单次经皮射频消融治疗小肝癌的预后及复发危险因素分析

背景与目的:射频消融( radiofrequency ablation, RFA)治疗作为肝癌局部治疗的新技术,近年得到了广泛的应用.本研究分析肝癌 RFA治疗的疗效和复发相关因素,并探索 RFA治疗的适应证.方法:采用回顾性队列研究方法,分析 2001年 1月至 2003年 12月期间, 94例在中山医院肝癌研究所行 RFA治疗的原发性小肝癌患者的 102个病灶,随访期至 2004年 3月.采用 SPSS 11.5统计软件对数据进行处理.结果: 94例患者的中位随访期为 16个月, RFA治疗后的 1年累积生存率为 85.5%, 2年累积生存率为 75.6%; 1年累积无瘤生存率为 31.3%, 2年累积无瘤生存率为 10.4%.共有 62例患者( 66.0%)复发.单因素分析显示复发与下列 3个因素有关:肿瘤近血管 (P< 0.01)、位于肝包膜下 (P< 0.05)、直径 >3 cm (P< 0.05);而与性别、 Child分级、 AFP值、是否联合瘤内无水乙醇注射治疗无关. Cox多因素分析显示:肿瘤近血管 (P=0.000, 95%可信区间为 2.102～ 7.899)、位于肝包膜下 (P=0.001, 95%可信区间为 1.672～ 6.289)是 RFA治疗后复发的独立危险因素.较严重并发症的发生率为 2.1% (2/94,胆道出血 1例,膈下积液 1例 ).未发生与手术相关的死亡.结论: RFA是一种安全的肝癌治疗方法.直径≤ 3 cm、不近肝内血管、非包膜下肿块是肝肿瘤 RFA治疗的适应证.

Prognosis and risk factors for recurrence of small liver cancer after a single session of percutaneous radiofrequency ablation

BACKGROUND & OBJECTIVE: As a new technique of local therapy for liver cancer, radiofrequency ablation (RFA) was widely used these years in China. This study was to evaluate the treatment efficacy of RFA on primary liver cancer (PLC), identify the risk factors of recurrence, and determine the indications of RFA for PLC. METHODS: Records of 94 primary small liver cancer patients underwent a single session of percutaneous RFA in Liver Cancer Institute/Zhongshan Hospital from Jan. 2001 to Dec. 2003 were reviewed retrospectively. Data analyses were performed using SPSS for windows Ver. 11.5 software. RESULTS: With a median follow-up of 16 months affer RFA treatment, the cumulative survival rate of 94 patients was 85.5% at 1 year, and 75.6% at 2 years. The cumulative recurrence-free survival rate was 31.3% at 1 year, and 10.4% at 2 years. The total recurrence rate was 66.0% (62/94). Log-rank test revealed that tumor with diameter of >3 cm (P< 0.05), proximity to intrahepatic vessels (P < 0.01), and subcapsular location (P< 0.05) were related to tumor recurrence,while gender, Child-pugh class, alpha fetoprotein (AFP) concentration, and combination therapy with percutaneous ethanol injection were not related to tumor recurrence. Cox regression analysis indicated that tumor proximity to intrahepatic vessels (95%CI, 2.102-7.899; P=0.000), and subcapsular location (95%CI, 1.672-6.289; P=0.001)were associated independently with recurrence after RFA treatment. Severe complications occurred in 2 cases (2.1%), including 1 case of bile duct hemorrhage, 1 case of sub-diaphragm effusion. No RFA related death and other severe complications occurred. CONCLUSIONS: RFA appears to be a safe treatment for liver cancer. Patients with tumor diameter of