微波消融治疗困难解剖部位肝细胞癌的安全性和疗效评价

Efficacy and safety of microwave ablation for hepatocellular carcinoma in difficult anatomical location

目的探讨临近膈肌、心脏、胃肠道、胆囊、肾脏、大血管困难解剖部位肝细胞癌微波消融(microwave ablation,MWA)的安全性和疗效。方法回顾性分析台州市中心医院2017年1月至2020年12月接受MWA治疗的早期原发性肝癌患者临床资料。根据病灶位置,其中28例(42个病灶)被纳入困难部位组,39例(57个病灶)为常规部位组,两组均行MWA。术后1个月行增强CT或MRI判断肿瘤完全消融率并定期随访。结果困难部位组完全消融率低于常规部位组[82.14%(23/28) vs 97.44%(38/39),P=0.031],术后1年肿瘤复发率高于常规部位组[35.00%(7/20) vs 7.14%(2/28),P=0.015]。困难部位组与常规部位组术后并发症发生率[7.14%(2/28) vs 7.69%(3/39),P=0.113]、肝功能一过性异常、术后谷丙转氨酶、总生存期[(22.13±14.13)个月 vs (23.29±17.27)个月,P=0.147]、无瘤生存期[(15.3±11.02)个月 vs (19.89±13.35)个月,P=0.790]、术后3年肿瘤复发率[85.71%(6/7) vs 42.86%(3/7),P=0.094]均无统计学差异(均P>0.05)。单因素分析显示肿瘤在困难部位与完全消融率以及术后1年肿瘤复发率相关,术后3年复发率则与肿瘤最大径相关。进一步二元Logistic回归分析显示肿瘤在困难部位并非肝癌不完全消融的独立危险因素,而是肝癌术后1年复发的独立危险因素。结论困难部位肝癌行微波消融治疗的肿瘤不完全消融率以及1年复发率虽然较与常规部位高,但结合术后补充治疗,不影响困难部位肝癌患者长期生存率,且并发症可控,个体化方案应用微波消融治疗位置困难的肝癌是安全可行并且有效的。

objective To investigate the safety and efficacy of microwave ablation(MWA) for hepatocellular carcinoma(HCC) difficult anatomical locations such as diaphragm, heart, gastrointestinal tract, gallbladder, kidney, and large vessels. Methods Clinical data of patients with early-stage primary liver cancer treated by MWA in Taizhou Central Hospital from Jan. 2017 to Dec. 2020 were retrospectively analyzed. According to the location of the lesions, 28 cases(42 lesions) were included in the difficult location group, and the remaining 39 cases(57 lesions) were included in the conventional location group, both groups received MWA. One month later, enhanced CT or MRI was performed to determine the complete ablation rate of the tumor and regular follow-up was implemented. Results The complete ablation rate in the difficult location group was lower than that in the conventional location group [82.14%(23/28) vs 97.44%(38/39), P=0.031], and the tumor recurrence rate within one year was higher than that in the conventional location group [35.00%(7/20) vs 7.14%(2/28), P=0.015]. There was no statistical differences between the two groups in terms of the incidence of complication rate [7.14%(2/28) vs 7.69%(3/39), P=0.113], transient abnormality of liver function occurred after operation, postoperative alanine transaminase(ALT), overall survival [(22.13±14.13)months vs(23.29±17.27)months, P=0.147], tumor-free survival [(15.3±11.02)months vs(19.89±13.35)months, P=0.790], or tumor recurrence rate within 3 years [85.71%(6/7) vs 42.86%(3/7), P=0.094]. Univariate analysis showed that the complete ablation rate of HCC and tumor recurrence rate within 1 year was related to whether the tumor was adjacent to the difficult location, while the recurrence rate 3 years within surgery was related to the tumor size(P=0.008). Further binary Logistic regression analysis showed that the difficult location was not an independent risk factor for complete ablation of HCC(P=0.061), but an independent risk factor for recurrence of HCC 1 year after surgery(P=0.019). Conclusion Compared with the conventional location, although the difficult location increases the incomplete ablation rate and recurrence rate within 1 year of HCC, but in addition with postoperative complementary therapy, the long-term survival rate is not affected, and the complications are controllable. Individualized microwave ablation therapy is safe, feasible and effective for the treatment of HCC with difficult location.