多中心射频消融治疗肝细胞癌患者远期生存影响因素分析

The risk factors for long-term survival after radiofrequency ablation for hepatocellular carcinoma: a multi-center study

目的探讨以射频消融为主要手段治疗肝细胞癌获得远期生存的影响因素。方法回顾性分析2004年5月1日至2015年2月28日,首都医科大学附属北京朝阳医院西院、辽宁省朝阳市中心医院及山东省滨州市第二人民医院,以射频消融为主要手段治疗的255例肝细胞癌患者的临床资料。按术后生存期将患者分为生存5年及以上组和5年以下组,比较两组年龄、肿瘤最大径及数目、射频消融次数等临床指标,采用Cox单因素及多因素分析远期生存的影响因素。结果 255例肝细胞癌的总生存期为0.5~15.5年,中位总生存期为4.3年;生存5年及以上患者115例(45.1%);5年以下140例(54.9%)。全组1、3、5年和10年生存率分别为86.7%、61.2%、44.8%和34.8%。两组在性别、年龄、伴随症状、肝病原因、甲胎蛋白、治疗方式方面的差异无统计学意义(均P>0.05),在Child-Pugh分级、合并肝硬化、肿瘤分期、肿瘤大小、数量和射频消融次数方面的差异均有统计学意义(均P<0.05)。多因素分析显示,年龄≥70岁、Child-Pugh B级、肿瘤最大径>5.0 cm、肿瘤多发是影响远期生存的独立危险因素。射频消融5次以上是影响远期生存的保护因素。结论对于中等体积肝细胞癌和孤立性巨大肝细胞癌,以射频消融为主要手段的综合序贯治疗也可获得满意的疗效;年龄、Child-Pugh分级、肿瘤大小及数量、射频消融次数是影响肝细胞癌患者远期生存的影响因素。

Objective To explore the influencing factors of long-term survival for hepatocellular carcinoma(HCC)treated by radiofrequency ablation(RFA).Methods A retrospective analysis of 255 patients who underwent RFA as the main treatment modality for HCC from May 1,2004 to Feb 28,2015 was performed.All patients were divided into two groups according to the postoperative survival time:the 5-year or more survival group and the less than 5-year survival group.Clinical indicators such as age,maximum tumor size and number,and frequency of radiofrequency ablation were compared between the two groups.Cox single factor and multiple factors were used to analyze the influencing factors of long-term survival.Results The median overall survival of all the 255 patients was 4.3 years(range 0.5-15.5 years).There were 115 patients(45.1%)who survived for 5 years or more and 140 patients(54.9%)who survived for less than 5 years.The 1-,3-,5-,and 10-year survival rates of all the patients were 86.7%,61.2%,44.8%and 34.8%,respectively.There were no significant differences in gender,age,accompanying symptoms,aetiology of liver disease,level of alpha fetoprotein and treatment(P>0.05),but there were significant differences in Child-Pugh class,liver cirrhosis,maximum diameter of tumor,tumor number,tumor stage,and frequency of RFA(P<0.05)between the 2 groups of patients.Multivariate analysis showed that age≥70 years old,Child-Pugh class B,maximum diameter of tumor>5.0 cm,multiple tumor were independent risk factors of long-term survival,but the number of sessions of RFA was a protective factor.Conclusions For medium sized HCC and solitary large HCC,RFA combined with other therapeutic modalities could achieve satisfactory therapeutic results.Age,Child-Pugh class,maximum diameter of tumor,tumor number and RFA frequency were influencing factors for long-term survival of HCC patients.