经皮微波消融术治疗合并肝硬化的原发性小肝癌患者生存分析*

doi:10.3969/j.issn.1672-5069.2018.02.025

摘要/Abstract

摘要： 目的探讨经皮微波消融术（PMCT）治疗合并肝硬化的原发性小肝癌患者的疗效。方法 2005年1月~2014年7月我院收治的108例合并肝硬化的原发性小肝癌患者,采用PMCT治疗40例,采用开腹肿瘤切除治疗68例。采用Cox回归分析影响患者术后生存的相关因素。结果治疗后3年,PMCT治疗患者总生存和无复发生存率分别为60.0%和40.0%,与手术切除治疗组的58.8%和38.2%比,无显著性差异（P>0.05）;单因素分析结果显示死亡患者肝功能分级为B级、血清甲胎蛋白水平高和白蛋白水平低者与生存患者存在显著性差异（P<0.05）;多因素Cox回归模型分析显示肝功能分级（HR=1.81,95%CI:0.97~3.38）、血清AFP（HR=1.83,95%CI:0.99~3.37）和白蛋白水平（HR=1.81,95%CI:0.98~3.36）为影响合并肝硬化的原发性小肝癌患者预后的独立危险因素（P<0.05）。结论采用PMCT治疗合并肝硬化的原发性小肝癌患者生存率与手术切除治疗者结果相似,患者预后与肝功能、血清AFP水平和白蛋白水平相关。

关键词: 原发性肝癌, 肝硬化, 经皮微波消融术, 预后

Abstract: Objective To investigate the efficacy of percutaneous microwave ablation（PMCT） in the treatment of patients with hepatocellular carcinoma with underlying liver cirrhosis. Methods 108 patients with small hepatocellular carcinoma between January 2005 and July 2014 in our hospital were recruited in this study,and 40 patients were treated with PMCT and 68 were with hepatectomy. The Cox regression analysis was applied to analyze the factors associated with postoperative survival. Results There was no significant difference as respect to total survival（60% vs. 58.8%） and recurrence-free survival rates（40.0% vs. 38.2%） between the patients subjected to PMCT or surgical resection at the end of three-year follow-up;univariate analysis showed the Child-Pugh class,serum alpha-fetoprotein and albumin levels at baseline in fatal patients were significantly poorer or lower than those in survival patients（P<0.05）;multivariate cox regression analysis showed that Child-Pugh class （HR=1.81,95%CI: 0.97~3.38）,serum alpha-fetoprotein（HR=1.83,95% CI:0.99~3.37）and albumin levels（HR=1.81,95%CI:0.98~3.36） were the independent factors for prognosis of patients with hepatocellular carcinoma with underlying liver cirrhosis（P<0.05）. Conclusion The survival rate of patients with small hepatocellular carcinoma and cirrhosis treated with PMCT is similar to that of those received surgical resection. The prognosis is correlated with liver function,serum alpha-fetoprotein and albumin levels.

Key words: Hepatocellular carcinoma, Liver cirrhosis, Percutaneous microwave ablation, Prognosis

廖凌峰, 薛建章, 李士坤. 经皮微波消融术治疗合并肝硬化的原发性小肝癌患者生存分析*[J]. 实用肝脏病杂志, 2018, 21(2): 257-260.

Liao Lingfeng, Xue Jianzhang, Li Shikun. Survival analysis of percutaneous microwave ablation for patients with small hepatocellular carcinoma with underlying liver cirrhosis[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(2): 257-260.

参考文献

[1] Medhat E,Abdel Aziz A,Nabeel M,et al.Value of microwave ablation in treatment of large lesions of hepatocellular carcinoma. J Dig Dis,2015,16(8):456-463.
[2] 刘平,魏子白,于俊岩,等. 微波消融与手术切除治疗早期PLC临床疗效的Meta分析. 中华消化外科杂志,2015,14(12):1031-1037.
[3] Zhou P,Liang P,Yu X,et al.Percutaneous microwave ablation of liver cancer adjacent to the gastrointestinal tract. J Gastrointest Surg,2009,13(2):318-324.
[4] Zhang M,Liang P,Cheng ZG,et al.Efficacy and safety of artificial ascites in assisting percutaneous microwave ablation of hepatic tumours adjacent to the gastrointestinal tract. Int J Hyperthermia,2014,30(2):134-141.
[5] Huang H,Liang P,Yu XL,et al.Safety assessment and therapeutic efficacy of percutaneous microwave ablation therapy combined with percutaneous ethanol injection for hepatocellular carcinoma adjacent to the gallbladder. Int J Hyperthermia,2015,31(1):40-47.
[6] 张宁宁,程晓静,刘建勇,等. 大功率微波消融治疗肝癌临床疗效及其复发危险因素分析. 实用肝脏病杂志,2015,18(3):249-253.
[7] Choi D,Lim HK,Kim MJ,et al.Therapeutic efficacy and safety of percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the gastrointestinal tract. AJR,2004,183(5):1417-1424.
[8] Abdelaziz AO,Nabeel MM,Elbaz TM,et al.Microwave ablation versus transarterial chemoembolization in large hepatocellular carcinoma:prospective analysis. Scand J Gastroentero,2015,50(4):479.
[9] Medhat E,Abdel Aziz A,Nabeel M,et al.Value of microwave ablation in treatment of large lesions of hepatocellular carcinoma. J Dig Dis,2015,16(8):456-463.
[10] Kang TW,Rhim H,Kim EY,et al.Percutaneous radiofrequency ablation for the hepatocellular carcinoma abutting the diaphragm:assessment of safety and therapeutic efficacy. Korean J Radiol,2009,10(1):34-42.
[11] Guo Y,Zhang Y,Huang J,et al.Safety and efficacy of transarterial chemoembolization combined with CT-guided radiofreque-ncy ablation for hepatocellular carcinoma adjacent to the hepatic hilum within Milan criteria. J Vasc Interv Radiol,2016,7(4):487-495.
[12] 王宝玲,周连新. 螺旋CT、能谱CT和MRI诊断PLC的临床价值比较. 实用肝脏病杂志,2016,19(4):467-470.
[13] Sartori S,Tombesi P,Macario F,et al.Subcapsular liver tumors treated with percutaneous radiofrequency ablation:a prospective comparison with nonsubcapsular liver tumors for safety and effectiveness. Radiology,2008,248(2):670-679.
[14] TCha DI,Lee MW,Rhim H,et al.Therapeutic efficacy and safety of percutaneous ethanol injection with or without combined radiofrequency ablation for hepatocellular carcinomas in high risk locations.Korean J Radiol,2013,14(2):240-247.
[15] Zhang TT,Luo HC,Cui X,et al.Ultrasound-guided percutaneous microwave ablation treatment of initial recurrent hepatocellular carcinoma after hepatic resection:long-term outcomes. Ultrasound Med Biol,2015,41(9):2391-2399.
[16] Hasegawa T,Takaki H,Miyagi H,et al.Hyaluronic acid gel injection to prevent thermal injury of adjacent gastrointestinal tract during percutaneous liver radiofrequency ablation.Cardiovasc Int Radiol,2013,36(4):1144-1146.
[17] Giorgio A,Di Sarno A,De Stefano G,et al.Percutaneous radiofrequency ablation of hepatocellular carcinoma compared to percutaneous ethanol injection in treatment of cirrhotic patients: an Italian randomized controlled trial. Anticancer Res,2011,31(6):2291-2295.