并发症的发生率为1.82%(1/55),未发生治疗相关性死亡。结论经皮超声引导下RFA是一种安全、有效的胃癌肝转移治疗方式,年龄、肿瘤数量、RFA后联合化疗是影响患者预后的独立因素。

Objective To investigate the efficacy and prognostic factors of percutaneous ultrasound-guided radiofrequency ablation （RFA） for liver metastases from gastric cancer. Methods Clinical and imaging data of 55 patients with liver me- tastasis from gastric cancer who underwent percutenous ultrasound guided RFA were retrospectively analyzed, and the o verall survival rates and prognostic factors were assessed. Results The overall survival rates of 1-, 2-, 3- and 5-year was 70.45%, 42.90%, 20.32% and 10.16%, respectively. The ablation rate was 94.12% （96/102） 1 month after RFA, and the local recurrent rate was 15.69% （16/102）, the new metastasis rate was 52.73% （29/55）. Age （P=0.015）, tumor number （P= 0.011）, extrahepatic metastasis before RFA （P = 0. 026） and chemotherapy after RFA （P= 0. 031） were sig- nificantly prognostic factors. Age （P= 0. 033）, tumor number （P= 0. 004） as well as chemotherapy after RFA （P= 0. 001） were independent prognostic factors. The severe complication rate was 1.82% （1/55）, while no treatment-related death occurred. Conclusion Percutaneous ultrasound-guided RFA is a safe and effective therapeutic option for liver metas- tases from gastric cancer. Age, tumor number, chemotherapy after RFA are independent prognostic factors.