经皮射频消融术治疗外科切除术后复发性肝细胞癌疗效分析

The efficacy of radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy

背景与目的:大部分复发性的肝癌结节的直径小于3 cm,且射频消融(radiofrequency ablation,RFA)治疗直径小于3 cm的肿瘤结节,其疗效已受到广泛认可。探讨RFA对手术切除术后复发性肝细胞癌(hepatocellular carcinoma,HCC)的临床疗效与安全性。方法:回顾性分析61例手术切除后复发性HCC患者在经动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)结合RFA的治疗下的1、3、5年总生存(overall survival,OS)率和无进展生存(progression-free survival,PFS)率,并发症发生率,死亡率,完全消融率以及影响患者生存率的独立风险因子。结果:完全消融率为93.4%(57/61),不完全消融率6.6%(4/61)。1、3、5年生存率分别为96.3%、77.9%和77.9%。1、3、5年PFS率分别为48.6%、20.3%和13.5%。消融术后出现主要并发症的患者1例,为肝包膜下出血;无消融治疗相关的死亡患者;消融后住院时间为4~7 d,中位值为5 d。影响OS的独立风险因子为患者HBs Ag阳性(P=0.044,HR=7.496,95%CI:1.057~53.152)。结论:RFA治疗手术切除术后复发的HCC安全、有效,能够有效提高切除术后复发性HCC患者的生存率,对改善HCC患者的预后具有重要意义。

Background andpurpose： The majority of recurrent hepatocellular carcinoma （HCC） is small nodule with less than 3 cm in diameter, and the treatment of radiofrequency ablation （RFA） is associated with a prolonging survival time in patients with small HCC. This study aimed to explore the efficacy and safety of RFA for recurrent HCC. Methods： The 1-, 3- and 5-year overall survival （OS） rate and progression-free survival （PFS） rate of 61 patients with recurrent HCC undergoing transcatheter arterial chemoembolization （TACE） and RFA after hepatectomy were retrospectively evaluated by the Kaplan-Meier method. Furthermore, the complication rate, mortality rate and prognostic factor for OS were evaluated in this study. Results： The 1-, 3-, and 5-year OS rates were 96.3%, 77.9% and 77.9%, respectively. The 1-, 3-, and 5-year PFS rates were 48.6%, 20.3% and 13.5%, respectively. Fifty-seven patients （93.4%） achieved complete ablation. There was one patient with a major complication, and no death case due to RFA was found. The median length of hospitalization was 5 days （quartile, 4-7）. The prognostic factor for OS was the expression of HBsAg （P=0.044, HR=7.496, 95%CI： 1.057-53.152）. Conclusion： RFA was a safe and effective treatment modality for recurrent HCC after hepatectomy.