肝切除和微波消融治疗结直肠癌肝转移的效果比较

目的 比较肝切除和微波消融（microwave ablation，MWA）治疗结直肠癌肝转移（CRLM）的疗效。方法 回顾性分析2013年1月至2020年7月98例CRLM患者的临床资料，根据治疗方法不同分为2组，肝切除组31例，MWA组67例。MWA组共治疗105个病灶，其中特殊部位病灶36个，非特殊部位病灶69个。Kaplan-Meier法绘制生存曲线，Log-rank（Mantel-Cox）检验比较两组肿瘤复发率和生存差异。χ²检验比较两组消融不完全率，单因素和多因素Logistic回归分析消融不完全的危险因素。结果 随访截止2020年10月30日，中位随访时间38（4～94）个月。肝切除组中位肝内复发时间22（95%CI 13～49）个月，明显长于MWA组9（95%CI 6～12）个月（P＜0.001）。肝切除组中位生存时间为60（95%CI 33～86）个月，也明显长于MWA组36（95%CI 30～41）个月（P=0.040）。肝切除组和MWA组1、5年累积生存率无统计学差异（100% vs97%，χ² =0.945，P=1.000；36% vs 27%，χ²=0.437，P=0.508）。肝切除组3年累积生存率高于MWA组（74% vs 48%，χ² =6.013，P=0.014）。特殊部位组消融不完全率明显高于非特殊部位33.3%（12/36）vs 15.9%（11/69），χ² =4.183，P=0.041]。肿瘤直径≥3 cm、特殊部位、CEA≥200 ng/mL是消融不完全的危险因素，其中肿瘤直径≥3 cm是消融不完全的独立危险因素。结论 可切除性CRLM手术切除的疗效优于微波消融，直径大于3 cm的肿瘤不宜微波消融治疗。

Efficacy comparison of liver resection and microwave ablation in the treatment of colorectal liver metastases

Objective To compare the efficacy of liver resection (LR) and microwave ablation (MWA) in the treatment of colorectal liver metastases (CRLM). Methods The clinical data of 98 patients with CRLM admitted in Tongji Hospital between Jan. 2013 and Jul. 2020 were retrospectively analyzed. Patients were divided into LR group (n=31) and MWA group (n=67). A total of 105 lesions were treated in MWA group, including 36 lesions at so-called “high-risk” locations and 69 lesions at elsewhere locations. Kaplan-Meier test and Log-rank test were used to compare the recurrence and survival between the two groups. The χ² test was used to compare the rate of incomplete ablation between the two groups, and univariate and multivariate Logistic analyses were used to identify risk factors for incomplete ablation. Results By Oct. 30, 2020, the median follow-up time was 38 months (4~94 months). The median intrahepatic recurrence time in the LR group was 22 months (95%CI 13~49months), which was significantly longer than that in the MWA group (9 months, 95%CI 6~12 months, P<0.001).The median survival time in the LR group was 60 months (95%CI 33~86 months), which was also significantly longer than that in the MWA group (36 months, 95%CI 30~41 months, P=0.040). There was no significant difference in 1-and 5-year survival between LR group and MWA group (100% vs 97%, χ² =0.945, P=1.000,36% vs 27%, χ² =0.437, P=0.508). The 3-year cumulative survival rates in the LR group were higher than those in MWA group (74% vs 48%, χ² =6.013, P=0.014). The incomplete ablation rate in the high-risk locations group was significantly higher than that in the elsewhere locations group 33.3%(12/36) vs 15.9%(11/69), χ² =4.183,P=0.041]. Tumor diameter ≥3 cm, high-risk locations, and CEA ≥200 ng/mL were risk factors for incomplete ablation, among which tumor diameter ≥3 cm was an independent risk factor for incomplete ablation.Conclusion The efficacy of LR is better than that of MWA for resectable CRLM. MWA therapy may be not suitable for CRLM with diameter greater than 3 cm.