射频毁损术与再手术切除治疗复发性小肝癌对照研究

目的 研究射频毁损术治疗肝癌切除术后疗效以及其与再手术切除效果的比较.方法 病例为2000年1月至2005年12月间在复旦大学肝癌研究所治疗的213例复发性小肝癌(肿瘤结节直径≤3 cm,结节数≤3个),包括射频毁损术68例,再手术切除145例.Kaplan-Meier方法估计生存期,Log-rank分析生存曲线之间的差别,COX比例风险模型多因素分析影响预后的因素.总体生存率和无瘤生存率从接受射频毁损术或再手术切除治疗时计算.结果 射频毁损术治疗的患者和再手术切除治疗的患者的1、3、5年总生存率分别为94.7%、65.1%、37.3%和88.1%、62.6%、41.0%,其生存曲线无明显差别(P=0.693).但射频毁损术的1、3、5年无瘤生存率低于再手术切除组,分别为58.0%、27.8%、12.4%和79.4%、48.1%、34.4%(P=0.001).首次肝癌切除术后复发问期超过2年的患者的预后较好.结论 虽然射频毁损治疗的无瘤生存率低于再手术切除,但其远期总体生存率类似于再手术切除,可作为复发性小肝癌再切除术的替代性治疗.

Treatment of postoperative recurrence of hepatocellular carcinoma with radiofrequency ablation comparing with repeated surgical resection

Objective To evaluate the efficacy of radiofrequeney ablation for the treatment of postoperative recurrence of hepatocellular carcinoma and whether radiofrequeney ablation can be used as first line treatment for recurrent hepatoeellular carcinoma. Methods There were 213 patients with small recurrent hepatocellular carcinoma (tumor size of 3 em or less and no more than 3 nodules) who treated in Liver Cancer Institute, Fudan University from January 2000 to December 2005. Among these patients 68 were treated with radiofrequency ablation and 145 were treated with repeated surgical resection. Kaplan-Meier method was used to evaluate the overall survival or disease free survival. Log-rank used to determine the survival difference between groups and COX proportional hazard was used for multivariate analysis to evaluate the risk factors for prognosis. The overall survival or disease free survival was calculated from the time treated with radiofrequency or repeated surgical resection. Results The 1-, 3-, 5-years overall survival rates were 94.7%,65.1%, 37.3% and 88.1%,62.6%,41.0% in radiofrequeney ablation group and surgical repeated resection group, respectively. There was no significant difference between two groups (P=0.693).However, the disease free survival was better in repeated surgical resection than in radiofrequeney ablation,which were 79.4%, 48.1%, 34.4% and 58.0%, 27.8%, 12.4% in repeated surgical resection and radiofrequeney ablation,respectively (P=0.001). The interval between recurrence and initial hepatectomy with more than 2 years was independent factor favor to good prognosis. Conclusions Radiofrequency ablation seems to be as effective as repeated surgical resection owing to comparable overall survival and can be ceousidered as alternative therapy for surgical resection treatment of small recurrent hepatocellular carcinoma.