微波消融治疗原发性肝癌的单中心回顾性研究

目的 评价微波消融治疗原发性肝癌的安全性和有效性。方法 回顾性分析2010年1月至2018年5月华中科技大学同济医学院附属同济医院肝脏外科中心收治的254例初诊为原发性肝癌并接受微波消融（microwave ablation,MWA）治疗患者的临床资料。采用Kaplan-Meier法绘制生存曲线,Cox风险比例模型分析影响患者生存时间的独立危险因素,单因素和多因素Logistic回归分析消融不完全的独立危险因素。结果 中位随访时间52（29~129）个月。所有患者的中位无复发生存时间（recurrence free survival,RFS）为39（95%CI 29~50）个月;中位生存时间（overall survival,OS）为68（95%CI 55~80）个月。Cox风险比例模型分析显示肿瘤最大径>3 cm（HR 1.954,95%CI 1.276~2.992）、Child-Pugh B级（HR 2.183,95%CI 1.481~3.217）、血小板计数（platelet,PLT）<50×10⁹/L（HR 4.344,95%CI 2.878~6.555）是预后不良的独立危险因素。肿瘤特殊部位患者（毗邻门静脉、下腔静脉、胆囊等） （n=61）与非特殊部位患者（n=193）中位OS 62（95%CI 34~90）个月 vs 70（95%CI 59~81）个月,P=0.160],Ⅲ、Ⅳ级并发症发生率9.8%（6/61） vs 5.2%（10/193）,P=0.226]无统计学差异。8.3%（21/254）原发性肝癌患者消融不完全,Logistic回归分析显示,肿瘤>3 cm是肿瘤MWA不完全的独立危险因素（OR 8.841,95%CI 3.322~23.527）。结论 原发性肝癌的MWA总体上是安全、有效的,且适用于特殊部位的肿瘤。消融最大径> 3 cm肿瘤存在MWA不完全的风险。肿瘤最大径>3 cm、Child-Pugh B级、PLT<50×10⁹/L是影响MWA术后患者长期生存的危险因素。

Microwave ablation for primary liver cancer: A single-center retrospective study

Objective To evaluate the safety and efficacy of microwave ablation for primary liver cancer. Methods A retrospective analysis was performed and included 254 primary liver cancer patients treated with microwave ablation (MWA) in Department of Liver Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from Jan. 2010 to May 2018. Kaplan-Meier method was used to draw survival curves, Log-rank (Mantel-Cox) test to compare the recurrence and survival rates, Cox proportional risk model to analyze the independent risk factors affecting survival, and Logistic regression analysis to determine the independent risk factors of incomplete ablation. Results The mean follow-up time was 57±22 months (median 52 months, 29-129 months). Median recurrence free survival (RFS) for all patients was 39 (95%CI 29-50) months; while the median overall survival (OS) was 68 (95%CI 55-80) months. Tumor diameter (>3 cm) hazard ratio (HR) 1.954, 95%CI 1.276-2.992], Child-Pugh grade B (HR 2.183, 95%CI 1.481-3.217), platelet count (<50×10⁹/L) (HR 4.344, 95%CI 2.878-6.555) were independent risk factors for poor prognosis. The median OS of microwave ablation for high-risk locations (adjacent to portal vein, inferior vena cava, gallbladder, etc.) (n=61) was 62 (95%CI 34-90) months, compared to 70 (95%CI 59-81) months for non-high-risk locations (n=193). No significant difference in survival time was observed between the two groups (P=0.160). The incidences of grade III and IV complications of microwave ablation was 9.8% (6/61) for high-risk locations, and 5.2% (10/193) for non- high-risk locations. However, no statistical difference was observed between the two groups (P=0.226). Incomplete ablation was recorded in 8.3% (21/254) of patients. Furthermore, Logistic regression analysis showed that tumor diameter (>3 cm) was an independent risk factor for incomplete tumor ablation odds ratio (OR) 8.841, 95%CI 3.322-23.527]. Conclusion Microwave ablation of primary liver cancer is generally safe and effective, and therefore is suitable for high-risk location tumors. However, a risk of incomplete ablation is present for tumors with diameters larger than 3 cm. Tumor diameter (>3 cm), Child-Pugh B and PLT count (<50×10⁹/L) are risk factors for long-term survival.