超声引导下肝恶性肿瘤微波消融术后临床疗效及影响因素分析

Analysis of the clinical effect and influencing factors of ultrasound-guided microwave ablation of liver malignant tumor

目的探讨肝恶性肿瘤微波消融(MWA)术后临床疗效及患者基本情况、肿瘤特征及消融变量等因素对临床疗效的影响。方法回顾性分析119例患者192个病灶接受肝肿瘤MWA治疗的肝细胞肝癌患者65例(98个病灶)与结肠癌肝转移患者54例(94个病灶),超声引导下经皮消融治疗后定期随访,记录患者基本情况、肿瘤特征、消融参数、术后并发症与肿瘤进展情况,计算一、二、三年生存率,并分析影响患者肿瘤进展的相关因素。结果初次治疗后完全消融率达90.6%,二次治疗后完全消融率达96.9%。MWA术后一、二、三年累计生存率分别为96.9%、75.5%、68.6%,无进展生存率分别为87.2%、71.5%、51.3%。单因素分析表明肝病背景(P=0.041)、病理类型(P=0.007)、肿瘤直径(P<0.001)、肿瘤形态(P<0.001)、肿瘤位置(P=0.001)、消融次数(P<0.001)、恒定功率(P=0.028)、消融坏死区长度(P<0.001)、消融坏死区宽度(P<0.001)、发生并发症(P<0.001)和肿瘤治疗后早期进展存在正相关关系。Cox回归多元分析显示病理类型(HR=0.352,P=0.018)、肿瘤直径(HR=3.483,P<0.001)、肿瘤位置(HR=0.383,P=0.005)和发生并发症(HR=4.596,P<0.001)是导致肝恶性肿瘤消融术后肿瘤进展的独立风险因素。结论MWA术后肿瘤进展与患者基本信息、肿瘤特征及消融变量等多种因素相关。肿瘤特征(病理、直径、位置及消融后并发症的发生)是主要的风险因素。

Objective To investigate the clinical efficacy of microwave ablation(MWA)for malignant liver tumors and the influence of the basic information of patients,tumor characteristics and ablation variables on the clinical efficacy.Methods A retrospective analysis was conducted of 119 patients with 192 lesions.65 patients with hepatocellular carcinoma(98 lesions)and 54 patients with colon cancer liver metastasis(94 lesions)received MWA of liver tumors.Regular follow-up was conducted after ultrasound-guided percutaneous ablation,and basic information,tumor characteristics,ablation parameters,postoperative complications and tumor progression were recorded.The 1-year,2-year,and 3-year survival rates were calculated,and related factors affecting tumor progression analyzed.Results The rate of complete ablation was 90.6% after the first treatment and 96.9% after the second treatment.The 1-year,2-year and 3-year cumulative overall survival rates were 96.9%,75.5% and 68.6%,respectively,and progression-free survival rates were 87.2%,71.5% and 51.3%,respectively.Univariate analysis showed liver disease background(P=0.041),pathological type(P=0.007),tumor diameter(P<0.001),tumor morphology(P<0.001),tumor location(P=0.001),ablation frequency(P<0.001),constant power(P=0.028),and ablation necrotic area length(P<0.001)and width(P<0.001)and the occurrence of complications(P<0.001)were positively correlated with early progression of tumor after treatment.Cox regression multivariate analysis showed pathological type(HR=0.352,P=0.018),tumor diameter(HR=3.483,P<0.001),tumor location(HR=0.383,P=0.005)and complications(HR=4.596,P<0.001)were independent risk factors for tumor progression after liver tumor ablation.Conclusion Tumor progression after MWA is related to the basic information of patients,tumor characteristics,ablation variables and other factors.Tumor characteristics such as pathology,diameter,location,and the occurrence of postablation complications are major risk factors.