超声造影辅助射频消融治疗结直肠癌肝转移术后短期复发及相关危险因素的单中心回顾性研究

A single-center retrospective study of short-term recurrence risk factors after ultrasonography-guided radiofrequency ablation for colorectal liver metastasis

目的分析超声造影辅助射频消融治疗结直肠癌肝转移(CRLM)的应用价值及术后短期复发危险因素。方法收集2019年10月至2022年4月北京医院肝胆胰外科收治的CRLM行射频消融治疗的患者资料,对比完全消融组及不完全消融组术中超声造影情况、病灶大小及位置。对影响患者术后复发因素进行多元Logistic回归,并对不同病灶数患者进行Kaplan-Meier生存分析,以截断值为分界将患者进行分组比较。结果共纳入53例患者,总计消融病灶147个。36例(68%)术中行肝脏超声造影,完全消融病灶137个(93.2%)。完全消融组术中行超声造影比例较高(77%∶40%,P=0.009)。多元Logistic回归显示肝转移病灶数多的患者复发风险较高(OR=2.224,95%CI为1.012~4.886,P=0.047)。Kaplan-Meier生存分析显示术中超声造影组中位无瘤生存时间较未行超声造影组长3.9个月(10.8个月∶6.9个月,P=0.399)。按病灶数分组比较中位无瘤生存时间,≤3个组为13.3(10.1~16.5)个月、4~8个组为9.5(4.3~14.8)个月、≥9个组为4.9(1.8~7.9)个月(P=0.010)。结论病灶数是影响CRLM患者射频消融后无瘤生存时间的主要因素,术中超声造影可使患者得到更长的无瘤生存时间。

ObjectiveTo analyze the value of ultrasonography-guided radiofrequency ablation in the treatment of colorectal liver metastasis(CRLM)and the short-term recurrence risk factors.MethodsThe data of consecutive CRLM patients who underwent ultrasound-guided radiofrequency ablation were collected from October 2019 to April 2022 in Beijing Hospital.The distribution of lesions was calculated.We compared the intraoperative ultrasonography,lesion size,and location between the complete ablation group and the incomplete ablation group.Based on patient data,multivariate logistic regression was performed to determine the factors affecting postoperative recurrence,and Kaplan-Meier survival analysis was performed on patients with different numbers of lesions.ResultsA total of 53 patients,and 147 lesions were included.36 patients(68%)had intraoperative ultrasonography and the rate of complete radiofrequency ablation was 93.2%(10/147).The percentage of intraoperative ultrasonography was higher than the incomplete ablation group(77%vs 40%,P=0.009).Multiple logistic regression showed that patients who had a large number of liver metastases had a higher risk of recurrence(OR=2.224,95%CI=1.012-4.886,P=0.047).Kaplan-Meier survival analysis showed that the median disease free survival time was 3.9 months longer than the group without ultrasonography(10.8 months vs 6.9 months,P=0.399).Compared to the median disease free survival time of the different number of lesions,13.3(10.1-16.5)months for≤3 groups,9.5(4.3-14.8)months for 4-8 groups,4.9(1.8-7.9)months for≥9 groups,which had significant differences(P=0.010).ConclusionThe number of lesions was a major risk factor affecting disease free survival time after radiofrequency ablation in patients with colorectal liver metastasis,and intraoperative ultrasonography patients may receive longer disease free survival time.