超声引导与CT引导射频消融治疗肝细胞癌患者疗效及预后比较

Comparison of efficacy and prognosis of ultrasound-guided and CT-guided radiofrequency ablation in the treatment of patients with hepatocellular carcinoma

目的探讨超声引导射频消融(RFA)和CT引导RFA对肝细胞癌患者血甲胎蛋白(AFP)、转铁蛋白(TRF)水平及预后生存的影响。方法选取2015年9月至2019年9月在玉林市红十字会医院行RFA的89例肝细胞癌患者为研究对象,其中以超声引导RFA的45例患者记为超声组,以CT引导RFA的44例患者记为CT组,记录两组治疗围手术期资料,并检测患者AFP及TRF水平,定期随访36个月,采用Kaplan-Meier法绘制生存曲线,比较两组预后。结果CT组完全消融率高于超声组、消融次数多于超声组、消融时间长于超声组,差异均有统计学意义(P<0.05)。术后超声组复发率和局部复发率分别为31.1%、20.0%,显著高于CT组的13.6%、4.6%,差异均有统计学意义(P<0.05)。术后两组肝细胞癌患者AFP、TRF水平均降低,CT组较超声组更低,差异均有统计学意义(P<0.05)。CT组术后3年无进展生存率为84.1%(37/44),显著高于超声组的46.7%(21/45),差异有统计学意义(P<0.05)。结论CT引导RFA治疗肝细胞癌效果较为显著,生存率较高,可能与降低患者AFP及TRF水平相关。

Objective To explore the effects of ultrasound-guided and CT-guided radiofrequency ablation(RFA)on serum alpha-fetoprotein(AFP),transferrin(TRF)and prognosis in patients with hepatocellular carcinoma.Methods A total of 89 patients with hepatocellular carcinoma undergoing RFA in Yulin Red Cross Hospital were enrolled as the research objects between September 2015 and September 2019,including 45 cases undergoing ultrasound-guided RFA in ultrasound group and 44 cases undergoing CT-guided RFA in CT group.The perioperative data in the two groups were recorded.AFP and TRF levels were detected.All patients were followed up regularly for 36 months.The survival curves were drawn by Kaplan-Meier method to compare prognosis in the two groups.Results The complete ablation rate in CT group was higher than that in ultrasound group,ablation frequency was higher than that in ultrasound group,and ablation time was longer than that in ultrasound group,with statistically significant differences(P<0.05).After surgery,recurrence rate and local recurrence rate in ultrasound group were 31.1%and 20.0%,significantly higher than those in CT group(13.6%,4.6%),with statistically significant differences(P<0.05).After surgery,the levels of AFP and TRF in both groups were decreased,which were lower in CT group than ultrasound group,with statistically significant differences(P<0.05).At 3 years after surgery,progression-free survival rate in CT group was significantly higher than that in ultrasound group[84.1%(37/44)vs.46.7%(21/45)],with a statistically significant difference(P<0.05).Conclusion Curative effect of CT-guided RFA is significant on hepatocellular carcinoma,which can increase survival rate.The mechanism may be significantly related to reducing AFP and TRF levels.