超声引导下经皮微波消融与冷冻消融治疗高风险部位肝癌的对照研究

Ultrasound-guided percutaneous microwave ablation versus cryoablation for treatment of hepatocellular carcinoma on the high-risk location

目的:比较超声引导下经皮微波消融与冷冻消融治疗高风险部位肝癌的临床结局及术后并发症,并分析影响预后和术后复发的因素。方法:选取2014年4月至2018年3月广州复大肿瘤医院收治的120例高风险部位肝癌患者,其中64例接受微波消融治疗(微波组),56例接受冷冻消融治疗(冷冻组)。比较两组的治疗结局,主要包括生存、复发及术后并发症。用Cox回归模型分析预后和术后复发的影响因素。结果:微波消融组1、3、5年总生存率分别为85.8%、63.5%、63.5%,冷冻消融组为92.0%、87.4%、74.9%,两组差异无统计学意义(P=0.141)。微波消融组1、3、5年无复发生存率分别为77.8%、49.0%、49.0%,冷冻消融组分别为81.4%、58.5%、46.8%,两组差异无统计学意义(P=0.469)。微波消融组的3、6、9、12个月的局部进展率分别为3.1%、6.3%、9.4%、15.9%,高于冷冻消融组(分别为0%、0%、3.7%、19.0%),差异有统计学意义(P=0.003)。微波组的主要和次要并发症发生率(分别为6.3%、82.8%)均高于冷冻组(分别为0%、32.1%),差异有统计学意义。年龄≥65岁,直径3~5 cm及Child-Pugh分级B级是肝癌术后预后较差的危险因素;直径3~5 cm、多个肿瘤以及多次消融是消融术后复发的危险因素。结论:冷冻消融治疗高风险部位的肝癌具有与微波消融接近的生存结局,但具有更好的局部肿瘤控制率及更少的并发症,适合在临床中推广应用。

Objective:The aims of this study were to compare the clinical outcomes between ultrasoundguided percutaneous microwave ablation(MWA)and cryoablation(CRA)in patients with hepatocellular carcinoma(HCC)on the high-risk location and to identify the prognostic factors associated with the two treatment methods.Methods:Retrospective study on 120 patients(88 men and 32 women)with one hundred and thirty-four HCCs on the high-risk location in our hospital from April 2014 to March 2018 were reviewed.Sixty-four patients underwent MWA and 56 patients underwent CRA.The treatment outcomes between the two groups were compared,including survival,recurrence,and postoperative complications.,Cox regression models were used to analyze the influencing factors of prognosis and postoperative recurrence.Effect of changes in key parameters[overall survival(OS),recurrence-free survival(RFS)and local tumor progression(LTP)]was statistically analyzed with the log-rank test.Univariate and multivariate analysis were performed on clinicopathological variables to identify factors affecting intermediate-term outcome.Results:The cumulative OS rates at 1,3,and 5-years were 85.8%,63.5%and 63.5%,respectively,in MWA group,and 92.0%,87.4%and 74.9%,respectively,in CRA group.There were no significant statistical difference(P=0.141).The cumulative RFS rates at 1,3,and 5-years were 77.8%,49.0%,49.0%,respectively,in MWA group,and 81.4%,58.5%,46.8%,respectively,in CRA group.There were no significant statistical difference(P=0.469).The LTP rates at 3,6,9,12 month were 3.1%,6.3%,9.4%,15.9%,respectively in MWA group,which were higher than those in CRA group(0%,0%,3.7%,and 19.0%,respectively)with statistically significant differences(P=0.003).The major and minor complications in MWA group(6.3%,82.8%,respectively)were higher than those in CRA goup(0%,32.1%,respectively)with statistically significant differences.Univariate analysis showed that age(P=0.007),tumor size(P=0.001),and CTP grade(P=0.003)were risk factors for OS,and multivariate analysis results showed that age≥65 years,3.0-5.0 cm in size and CTP grade B were independently associated with poor OS.3~5 cm in diameter,multiple tumors and multiple ablation are risk factors for recurrence after ablation.Conclusions:CRA had comparable oncologic outcomes with MWA and could be a safe and effective treatment for HCC on the high-risk location.