超声引导下微波消融治疗肝细胞肝癌的短期预后及影响因素分析

Short-term prognosis of hepatocellular carcinoma patients treated with ultrasound-guided microwave ablation and its influencing factors

目的探讨超声引导下肝细胞肝癌微波消融术后短期预后情况及其危险因素。方法回顾性分析2017年1月1日至2018年6月30日在我院接受微波消融治疗的410例肝细胞肝癌患者资料。采用Kaplan-Meier法估算局部肿瘤进展率、肝内远处复发率、无复发生存率和总生存率,采用log-rank检验分析无复发生存的影响因素,采用Cox比例风险回归模型分析无复发生存和局部肿瘤进展的影响因素,并采用二分类多因素logistic多因素回归分析早期复发(术后2年内)的危险因素。结果微波消融术后1、2、3年总生存率分别为96.8%、88.3%、75.4%,1、2、3年无复发生存率分别为71.1%、59.2%、53.7%,0.5、1、2、3年局部肿瘤进展率分别为4.6%、11.9%、13.9%、14.4%,1、2、3年肝内远处复发率分别为19.7%、30.4%、34.9%。log-rank单因素分析显示,是否合并糖尿病、HBV-DNA指数、肿瘤数量、肿瘤大小、肿瘤位置及是否符合米兰标准是肝细胞肝癌患者微波消融术后无复发生存的影响因素(P均<0.05);多因素Cox比例风险回归分析显示,合并糖尿病(HR=1.757,95%CI 1.156~2.670,P=0.008)、多发肿瘤(HR=1.763,95%CI 1.231~2.525,P=0.002)、肿瘤最大径≤3 cm(HR=0.619,95%CI 0.441~0.838,P=0.005)和特殊位置肿瘤(HR=1.567,95%CI 1.084~2.256,P=0.017)是影响患者无复发生存的独立因素。二分类多因素logistic回归分析显示,合并糖尿病(OR=2.165,95%CI 1.071~4.376,P=0.032)、肿瘤位置(OR=2.033,95%CI 1.144~3.613,P=0.016)、肿瘤最大径≤3 cm(OR=0.530,95%CI 0.299~0.940,P=0.030)是肝细胞肝癌患者微波消融术后早期复发的影响因素。结论微波消融治疗肝细胞肝癌患者的短期预后良好,合并糖尿病、肿瘤位置、肿瘤大小是微波消融术后早期复发的危险因素。

Objective To investigate the short-term prognosis of hepatocellular carcinoma(HCC)patients treated with ultrasound-guided microwave ablation and its influencing factors.Methods The clinical data of 410 HCC patients who underwent microwave ablation in our hospital from Jan.1,2017 to Jun.30,2018 were analyzed retrospectively.The rates of local tumor progression(LTP),intrahepatic distant recurrence(IDR),recurrence-free survival(RFS)and overall survival(OS)were estimated by Kaplan-Meier test.The influencing factors of RFS were analyzed by log-rank test.The influencing factors of RFS and LTP were analyzed by Cox proportional hazard regression model.The risk factors of early recurrence(within 2 years after operation)were analyzed by binary multivariate logistic regression.Results The 1-,2-and 3-year OS rates were 96.8%,88.3%and 75.4%,respectively.The 1-,2-and 3-year RFS rates were 71.1%,59.2%and 53.7%,respectively.The 0.5-,1-,2-and 3-year LTP rates were 4.6%,11.9%,13.9%and 14.4%,respectively.The 1-,2-and 3-year IDR rates were 19.7%,30.4%and 34.9%,respectively.Log-rank univariate analysis showed that diabetes mellitus(DM),hepatitis B virus(HBV)-DNA index,tumor number,tumor size,tumor location and whether meeting Milan criteria or not were influencing factors of RFS in HCC patients after microwave ablation(all P<0.05).Multivariate Cox proportional hazard regression analysis showed that DM(hazard ratio[HR]=1.757,95%confidence interval[CI]1.156-2.670,P=0.008),multiple tumors(HR=1.763,95%CI 1.231-2.525,P=0.002),tumor maximum diameter≤3 cm(HR=0.619,95%CI 0.441-0.838,P=0.005),and unfavorable tumor location(HR=1.567,95%CI 1.084-2.256,P=0.017)were independent influencing factors of RFS.Binary multivariate logistic regression analysis showed that DM(odds ratio[OR]=2.165,95%CI 1.071-4.376,P=0.032),tumor location(OR=2.033,95%CI 1.144-3.613,P=0.016),and tumor maximum diameter≤3 cm(OR=0.530,95%CI 0.299-0.940,P=0.030)were influencing factors for early recurrence of HCC after microwave ablation.Conclusion HCC patients have good short-term prognosis after microwave ablation,and DM,tumor location and tumor size are risk factors of early recurrence.