射波刀与射频消融治疗小肝癌的近期效果比较

Short-term clinical effect of cyberknife versus radiofrequency ablation in treatment of small hepatocellular carcinoma

目的比较射波刀与射频消融治疗小肝癌的疗效及安全性。方法选取2017年10月-2018年3月解放军总医院第五医学中心收治的初治小肝癌患者80例,其中35例患者接受射波刀治疗,共41个靶病灶;45例患者接受射频消融治疗,共47个靶病灶。观察两组患者的客观有效率(完全缓解+部分缓解)、1年总生存率、1年局部控制率以及术后不良反应的发生率。计数资料2组间比较采用χ^2检验或连续校正χ^2检验。生存分析采用Kaplan-Meier法计算局部控制率,并应用log-rank法检验。结果研究共随访6.0~17.7个月,中位随访时间13.5个月,其中2例(2.5%)患者失访,每组各1例。射波刀组31个病灶(75.6%)完全缓解,4个病灶(9.8%)部分缓解,4个病灶(9.8%)稳定,2个病灶(4.9%)进展,客观有效率为85.4%,1年总生存率为100%,1年局部控制率为94.3%;射频消融组38个病灶(80.9%)完全缓解,9个病灶(19.1%)进展,客观有效率为80.9%,1年总生存率为100%,1年局部控制率为91.0%。2组客观有效率和局部控制率比较,差异均无统计学意义(P值均> 0.05)。2种治疗方式术后不良反应多为1~2级,均未出现严重不良事件。结论射波刀治疗小肝癌的安全性及有效性与射频消融治疗相当,是小肝癌治疗的备选方案之一。

Objective To investigate the clinical effect and safety of cyberknife versus radiofrequency ablation in the treatment of small hepatocellular carcinoma.Methods A total of 80 previously untreated patients with small hepatocellular carcinoma who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from October 2017 to March 2018 were enrolled.Among these patients,35 patients with 41 target lesions received cyberknife,and 45 patients with 47 target lesions received radiofrequency ablation.The two groups were compared in terms of objective response rate( complete remission + partial remission),1-year overall survival rate,1-year local control rate,and incidence rate of postoperative adverse events.The chi-square test or the continuous calibration chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to calculate local control rate,and the log-rank test was used for survival analysis.Results The patients were followed up for 6.0-17.7 months,with a median follow-up time of 13.5 months.Two patients( 2.5%) were lost to follow-up,with one patient from each group.In the cyberknife group,there were 31 lesions with complete remission( 75.6%),4 lesions with partial remission( 9.8%),4 lesions with a stable state( 9.8%),and 2 lesions with progression( 4.8%),with an objective response rate of 85.4%,a 1-year overall survival rate of 100%,and a 1-year local control rate of 94.3%.In the radiofrequency ablation group,there were 38 lesions with complete remission( 80.9%) and 9 lesions with progression( 19.1%),with an objective response rate of 80.9%,a 1-year overall survival rate of 100%,and a 1-year local control rate of 91.0%.There were no significant differences in objective response rate and local control rate between the two groups( both P>0.05).Most postoperative adverse events were mild( grade 1-2),and no serious adverse events were observed.Conclusion Cyberknife is as safe and effective as radiofrequency ablation in the treatment of small hepatocellular carcinoma and is one of the options for the treatment of small hepatocellular carcinoma.