射频消融治疗中等肝细胞癌5年预后及影响因素分析

Radiofrequency ablation for the treatment of medium-sized hepatocellular carcinomas:analysis of 5-year prognosis and influencing factors

目的前瞻性评估中等肝细胞癌(HCC,数目≤3,长径:3～5 cm)射频消融(RFA)治疗的安全性及是否有益于长期生存。方法 RFA治疗48例中等HCC。Kaplan-Meier计算总生存期(OS)和无瘤生存期(DFS),Cox模型评估预后影响因素。结果患者平均行RFA(2.2±1.6)(1～8)次。初治完全应答率(CR)为98%。无治疗相关死亡,主要并发症发生率为2%。随访5年,中位OS:54.0个月,1、3和5年OS分别为73%、57%和53%。中位DFS:7(3～11)个月。1、3和5年FS分别为32%、23%和8%。Cox分析:Child-Pugh,肿瘤数目, HBV DNA定量和DFS是独立预后影响因素(P<0.001,0.015,0.005和0.002)。肿瘤数目是独立复发因素(P=0.015)。结论中等HCC RFA安全且有益于长期预后。

Objective To prospectively evaluate the safety of radiofrequency ablation(RFA)for the treatment of medium-sized hepatocellular carcinoma(HCC,number of lesions≤3,long diameter:3-5 cm),and to clarify whether this therapy is beneficial to prolong the survival time of patients.Methods RFA was used to treat 48 patients with medium-sized HCC.Using Kaplan-Meier method,the overall survival time(OS)and disease-free survival time(DFS)were calculated.Cox model was used to evaluate the prognostic factors.Results The patients received an average of(2.2±1.6)times(ranging 1-8 times)of RFA treatment.The initial complete response(CR)rate was 98%.No treatment-related death occurred,and the major complications rate was 2%.The patients were followed up for 5 years.The median OS time was 54.0 months,and the one-,3-and 5-year survival rates were 73%,57%and 53%respectively.The median DFS time was 7.0 months(ranging 3-11 months),and the one-,3-and 5-year DFS rates were 32%,23%and 8%respectively.Cox hazards regression analysis revealed that Child-Pugh classification,number of tumor lesions,HBV-DNA quantity and DFS were the independent prognostic factors(P=0.000,P=0.015,P=0.005 and P=0.002 respectively).The number of tumor lesions was an independent recurrence factor(P=0.015).Conclusion For the treatment of medium-sized HCC,RFA is clinically safe,and this therapy is beneficial for prolonging the survival time of patients.(J Intervent Radiol,2019,28:343-346)