射频消融治疗复发性肝细胞癌疗效分析

目的探讨射频消融对肝细胞癌(HCC)手术切除后复发病例再治疗的效果,比较不同复发时间的疗效差别。方法以行超声引导经皮射频消融(RFA)治疗的手术切除后复发性肝细胞癌(RHCC)患者(RHCC组)和同期行RFA治疗的首发HCC患者(首发HCC组)为研究对象。(1)RHCC组42例患者,男34例,女8例,平均年龄(58±10)岁;复发灶大小1.5~6.6cm,平均(3.8±1.4)cm。RFA治疗前5例伴肝外转移。肝功能A级21例,B级19例,C级2例。手术切除距肝内初次复发时间为1~96个月,平均22.8个月。术后1年内肿瘤复发者20例40灶(RHCC近期组),术后1年以上复发者22例37灶(RHCC远期组)。(2)首发HCC组148例患者,男117例,女31例,平均年龄59岁。肿瘤大小1.2~7.0cm,平均(4.0±1.4)cm。RFA治疗后1个月采用增强CT检查评价消融成功率;比较RHCC近期组、RHCC远期组和首发HCC组的治疗效果、复发转移情况及生存期。结果首发HCC组RFA成功率为87.2%(129例),局部复发率为16.2%(24例),另位复发率为37.8%(56例),平均生存期为(39.0±2.1)个月;RHCC近期组、远期组RFA成功率分别为85.0%和95.5%(P>0.05),局部复发率分别为15.0%和13.6%(P>0.05),另位复发率为60.0%和18·2%(P=0.005),平均生存期为(15.4±2.3)个月和(39.5±4.5)个月(P<0.005)。与首发HCC组相比,RHCC远期组消融成功率与局部复发率均无显著性差异(P>0.05),RHCC近期组生存期低于首发HCC组(P<0.05)。RHCC远期组1例患者治疗后出血,经射频止血、输血等保守治疗缓解。结论RFA治疗RHCC的预后及疗效与复发的时间相关;对于术后远期复发者,行RFA治疗可获得同首发HCC相似的生存期,而手术后近期复发者疗效相对较差。

Radiofrequency ablation of recurrent hepatocellular carcinoma after hepatectomy

OBJECTIVE: To assess the efficiency and safety of radiofrequency ablation (RFA) of recurrent hepatocellular carcinoma (RHCC) after hepatectomy and to investigate efficacy of RFA for patients with early and late phase recurrence, separately, setting 1 year as the cut-off between the early and late phases. METHODS: A total of 42 patients with 77 RHCC and a history of hepatic resection for hepatocellular carcinoma (HCC) underwent ultrasound-guided percutaneous radiofrequency ablation in our department and entered this study (RHCC group). The average diameter of RHCC was (3.8 +/- 1.4) cm (range, 1.5-6.6 cm). 21 of the 42 RHCC patients had Child-Pugh class A cirrhosis 19, class B and two, class C cirrhosis. The average interval between initial surgery and the diagnosis of recurrence was 22.8 months (range, 1-96 month). 42 RHCC patients were divided into two groups as early recurrence group including 20 patients with 40 RHCC, and late recurrence group including the other 22 patients with 37 RHCC according to the recurrence interval. During the same period 148 patients with 217 primary HCC were also treated by RF ablation and regarded as primary HCC group. The average diameter of primary HCC was (4.0 +/- 1.4) cm (range, 1.2-7.0 cm). Regular follow-up with enhanced CT was performed to evaluate the treatment results. Ablation was considered a success if no contrast enhancement was detected in the treated area on 1 month CT scans. RESULTS: The ablation success rate, local recurrence rate, new tumor incidence and mean survival in RHCC group were 90.5%, 14.3%, 38.1% and (28.0 +/- 3.5) months, respectively, which were similar to the corresponding results of 87.2%, 16.2%, 37.8% and (39.0 +/- 2.1) month in primary HCC group. However, when further comparison was performed between early recurrence group, late recurrence group and primary HCC group, there were some significant differences. The incidence of new tumors in early recurrence group was significantly higher than that in late recurrent group (60.0% vs. 18.2%, P = 0.005); early recurrence group survived shorter than primary HCC group [(15.4 +/- 2.3) vs. (39.0 +/- 2.1) months, P < 0.005]. The survival time was similar between late recurrence group and primary HCC group. One case was found haemorrhage after RFA and recovered with conservative treatment. No major complications occurred in the remaining 41 patients. CONCLUSIONS: RF ablation is generally effective and safe in treating RHCC. And it's more effective in late recurrence than in early recurrence.