应用米兰标准微波消融治疗肝细胞癌患者预后及其影响因素分析*

doi:10.3969/j.issn.1672-5069.2020.06.029

摘要/Abstract

摘要： 目的探讨应用米兰标准施行微波消融术(MWA)治疗肝细胞癌(HCC)患者影响生存的因素。方法 2013年1月～2016年12月我院消化内科住院的94例直径≤5 cm的HCC患者接受超声引导下MWA治疗,随访5年。分析不同HCC结节个数和不同肿瘤直径对总生存率(OS)和无进展生存率(PFS)的影响。结果随访5年,本组HCC患者OS为64.9%,1 a和2 a 肿瘤复发率分别为12.8%和53.2%;HCC直径> 3 cm患者的PFS显著短于直径≤3 cm的患者(P=0.005),PFS≤2年的HCC患者OS显著低于PFS> 2年的患者(48.0%对 84.1%,P<0.001);多因素回归分析显示HCC直径> 3 cm (HR=0.42,95%CI:0.21～0.83,P=0.01)是MWA术后肿瘤复发的独立危险因素,而白细胞计数< 4.0×10⁹ /L (HR=0.38, 95%CI:0.18～0.84,P=0.017)和PFS≤2 年(HR=0.24, 95%CI:0.10～0.56,P=0.001)是影响HCC患者OS的独立危险因素。结论直径> 3 cm的HCC患者PFS较短,但似乎不影响OS,因为大多数肝内复发的HCC患者仍然可进行重复MWA治疗。

关键词: 肝细胞癌, 米兰标准, 微波消融术, 疗效, 预后

Abstract: Objective The aim of this study was to investigate the influencing factors of outcomes of patients with hepatocellular carcinoma (HCC) after ultrasound-guided percutaneous microwave ablation (MWA) by Milan criteria. Method 94 patients with HCC with hepatic solitary tumor≤5 cm were treated with ultrasound-guided MWA in our hospital between January 2013 and December 2016, and were all followed-up for 5 years. Independent risk factors for overall survival (OS) and progression-free survival (PFS) were analyzed. Result The cumulative overall survival rate in our series at 5 years were 64.9%, and the cumulative 1-year and 2-year tumor recurrence rates were 12.8% and 53.2%; the PFS in patients with tumor mass > 3 cm was significantly shorter than that in patients with tumor diameter≤3 cm (P = 0.005), and the OS in patients with PFS≤2 years was significantly shorter than that in patients with PFS> 2 years (48.0% vs. 84.1%, P < 0.001); multivariate Cox analysis showed that the tumor > 3 cm (HR=0.42,95%CI:0.21-0.83, P=0.011) was the independent risk factor for postoperative recurrence of HCC, and the leukocyte counts < 4.0×10⁹ /L ( HR=0.38, 95%CI:0.18-0.84,P=0.017) and PFS≤2 years (HR=0.24,but most patients with intrahepatic tumor recurrence remain eligible for repeated treatment and get a relatively good outcomes. 95%CI:0.10-0.56,P=0.001) were the independent risk factors for OS. Conclusion The patients with hepatic tumor > 3 cm by Milan criteria might have less PFS after MWA.

Key words: Hepatocellular carcinoma, Microwave ablation, Milan criteria, Efficacy, Outcomes

张静, 郭长存. 应用米兰标准微波消融治疗肝细胞癌患者预后及其影响因素分析^*[J]. 实用肝脏病杂志, 2020, 23(6): 873-876.

Zhang Jing, Guo Changcun. Outcomes of ultrasound-guided percutaneous microwave ablationby Milan criteria for the treatment of patients with hepatocellular carcinoma[J]. Journal of Practical Hepatology, 2020, 23(6): 873-876.

