射频消融治疗初发小肝癌的疗效及预后因素分析

目的 分析射频消融治疗初发小于5 cm 肝细胞癌的疗效和预后因素,探索射频消融治疗小肝癌的适应证及进一步提高疗效的方法 .方法 采用回顾性队列研究方法 ,分析2001年10月至2006年12月期间,124例在中山医院肝癌研究所行射频消融治疗初发小于5 cm肝细胞癌135个病灶,随访期至2008年3月.结果 中位随访期22个月,中位、平均总体生存期为46个月、(42.7± 2.7)个月;1、2、3、4、5年的总体生存率为86.8%、66.5%、56.5%、45.6%、36.5%.与总体生存相关的独立危险因素有:白蛋白(P=0.007,r=2.227)和凝血酶原时间(P=0.035,r=2.010).白蛋白≤35 g/L且凝血酶原时间＞13 s(45例)和白蛋白＞35 g/L且凝血酶原时间≤13 s(42例)两组病人5年生存率和中位生存时间分别为25%、21个月和67%、63个月.结论 白蛋白和凝血酶原时间正常的初发小肝癌病人接受射频消融治疗能获得较高的5年生存率.

Therapeutic effect and prognostic factors for small hepatocellular carcinoma after percutaneous radiofrequency ablation as a first-line treatment modality

Objective To evaluate the therapeutic efficacy of radiofrequency ablation(RFA)for small hepatocellular carcinoma(HCC)as a first-line treatment modality,identify the prognostic factors and determine the indications of RFA for small HCC.Methods The clinical data of 124 patients with 135 HCC nodules less than 5 cm undergoing RFA as a first-line treatment modality in Liver Cancer Institute,Zhongshan Hospital from October 2001 to December 2006 were retrospectively reviewed.The patients were followed up till March.2008.Results With a median follow-up of 22 months after RFA treatment,the median and mean overall survival time and those of recurrence-free survival time were 46 months and 42.7±2.7 months versus 20 months and 27.6±2.9 months.The 1-,2-,3-,4-and 5-year overall survival rates were 86.8%,66.5%,56.5%,45.6% and 36.5%,respectively.Cox regression analysis indicated that albumin(P = 0.007,r=2.227)and PT(P=0.035,r = 2.010)were independently associated with survival after RFA.The 5-year overall survival rates and median overall survival time in the patients whose albumin≤35 g/L and PT＞13 s(45 cases),and those of albumin＞35 g/L and PT≤13 s(42 cases)were 25% and 21 months versus 67% and 63 months,respectively.Conclusion A good 5-year survival rate can be anticipated in patients receiving RFA as a first-line treatment modality with normal albumin and prothrombin time levels.