超声引导下经皮射频消融治疗小肝癌患者疗效及预后分析

Efficacy and prognosis of ultrasound-guided percutaneous radiofrequency ablation in treatment of patients with small hepatocellular carcinoma

目的比较超声引导下经皮射频消融与肝切除术治疗小肝癌患者的疗效及分析影响生存的危险因素。方法 2011年1月～2015年4月在我院接受治疗的107例肝细胞癌(HCC)患者,接受超声引导下射频消融治疗58例,接受肝叶切除术治疗49例。术后随访3年,采用Cox单因素和多因素回归分析影响HCC患者生存的独立危险因素。结果治疗后,射频消融患者血清ALT水平显著低于肝切除术组(P<0.05),而血清ALB水平显著高于肝切除术组(P<0.05);两组术后并发症发生率(10.3%对16.3%)比较,差异无统计学意义(P>0.05);射频消融治疗患者1 a、2 a和3 a总生存率分别为84.5%(49/58)、65.5%(38/58)和44.8%(26/58),而肝切除术组则分别为85.7%(42/49)、67.3%(33/49)和46.9%(23/49),差异不具有统计学意义(x^2=0.032,P=0.859;x^2=0.040,P=0.842;x^2=0.048,P=0.827);Cox单因素分析结果显示肿瘤数目(HR=0.372,95%CI:0.105～0.876,P=0.033)与HCC患者无瘤生存时间有关,而血清AFP水平(HR=3.043,95%CI:1.007～5.248,P=0.035)、肿瘤数目(HR=0.871,95%CI:0.344～0.902,P=0.401)和肿瘤直径(HR=1.631,95%CI:1.273～3.045,P=0.005)与HCC患者总生存时间有关;Cox多因素回归分析结果显示肿瘤数目多(HR=0.087,95%CI:0.045～0.498,P=0.009)是影响HCC患者无瘤生存的独立危险因素,而肿瘤分化低(HR=2.974,95%CI:1.865～4.097,P=0.046)、肿瘤数目多(HR=0.062,95%CI:0.033～0.378,P=0.002)和肿瘤直径大(HR=2.216,95%CI:1.778～5.026,P=0.007)是影响HCC患者总生存时间的独立危险因素。结论超声引导下经皮射频消融治疗与肝切除术治疗小肝癌患者的临床疗效相当,但射频消融治疗创伤小,术后恢复快,对肝功能的影响小。

Objective To compare the efficacy of ultrasound-guided percutaneous radiofrequency ablation and hepatectomy in treatment of patients with hepatocellular carcinoma(HCC) of less than 3 cm diameters and to analyze the impacting factors of prognosis. Methods A total of 107 patients with HCC were recruited in our hospital between January 2011 and April 2015,and 58 patients with HCC received US-guided RPA,and 49 underwent hepatectomy. The independent risk factors affecting their survival was analyzed by Cox univariate and multivariate analysis. Results After treatment,serum ALT level in patients receiving radiofrequency ablation was significantly lower than that in patients receiving hepatectomy(P<0.05),while serum albumin level was significantly higher than that in hepatectomy group(P <0.05);the incidences of post-operational complications in the two groups(10.3% vs. 16.3%,P >0.05) were not statistically significantly different;the 1 a,2 a and 3 a overall survival(OS) rates in PRA-treated patients were 84.5%,65.5% and 44.8%,not significantly different as compared to 85.7%,67.3% and 46.9% in hepatectomy-treated patients(x^2=0.032,P=0.859;x^2=0.040,P=0.842;x^2=0.048,P=0.827);Cox univaritate analysis showed that tumor number(HR=0.372,95%CI:0.105-0.876,P=0.033) was related to the disease-free survival(DFS),while serum AFP level(HR=3.043,95%CI:1.007-5.248,P=0.035),tumor number(HR=0.871,95%CI:0.344-0.902,P=0.401) and tumor diameter(HR=1.631,95%CI:1.273-3.045,P=0.005) were related to the OS;Cox multivariate analysis showed that more than one tumor number(HR=0.087,95%CI:0.045-0.498,P =0.009) was the risk factor affecting the DFS,while lower tumor differentiation(HR =2.974,95% CI:1.865-4.097,P =0.046),multiple tumor(HR =0.062,95% CI:0.033-0.378,P =0.002) and large tumor diameter(HR=2.216,95%CI:1.778-5.026,P=0.007) were the risk factors affecting the OS of patients with HCC. Conclusions Ultrasound-guided percutaneous radiofrequency ablation and hepatectomy are efficient in treating patients with HCC,while the patients undergoing radiofrequency ablation might have little trauma,less liver injuries and recover rapidly.