经皮射频消融治疗复发性肝癌的疗效及预后因素分析

Analysis of curative effect and prognostic factors of percutaneous radiofrequency ablation for recurrent liver cancer

目的探究原发性肝癌术后复发行经皮射频消融(RFA)后的疗效、生存率及其影响因素。方法回顾性分析2012年6月至2016年6月郑州大学第一附属医院行手术切除的原发性肝癌术后复发的67例患者临床资料,采用统计软件SPSS 21.0分析,生存曲线采用Kaplan-Meier法绘制,组间比较采用LogRank检验,Cox风险比例模型进行预后因素分析。结果 67例术后复发的肝癌患者经皮RFA治疗后1、3、5年总体生存率分别为94%、62%、50%,1、3、5年无瘤总体生存率分别为56%、39%、26%。根据肝癌切除术后复发的肿瘤直径分为小肝癌组(≤3 cm,n=47)和中肝癌组(>3 cm且≤5 cm,n=20),小肝癌组及中肝癌组行经皮RFA治疗后1、3、5年生存率分别为98%、67%、54%及86%、55%、40%,小肝癌组的生存率明显高于中肝癌组(P=0.007)。通过Cox模型多因素分析,结果显示复发病灶直径、术后甲胎蛋白(AFP)水平是影响患者经皮RFA后生存时间的危险因素。结论经皮RFA治疗术后复发性肝癌疗效确切,能以较小的创伤达到治疗的目的,小肝癌及术后AFP低行RFA预后更好。

Objective To explore the efficacy, survival rate and influencing factors of percutaneous radiofrequency ablation (RFA) for recurrent hepatocellular carcinoma after surgical resection. Methods The clinical data of 67 patients with recurrent liver cancer in the First Affiliated Hospital of Zhengzhou University from Jun. 2012 to Jun. 2016 was retrospectively analyzed. Statistical software SPSS 21.0 was used. The survival curve was plotted by Kaplan-Meier analysis. Log-Rank test was used for inter-group comparison, Cox risk ratio model for prognostic factor analysis. Results After percutaneous RFA in 67 patients with recurrent liver cancer, the overall survival rates at 1-, 3- and 5- year were 56%, 39%, 26%, and the overall disease-free survival rates at 1-, 3- and 24 months were 58%, 33% and 7%, respectively. According to the tumor diameter recurrent after hepatectomy, patients were divided into small liver cancer group (≤3 cm, n=47) and medium liver cancer group (>3 cm and≤5 cm, n=20). After RFA, the 1-, 3- and 5- year survival rates in small liver cancer group and medium liver cancer group were 98%, 67%, 54% and 86%, 55%, 40%, respectively. The survival rates in small liver cancer group were significantly higher than those in medium liver cancer group (P<0.05). Multivariate analysis of Cox model showed that diameter of recurrent lesions and postoperative alpha fetoprotein (AFP) level were risk factors for survival after percutaneous RFA. Conclusion Percutaneous radiofrequency ablation is effective in the treatment of recurrent liver cancer, which can achieve the goal of treatment with less trauma. Patients with small liver cancer and low AFP level can obtain better prognosis.