参考文献

[1] 侯帅, 樊琳琳. 非手术治疗原发性肝癌研究进展. 实用肝脏病杂志, 2016, 19(2):249-252.
[2] Facciorusso A, Serviddio G, Muscatiello N. Local ablative treatments for hepatocellular carcinoma: an updated review. World J Gastrointest Ther, 2016, 7(4):477-489.
[3] Galle PR, Forner A, Llovet JM, et al. EASL clinical practice guidelines:management of hepatocellular carcinoma. J Hepatol, 2018, 69(1):182-236.
[4] Liu W, Zheng Y, He W, et al. Microwave vs radiofrequency ablation for hepatocellular carcinoma within theMilan criteria: a propensity score analysis. Aliment Pharmacol Ther, 2018, 48(6):671-681.
[5] Tan WC, Deng QW, Lin SY, et al. Comparison of microwave ablation and radiofrequency ablation for hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperthermia, 2019, 36(1):263-271.
[6] Izzo F, Granata V, Rrassi R, et al. Radiofrequency ablation and microwave ablation in liver tumors: an update. Oncologist, 2019, 24(10):e990-e1005.
[7] Liu WW, Zou RH, Wang CW, et al. Microwave ablation versus resection for hepatocellular carcinoma within the Milan criteria: a propensity-score analysis. Ther Adv Med Oncol, 2019, 11:1-13.
[8] Xu Y, Shen Q, Wang N, et al. Microwave ablation is as effective as radiofrequency ablation for very-early-stage hepatocellular carcinoma. Chin J Cancer, 2017, 36(1):14.
[9] 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版). 中华肝脏病杂志, 2020, 2:112-128.
[10] 马履翔, 张雪松. 超声引导下经皮射频消融治疗小肝癌患者疗效及预后分析. 实用肝脏病杂志, 2019, 1(22):125-128.
[11] Ryu T, Takami Y, Wada Y, et al. Hepatic resection versus operative microwave ablation for single hepatocellular carcinoma≤5 cm: a propensity score-matched analysis. Surgery, 2019, 166(3):254-262.
[12] Facciorusso A, Di Maso M, Muscatiello N. Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperthermia, 2016, 32(3):339-344.
[13] Poulou LS, Botsa E, Thanou I, et al. Percutaneous microwave ablation vs. radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol, 2015, 7(8):1054-1063.
[14] Zhang L, Wang N, Shen Q, et al. Therapeutic efficacy of percutaneous radiofrequency ablation versus microwave ablation for hepatocellular carcinoma. PLoS One, 2013, 8(10):e76119.
[15] Vogl TJ, Nour-Eldin ANE, Hammerstingl RM, et al. Microwave ablation (MWA): basics, technique and results in primary and metastatic liver neoplasms-review article. Rofo, 2017, 189(11):1055-1066.
[16] Zhang M, Ma H, Zhang J, et al. Comparison of microwave ablation and hepatic resection for hepatocellular carcinoma: a meta-analysis. Onco Targets Ther, 2017, 10:4829-4839.
[17] Nault JC, Sutter O, Nahon P, et al. Percutaneous treatment of hepatocellular carcinoma: state of the art and innovations. J Hepatol, 2018, 68(4):783-797.
[18] Pawlik TM, Delman KA, Vauthey JN, et al. Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl, 2005, 11(9):1086-1092.
[19] Rossi S, Ravetta V, Rosa L, et al. Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: a long-term cohort study. Hepatology, 2011, 53(1):136-147.
[20] Okuwaki Y, Nakazawa T, Kokubu S, et al. Repeat radiofrequency ablation provides survival benefit in patients with intrahepatic distant recurrence of hepatocellular carcinoma. Am J Gastroenterol, 2009, 104(11):2747-2753.
[21] Cucchetti A, Piscaglia F, Cescon M, et al. An explorative data-analysis to support the choice between hepatic resection and radiofrequency ablation in the treatment of hepatocellular carcinoma. Dig Liver Dis, 2014, 46(3):257-263.

应用米兰标准微波消融治疗肝细胞癌患者预后及其影响因素分析^*

Outcomes of ultrasound-guided percutaneous microwave ablationby Milan criteria for the treatment of patients with hepatocellular carcinoma

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