肝癌射频消融术后肝内远处复发的相关因素分析

目的 分析原发性肝癌射频消融(RFA)治疗后肝内远处复发的影响因素.方法 回顾性分析天津医科大学附属肿瘤医院肝胆科2002年1月至2005年6月80例接受RFA治疗的原发性肝癌患者的临床资料.男性49例,女性31例;年龄34～84岁,平均64岁.所有患者均符合该研究的纳入标准.通过单因素分析与多因素分析筛选与肝内远处复发可能相关的因素.结果 原发性肝癌RFA治疗后1、3、5年肝内累积复发率为6.3%、32.0%、67.3%.单因素分析显示治疗前血清甲胎蛋白(AFP)≥50μg/L(P=0.029)、血清凝血酶原(DCP)≥40 mAu/ml(P=0.004)、凝血酶原时间活动度<70%(P=0.012)、烧灼边缘<1 cm(P=0.035)、术前肝功能(Child-Pugh分级)(P=0.002)与肝内远处复发相关.多因素分析显示血清AFP、DCP水平、烧灼边缘范围和术前Child-Pugh分级为肝内远处复发的独立危险因素.结论 血清高AFP、DCP水平和肝功能较差的原发性肝癌患者应用RFA治疗应警惕肝内远处复发,治疗过程中充足的烧灼边缘对预防肝内复发有很重要意义.

Influencing factors for intrahepatic distant recurrence of liver cancer after radiofrequency ablation

Objective To analyze the influencing factors affecting intrahepatic distant recurrence after radiofrequency ablation (RFA) for primary hepatic cancer. Methods Eighty patients with primary hepatic tumors underwent RFA treatment between January 2002 and June 2005 were retrospectively analyzed. There were 49 males and 31 females aged from 34 to 84 years old. The tumor size was less than 5 cm and no more than 3 nodules. Univariate analysis and multivariate analysis were used to evaluate the risk factors for intrahepatic distant recurrence after RFA. Results The cumulative rates of intrahepatic distant recurrence were 6.3%, 32.0%, and 67.3% at 1,3, and 5 years, respectively. Univariate analysis revealed that pretreatment serum AFP level of ≥50 μg/L (P=0.029),descarboxy pruthrombin (DCP) level of ≥ 40 mAu/ml (P=0.004),ablative margin of <1 cm (P=0.035),prothrombin time activity percent tage of <70% (P=0.012), and poor Child-Pugh grade (P=0.002) were related to intrabepatic distant recurrence. A multivariate analysis revealed that pretreatment serum AFP and DCP level,ablative margin and Child-Pugh grade were independent risk factors for intrahepatic distant recurrence. Conclusions Primary liver cancer patients with high serum AFP, DCP and poor Child-Pugh grade before RFA should be carefully followed up to monitor any intrahepatic distant recurrence. A sufficient ablative margin in RFA for primary liver cancer is required to prevent recurrence.