结直肠癌肝转移灶微波消融后的预后影响因素分析

Prognostic risk factors in patients with microwave ablation therapy for colorectal cancer liver metastasis

目的探讨微波消融(MWA)治疗结直肠癌肝转移灶后肝内复发和生存的相关危险因素。方法回顾性分析中山大学附属第六医院2013年1月至2015年12月行结直肠癌肝转移灶超声引导下微波消融治疗的60例患者的临床、病理及随访资料,对影响肝转移灶消融后肝内复发和总生存的危险因素进行Cox单因素和多因素回归分析。结果随访12.5~47.4个月,其中有26例发生肝内复发,其中6.1%(7/114)原消融灶出现局部肿瘤进展;11例出现肿瘤相关死亡。多因素Cox回归分析结果显示,年龄≥60岁和肝转移灶最大直径≥2 cm是患者术后发生肝内复发的独立危险因素;HBsAb阳性和消融后至肝内复发前有化疗是患者术后发生肝内复发的独立保护因素。多因素Cox回归分析结果显示,肝转移灶个数≥3个是影响患者总生存的独立危险因素。结论结直肠癌肝转移患者行肝转移灶微波消融治疗后,年龄≥60岁、HBsAb阴性和肝转移灶最大直径≥2 cm的患者更容易再发肝内转移,而消融后的积极化疗则可有效降低再发肝内转移,肝转移灶个数≥3个提示总体预后不良。

Objective To investigate the risk factors of intrahepatic recurrence and survival in patients with microwave ablation therapy for colorectal cancer liver metastasis. Methods Clinical, pathological and follow-up data of 60 patients with colorectal cancer liver metastasis undergoing microwave ablation therapy at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2013 and December 2015 were retrospectively analyzed. Cox regression analysis was used to evaluate the risk factors of intrahepatic recurrence and total survival in patients with microwave ablation therapy for colorectal cancer liver metastasis. Results The follow-up duration ranged from 12.5 to 47.4 months. During the follow-up period, 26 patients had intrahepatic recurrence, of which 6.1%(7/114) had local tumor progression in the original ablation site. Multivariate Cox regression analysis showed that the age of 60 years or above and the maximum diameter of liver metastases of 2 cm or above were independent risk factors for postoperative intrahepatic recurrence. HBsAb-positive and chemotherapy between microwave ablation and intrahepatic recurrence were independent protective factors for postoperative intrahepatic recurrence. Multivariate Cox regression analysis showed that 3 liver metastases or more was an independent risk factor affecting the total survival. Conclusion After microwave ablation for patients with colorectal cancer liver metastases, patients with the age of 60 years or above, HBsAb negative and the maximum diameter of liver metastases of 2 cm or more were more likely to have recurrent intrahepatic metastases, but aggressive chemotherapy after ablation could effectively reduce the recurrence of intrahepatic metastases. The number of 3 liver metastases or more suggested poor overall prognosis.