影响射频消融治疗大肝癌临床疗效的因素探讨

目的：探讨影响射频消融治疗大肝癌临床疗效的相关因素。方法：51例大肝癌RFA治疗前超声引导下肝穿刺取样活检,POWERVISION TM免疫组织化学S-P法检测肝癌热休克蛋白-70（HSP-70）的表达;射频消融治疗;统计分析肝癌HSP-70表达情况及临床参数与RFA疗效的关系。结果：RFA治疗后完全灭活组患者半年、1年、2年及3年生存率分别为54.9%、31.3%、13.7%和9.8%。部分灭活组半年、1年、2年和3年生存率为41.1%、15.8%、9.8%和0%,完全灭活组疗效明显优于部分灭活组的疗效,P〈0.05。肝癌HSP-70阳性表达率为62.75%,正常肝组织中的阳性表达率为33.33%,肝癌组织HSP-70的表达明显高于正常肝组织P〈0.05。HSP-70指数≤2的半年、1年、2年和3年生存率分别为100.0%、47.37%、36.84%和15.79%,HSP-7 0指数〉2的半年、1年、2年和3年生存率为93.80%、46.88%、15.63%和6.25%,HSP-70指数〉2的RFA疗效明显低于HSP-70指数≤2的病例,P〈0.05。Ⅱ-Ⅲ期患者半年、1年、2年和3年的生存率分别是100.00%（41/41）、51.22%（21/41）、29.27%（12/41）和12.20%（5/41）,Ⅳ期肝癌的半年、1年、2年和3年生存率为80.00%（8/10）、20.00%（2/10）、0%（0/10）及0%（0/10）,临床分期越晚,RFA治疗效果越差,P〈0.05。肿瘤分布于1个肝段的生存率与肿瘤分布多个肝段的生存率无差异,P〉0.05。AFP〈20μg/L的生存率明显高于AFP〉500μg/L的患者,P〈0.05。肝功能A级患者的半年、1年、2年和3年生存率高于肝功能B级和C级的患者,P〈0.05。结论：RFA可作为大肝癌治疗的一种补充手段,对无手术指征或不愿意接受手术治疗的肝癌患者只要条件允许,可选择RFA治疗。肝癌组织内HSP-70表达水平、临床分期、肝功能分级、肿瘤灭活、AFP表达均与大肝癌RFA治疗效果有关。

Factors affected the clinical prognosis of liver cancer with radiofrenquency ablation therapy

Objective：To study the factors that affected the clinical prognosis of liver cancer with radiofrenquency ablation（RFA）therapy.Methods： Total of 51 cases with liver cancer were treated by RFA,and then analyze the relationship of prognosis with the stage of liver cancer,inactive of tumor,grade of liver function,HSP-70,AFP,and distribution of tumors in liver.Results： The ratio of complete inactivation group was 54.9% in 51 cases,and the ratio of partial inactivation was 45.1%.The survival rate of complete inactivation group in half a year,one year,two years,and three years were 54.9%,31.3%,13.7% and 9.8% respectively,and that of the partial inactivation group were 41.1%,15.8%,9.8% and 0% respectively.The prognosis of complete inactivation group was better than that of partial inactivation group,P 0.05.Positive expression rate of HSP-70 in liver cancer was 62.75%,and it was 33.33% in normal liver tissues,the positive expression rate of HSP-70 in liver cancer was higher than that in normal tissues,P0.05.The survival rates of HSP-70 negative expression in 19 of cases treated by RFA were 100.0%,47.37%,36.84% and 15.79 respectively in half a year,one year,two years and three years;The survival rates of positive expression of 32 patients were 93.80%,46.88%,15.63% and 6.25% respectively.The higher of HSP-70 expression,the worse of the survival rate with RFA,P0.05.The survival rates of 41 cases stage Ⅱ-Ⅲ treated by RFA in half a year,one year,two years and three years were 80.3%,41.1%,23.5% and 9.8% respectively,and the survival rates of 10 cases stage Ⅳ treated by RFA in half a year,one year,two years and three years were 15.6%, 5.9%,0% and 0%.The higher of liver cancer stage was,the worse of survival rate with RFA was,P0.05.37 cases tumor distributed in one hepatic segment,and 14 cases tumor distributed in multi-hepatic segments,the survival rate was not related with tumor distribution in liver treated by RFA in half a year,one year,two years and three years,P0.05.Liver function of Child-Pugh was related with the prognosis of patients treated by RFA,the survival rate of patients with Child-Pugh B and C was worse then that of patients with Child-Pugh A,P0.05.Conclusion： RFA is an adjuvant therapy method for patients with large liver cancer who have no operation chance or will not be operated.Expression of HSP-70,clinical stage,inactive state of tumor,grade of liver function and AFP are the factors that affect clinical prognosis of liver cancer with RFA therapy.