超声引导下微波消融治疗肝细胞癌术后肿瘤复发及其危险因素分析

Analysis of tumor recurrence and its risk factors after ultrasound-guided microwave ablation for hepatocellular carcinoma

目的探讨微波消融治疗早期肝细胞癌(hepatocellular carcinoma,HCC)患者术后肿瘤复发率及其危险因素。方法收集2016年1月至2018年1月海军军医大学第三附属医院762例接受微波消融治疗HCC患者的临床、治疗和预后资料。分析治疗后肝内无进展生存率(progression free survival,PFS)包括:肿瘤局部进展率(local tumor progression,LTP)和肝内远处转移率(intrahepatic distant recurrence,IDR)。同时分析各类型肝内复发的风险因素。结果762例HCC患者中,716例(94.0%)达到完全消融,经补充治疗技术成功率达98.1%(748/762)。9例(1.2%)患者发生严重并发症,未发生治疗相关死亡。至随访结束,肝内PFS为52.9%,其中LTP和IDR分别13.4%和40.7%。高HBV DNA、多发肿瘤、肿瘤直径>3 cm和不完全消融是肝内PFS的独立风险因素;不完全消融和肿瘤直径>3 cm是LTP的风险因素;高HBV DNA、多发肿瘤、术前血GGT>50 U/L和不完全消融是影响IDR的风险因素。结论微波消融是治疗早期HCC安全有效的方法,但术后的肝内复发率较高。肿瘤大小、数量以及是否完全消融是治疗后肝内复发的独立危险因素。

Objective To discuss the intrahepatic tumor recurrence rate in patients with early hepatocellular carcinoma(HCC)after microwave ablation(MWA)treatment,and to analyze its risk factors.Methods The clinical,therapeutic and prognostic data of a total of 762 patients with HCC,who were admitted to the Oriental Hepatobiliary Hospital of Naval Military Medical University of China between January2016 and January 2018 to receive MWA treatment,were retrospectively analyzed.The postoperative intrahepatic progression-free survival(PFS)rates,including local tumor progression(LTP)rate and intrahepatic distant recurrence(IDR)rate,were calculated.The risk factors for each type of intrahepatic recurrence were analyzed.Results Of the 762 patients,complete ablation was obtained in 716(94.0%),and the success rate,when additional supplementary therapeutic technique was adopted,was 98.1%(748/762).Nine patients(1.2%)developed serious complications and no treatment-related death occurred.By the end of the follow-up,the intrahepatic PFS was 52.9%,with 13.4%and 40.7%for LTP and IDR respectively.High HBV index,multiple tumor lesions,tumor diameter>3 cm,and incomplete ablation were the independent risk factors for intrahepatic PFS.Incomplete ablation and tumor diameter>3 cm were the risk factors for LTP.High HBV index,multiple tumor lesions,preoperative blood GGT>50 U/L and incomplete ablation were the risk factors for IDR.Conclusion MWA is a safe and effective method for the treatment of early HCC,although its postoperative intrahepatic recurrence rate is high.The tumor size,the number of tumor lesions,and the complete degree of ablation are the independent risk factors for intrahepatic recurrence after MWA treatment.(J Intervent Radiol,2022,31:1174-1178)