对比经皮微波消融与手术切除治疗合并肝硬化的单发小肝癌疗效分析

Comparison of the Therapeutic Outcomes Between Surgical Resection and Percutaneous Microwave Coagulation therapy for Single Small Hepatocellular Carcinoma with Cirrhosis

目的比较经皮微波消融(Percutaneous Microwave Coagulation Therapy,PMCT)和手术切除(Surgical Resection,SR)治疗原发性单个小肝癌(最大径≤3cm)合并肝硬化患者的生存预后。方法回顾性收集2004年6月~2013年7月在我院肝脏外科中心接受治疗的单个小肝癌患者共250例,其中SR组152例,PMCT组98例,比较两组患者的近远期治疗疗效。采用Cox模型分析影响预后的危险因素。结果两组平均随访40.6个月(9~96个月),SR与PMCT组1、3、5年无瘤生存率分别为94.7%、68.0%、42.7%和88.8%、60.0%、37.1%(P=0.076),1、3、5年总体生存率分别为98.7%、94.2%、60.1%与96.9%、88.3%、59.0%(P=0.211)。单因素及多因素分析结果显示高胆红素是影响肝癌外科治疗后的独立危险因素,而治疗方式的不同不是其预后危险因素。结论对于单个原发性小肝癌合并肝硬化患者,PMCT治疗安全、有效,能取得与SR相当的近期、远期疗效,操作方便、费用低廉,临床可考虑作为小肝癌合并肝硬化患者的首选治疗手段之一。

Objective To compare the therapeutic outcomes between percutaneous microwave coagulation therapy( PMCT)and surgical resection( SR) in patients with single small hepatocellular carcinoma( HCC) and cirrhosis. Methods This retrospective study involved 250 Child-Pugh A cirrhotic patients( 122 in the LR group and 68 in the MCT group) observed in our hepatic surgery center from June 2004 to July 2013. Overall survival( OS) and recurrence-free survival( RFS) were analyzed using the Kaplan Meier methods. Cox regression models were used to identify factors associated with overall survival and tumor recurrence. Results The median follow-up time was 40. 6 months( 9 ~ 96 months). The 1-,3-,and 5- year DFS rates for LR group and MCT group were94. 7% 、68. 0% 、42. 7% and 88. 8% 、60. 0% 、37. 1%, respectively. The corresponding 1-,3-, and 5- year OS rates were98. 7% 、94. 2% 、60. 1% and 96. 9% 、88. 3% 、59. 0%,respectively. There were no significant difference in OS and DFS rates between the two groups( P = 0. 076 and P = 0. 211). Univariate and Multivariate analysis showed that only high total bilirubin was a significant predictive factor for therapeutic outcomes,but not surgical modality. Conclusion PMCT yielded similar OS and DFS but more safety,convenient,effective and lower cost when compared to SR for cirrhotic patients with single small HCC. PMCT can be used as the first-line treatment method for patients with single small HCC and cirrhosis.