结直肠癌肝转移超声引导下经皮微波消融与手术切除疗效的对比分析

Comparative study of ultrasound-guided percutaneous microwave ablation and surgical resection for colorectal cancer with liver metastasis

目的比较超声引导下经皮微波消融和手术切除治疗结直肠癌肝转移的临床疗效。方法回顾性分析2012年1月至2017年6月华中科技大学同济医学院附属同济医院结直肠癌肝转移患者184例,肝转移灶选择超声引导下经皮微波消融或手术切除治疗,根据肝转移灶的治疗方式进行亚组分析,其中单纯微波组98例[男56例、女42例,年龄(59±11)岁],单纯手术组86例[男56例、女30例,年龄(56±11)岁],对两组病例基线资料进行比较,单纯微波组的转移灶病灶大小<单纯手术组,余数据差异均无统计学意义。分别分析两组患者的生存时间。根据转移灶大小,将转移灶分为直径<3 cm组和≥3 cm组,分别分析病灶直径<3 cm和≥3 cm中单纯微波组与单纯手术组患者的生存时间。根据不同结直肠癌原发灶等级分析单纯微波组与单纯手术组患者的生存时间。结果单纯微波消融组的1、3、5年总体生存率分别为100%、50.9%、20.9%;单纯手术组的1、3、5年总体生存率分别为100%、42.8%、20.8%,两组总体生存率差异无统计学意义(P=0.972)。转移灶直径≥3 cm,单纯微波消融组的1、3、5年总体生存率为100%、65.4%、12.1%;单纯手术组的1、3、5年总体生存率为100%、59.5%、30.9%,两组总体生存率差异无统计学意义(P=0.067)。单纯手术组长期生存率>单纯微波组(P=0.018)。转移灶直径<3 cm,单纯手术组与单纯微波组总体生存率差异无统计学意义(P=0.103)。在结直肠癌原发灶Duck B、C期肝转移灶治疗中,单纯微波与单纯手术治疗总体生存率差异无统计学意义(P值分别为0.376和0.385)。多因素分析显示结直肠癌转移灶大小是影响结直肠癌肝转移患者预后的独立危险因素。结论超声引导下经皮微波消融对结直肠癌肝转移灶效果好,且与手术治疗有着相似的生存预后。但对于直径≥3 cm结直肠癌肝转移灶,手术治疗远期效果优于超声引导下经皮微波消融。

Objective To study the clinical efficacy of ultrasound-guided percutaneous microwave ablation and surgical resection for liver metastases from colorectal cancer.Methods Retrospective analysis of 184 patients with liver metastases from colorectal cancer in Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2012 to June 2017.Percutaneous microwave ablation or surgical resection for liver metastases were selected under ultrasound guidance.Subgroup analysis was performed according to the treatment of liver metastases.There were 98 patients in the microwave-only group(56 males and 42 females,aged(59±11)years)and 86 cases in the surgery-only group(56 males and 30 females,aged(56±11)years).The baseline data of the two groups were compared,and the results showed that the size of the metastatic lesions in the microwave-only group was smaller than that in the surgery-only group,and the remaining data didn′t had statistical differences.The survival time of the two groups of patients was analyzed separately.According to the size of the metastases,the metastases were divided into groups with a diameter of<3 cm and a group of≥3 cm.The survival time of patients in the microwave-only group and the surgery-only group were analyzed respectively.According to the different primary tumor grades of colorectal cancer,the survival time of patients in the simple microwave-only group and the surgery-only group in the primary tumors Duck A,Duck B,and Duck C were analyzed.Results In the microwave-only group,the overall survival rates at 1,3,and 5 years were 100%,50.9%,and 20.9%;in the surgery-only group,the overall survival rates at 1,3,and 5 years were 100%,42.8%,and 20.8%,respectively.There was no significant difference in overall survival between the groups(P=0.972).Metastatic focus diameter≥3 cm:the overall survival rates of 1,3,and 5 years with microwave-only were 100%,65.4%,and 12.1%;the overall survival rates of 1,3,and 5 years with surgery-only were 100%,59.5%,and 30.9%.There was no significant difference in overall survival between the groups(P=0.067).The long-term survival rate of the surgery-only group was greater than that of the microwave-only group(P=0.018).Metastasis diameter<3 cm:there was no significant difference in overall survival between the surgery-only group and the microwave-only group(P=0.103).In the treatment of Duck B and C liver metastases of primary colorectal cancer,there was no significant difference in overall survival between microwave alone and surgery alone(P=0.376,P=0.385).Multivariate analysis showed that the size of colorectal cancer metastases was an independent risk factor affecting the prognosis of patients with colorectal cancer liver metastases.Conclusions Percutaneous microwave ablation has a good effect on colorectal cancer liver metastases and has a similar survival prognosis as surgery.For livers with color≥3 cm in colorectal cancer,the long-term survival rate of the surgery-only group is greater than that of the microwave-only group.