影响肝细胞癌射频消融术后疗效的相关因素分析

目的分析影响超声引导下射频消融术（RFA）治疗肝细胞癌（HCC）预后的相关因素。 方法收集2008年5月至2012年6月哈尔滨医科大学附属第一医院进行RFA治疗且随访资料完整的HCC患者104例，共147个病灶。随访36个月，记录HCC患者生存情况，采用超声造影监测RFA术后HCC患者局部复发的情况。采用Kaplan-Meier法及Log-rank检验对影响HCC患者RFA术后预后的因素进行单因素分析，对单因素分析与HCC患者RFA术后预后有关的因素再采用Cox比例风险回归模型进行多因素分析。 结果104例HCC患者RFA术后半年、1、2、3年生存率分别为96.1%、92.0%、80.0%、53.3%，中位生存时间19个月，RFA术后1年局部复发率为13.6%。单因素分析结果显示术前肝功能Child-Pugh分级、首发癌、术后肝内产生新发病灶、消融范围、首选RFA治疗等因素与HCC患者RFA术后生存率有关（χ²=7.119，P=0.008；χ²=20.485，P=0.000；χ²=14.160，P=0.000；χ²=11.825，P=0.001；χ²=7.979，P=0.005）；多因素分析结果显示术前肝功能Child-Pugh分级、首发癌、术后肝内产生新发病灶为影响HCC患者RFA术后生存率的独立因素（P=0.001；P=0.005；P=0.003）。单因素分析结果显示，病毒标志物、首发癌、背景肝、肿瘤直径、肿瘤边界、邻近脏器或大血管、消融范围、首选RFA治疗等因素与HCC患者RFA术后1年局部复发率有关（χ²=7.234，P=0.007；χ²=9.083，P=0.003；χ²=7.791，P=0.005；χ²=13.042，P=0.000；χ²=20.657，P=0.000；χ²=58.615，P=0.000；χ²=6.681，P=0.010）；多因素分析结果显示，肿瘤边界、消融范围为影响HCC患者RFA术后1年局部复发率的独立因素（P=0.017；P=0.002）。 结论影响HCC患者RFA术后生存率的独立因素是术前肝功能Child-Pugh分级、首发癌、术后肝内产生新发病灶，影响HCC患者RFA术后1年局部复发率的独立因素是肿瘤边界、消融范围。为了提高HCC患者生存期、减少局部复发应对高危人群建立良好的观察随访制度，治疗中采取多学科合作方式及规范的治疗方案。

The influence factors on therapeutic effect of radiofrequency ablation for hepatocellular carcinoma

ObjectiveTo evaluate the prognostic factors of hepatocellular carcinoma (HCC) patients with treatment of ultrasound-guided pereutaneous radiofrequency ablation (RFA). MethodsA total of 104 patients with 147 HCC tumors who had 36-month regular follow-up after percuatenous RFA therapy in the First Affiliated Hospital of Harbin Medical University between May 2008 tand June 2012 were included in this study. Contrast-enhanced ultrasound (CEUS) was the main method in evaluating the therapeutic effect of RFA. Kaplan-Meier model and Log-rank test were used in univariate analysis, and Cox regression model was used in multivariate analysis to identify the independent factors on therapeutic effect of RFA. ResultsThe 0.5-, 1-, 2-, 3-year overall survival rates after RFA were 96.1%, 92.0%, 80.0%, 53.3% respectively, and the median survival time was 19 months. 1-year local recurrence rate was 13.6%. The univariate analysis showed that Child-Pugh classification, original lesion condition, intrahepatic recurrence, ablative area, and RFA priority were related to survival rate (χ²=7.119, P=0.008; χ²=20.485, P=0.000; χ²=14.160, P=0.000; χ²=11.825, P=0.001; χ²=7.979, P=0.005). The Child-Pugh classification, original lesion condition, intrahepatic recurrence were identified as independent prognostic factors of survival rate (P=0.001; P=0.005; P=0.003). The univariate analysis showed that virus marker, original lesion condition, hepatic background, tumor diameter, tumor boundary, relation with adjacent organ and vessels, ablative area, RFA priority weresignificantly related to local recurrence rate (χ²=7.234, P=0.007; χ²=9.083, P=0.003; χ²=7.791, P=0.005; χ²=13.042, P=0.000; χ²=20.657, P=0.000; χ²=58.615, P=0.000; χ²=6.681, P=0.010). The ablative area and tumor boundary were identified as independent prognostic factors of local recurrence rate (P=0.017; P=0.002). ConclusionsChild-Pugh classification, original lesion condition, intrahepatic recurrence were identified as independent prognostic factors of survival. And ablative area and tumor boundary were identified as independent prognostic factors of local rcurrence rate. In order to improve patient`s survival and reduce local recurrence in high-risk cases, it is importantant to establish appropriate follow-up plan and multidisciplinary cooperation framework within a standard treatment procedure.