超声引导下经皮微波消融治疗肝癌胸腹壁种植转移

目的：探讨超声引导下经皮微波消融治疗肝癌胸腹壁种植转移的有效性和可行性。 方法：选取2007年1月至2017年1月在中国人民解放军总医院出现肝癌胸腹壁种植转移后接受超声引导下经皮微波消融治疗的患者15例，男13例，女2例，平均年龄（57.2±17.6岁）。收集种植转移的人口和肿瘤特征，分析患者治疗情况，采用Log-Rank χ²检验统计分析种植灶消融后的局部进展率及患者的总生存率，采用多因素Cox回归分析肝癌胸腹壁种植转移患者总体生存情况的危险因素。 结果：15例患者的中位随访27.8（3.8~67.2）个月，消融治疗后种植肿瘤患者的0.5、1、2年的累积局部进展率分别为6.7%、23.0%、23.0%；1、3、5年的累积总生存率分别为80.0%、61.7%、46.3%。多因素Cox回归分析显示年龄>65岁、肝内病灶控制差及肿瘤分型差是影响肝癌胸腹壁种植转移患者总体生存情况的危险因素。 结论：超声引导下经皮微波消融治疗肝癌胸腹壁种植转移能够产生令患者满意的肿瘤结局，但延长患者生存时间还主要依靠对肝内病灶的控制。

Ultrasound-guided percutaneous microwave ablation of seeding from hepatocellular carcinoma in thoracoabdominal wall

Objective:The objective of the study is to evaluate the effectiveness and feasibility of ultrasound-guided percutaneous microwave ablation (MWA) in patients who occurred seeding from hepatocellular carcinoma (HCC) in thoracoabdominal wall. Methods:A total of 15 patients (13 men, 2 women; 57.2±17.6 years) with the seeding from HCC in thoracoabdominal wall, underwent US-guided percutaneous MWA and were included in the study from January 2007 to January 2017. We collect the population and tumor characteristics of the seeding. Local seeding progression (LSP) and overall survival (OS) are analyzed statistically with the log-rank test. Multivariate analysis are performed on clinico-pathological variables to identify factors affecting OS. Results:After a median follow-up time of 27.8 (3.8-67.2) months, cumulative 0.5-, 1-, 2-years LSP rate is 6.7%, 23.0% and 23.0%, respectively. And cumulative 1-, 3-, 5-years OS rate is 80.0%, 61.7%, and 46.3%, respectively. Multivariate analysis show that older age (P=0.006, HR=2.218, 95%CI=1.338-4.923) , poor control of intrahepatic lesion (P=0.002, HR=5.529, 95%CI=2.372-15.443) and poor pathological type (P=0.021, HR=2.782, 95%CI=1.035-4.112) are independently associated with OS. Conclusions:Ultrasound-guided percutaneous microwave ablation in the treatment of seeding from HCC in thoracoabdominal wall, which can produce satisfactory tumor outcomes, but the survival of patients depends mainly on the control of intrahepatic lesions.