超声引导下射频消融治疗小原发性肝癌疗效及死亡危险因素分析*

doi:10.3969/j.issn.1672-5069.2024.02.028

摘要/Abstract

摘要： 目的探讨在超声引导下采用射频消融(RFA)治疗小肝细胞癌(HCC)患者的疗效, 并分析影响患者死亡的危险因素。方法 2019年12月～2021年1月我院收治的102例HCC患者, 均接受在超声引导下行RFA治疗。在术后一个月复查评估疗效, 并随访2年。采用单因素和多因素Logistic回归分析影响患者死亡的因素。结果观察近期疗效发现疾病进展6例, 疾病稳定21例, 部分缓解52例, 完全缓解23例, 总有效率为73.5%;随访发现, 1 a和2 a 生存率分别为90.2%和77.5%;死亡与生存患者性别、年龄、饮酒史、合并乙型肝炎、凝血酶原时间国际标准化比值(INR)和血小板计数比较, 差异均无统计学意义(P>0.05), 但死亡患者Child Pugh C级、肿瘤细胞低分化、病灶临近血管和未接受抗病毒治疗占比及甲胎蛋白(AFP)水平分别为43.5%、34.8%、69.6%、69.6%和(292.4±28.5)μg/L, 均显著高于生存患者【分别为12.7%、21.5%、39.2%、34.2%和(243.8±25.0)μg/L, P<0.05】, 而血清白蛋白水平为(32.2±4.5)g/L, 显著低于生存患者【(41.7±5.8)g/L, P<0.05】;Logistic多因素回归分析结果显示, 血清AFP水平高、Child Pugh C级、病灶临近血管和未接受抗病毒治疗均是影响RFA治疗的HCC患者死亡的独立危险因素(P<0.05)。结论在超声引导下采用RFA治疗小肝癌患者近远期疗效肯定, 了解影响患者长期生存的因素并给予积极的干预和处理, 可能能延长生存时间。

关键词: 肝细胞癌, 射频消融, 超声引导, 治疗, 疗效

Abstract: Objective This study was conducted to investigate the efficacy of ultrasound(US)-guided radiofrequency ablation ( RFA ) in the treatment of patients with small hepatocellular carcinoma (sHCC), and analyze the risk factors affecting the survivals. Methods 102 patients with sHCC were encountered in our hospital between December 2019 and January 2021, and all underwent US-guided RFA. The patients in our series were followed-up for two years. The univariate and multivariate Logistic regression analysis were applied to analyze the factors affecting the survivals of patients after RFA treatment. Results One-month observation showed progression diseases in 6 cases, stable diseases in 21 cases, partial remission in 52 cases and complete remission in 23 cases, with the objective response rate of 73.5%; the one-year and two-year survival rates were 90.2% and 77.5%; there were no significant differences respect to the ages, gender, history of alcohol abuse, underlying hepatitis B viral infection as well as plasma prothrombin time international normalized ratio and blood platelet counts between died and survived patients (P>0.05), while the percentages of Child-Pugh class C, low differentiation of tumor cells, lesions adjacent to vessels, without antiviral therapy of nucleos(t)des and serum AFP level in dead patients at admission were 43.5%, 34.8%, 69.6%, 69.6% and (292.4±28.5) ug/L, all significantly higher than , and serum albumin level was (32.2±4.5) g/L, much lower than in survivors; the Logistic analysis showed that high serum AFP levels, Child-Pugh class C, foci adjacent to blood vessels and without antiviral therapy were all the independent risk factors (P<0.05) impacting the long-term survival of patients with HCC after RFA therapy . Conclusion The RFA under US-guidance in managing patients with sHCC is definitely efficacious, and take the risk factors affecting the survival into consideration and intervenes with them in time might prolong the survivals of patients with sHCC.

Key words: Hepatoma, Radiofrequency ablation, Ultrasound-guidance, Therapy, Prognosis

张亚龙, 胡冬梅, 赵晟, 孟海生. 超声引导下射频消融治疗小原发性肝癌疗效及死亡危险因素分析^*[J]. 实用肝脏病杂志, 2024, 27(2): 271-274.

Zhang Yalong, Hu Dongmei, Zhao Sheng, et al.. Two-year survival of radiofrequency ablation for small solitary hepatocellular carcinoma: a single center study[J]. Journal of Practical Hepatology, 2024, 27(2): 271-274.

参考文献

[1] Godfrey TM, Villavicencio EA, Barra K, et al. Advancing liver cancer prevention for american indian populations in arizona: an integrative review. Int J Environ Res Public Health, 2022, 19(6):3268-3277.
[2] Macias R, Monte MJ, Serrano MA, et al. Impact of aging on primary liver cancer: epidemiology, pathogenesis and therapeutics. Aging (Albany NY), 2021,13(19):23416-23434.
[3] Bai XM, Cui M, Yang W, et al. The 10-year survival analysis of radiofrequency ablation for solitary hepatocellular carcinoma 5 cm or smaller: primary versus recurrent HCC. Radiology, 2021, 300(2):458-469.
[4] Spiliotis AE, Gäbelein G, Holländer S, et al. Microwave ablation compared with radiofrequency ablation for the treatment of liver cancer: a systematic review and meta-analysis. Radiol Oncol, 2021, 55(3):247-258.
[5] Xia Y, Li J, Liu G, et al. Long-term effects of repeat hepatectomy vs percutaneous radiofrequency ablation among patients with recurrent hepatocellular carcinoma: a randomized clinical trial. JAMA Oncol, 2020, 6(2):255-263.
[6] Bai L, Wang X, Shi S, et al. Evaluation of 3D-CEUS in the recurrence of liver cancer after radiofrequency ablation. J Healthc Eng, 2021, 31(2):553-564.
[7] 中华人民共和国卫生和计划生育委员会医政医管局. 原发性肝癌诊疗规范(2017年版) . 中华消化外科杂志, 2017, 16(7) :635-647.
[8] Chan LK, Tsui YM, Ho DW, et al. Cellular heterogeneity and plasticity in liver cancer. Semin Cancer Biol, 2022, 82(6):134-149.
[9] Maki H, Hasegawa K. Advances in the surgical treatment of liver cancer. Biosci Trends, 2022, 16(3):178-188.
[10] Lee J, Shin IS, Yoon WS, et al. Comparisons between radiofrequency ablation and stereotactic body radiotherapy for liver malignancies: meta-analyses and a systematic review. Radiother Oncol, 2020, 145(2):63-70.
[11] Qi X, Yang M, Ma L, et al. Synergizing sunitinib and radiofrequency ablation to treat hepatocellular cancer by triggering the antitumor immune response. J Immunother Cancer, 2020, 8(2):1038-1045.
[12] Yap S, Ooi EH, Foo JJ, et al. Bipolar radiofrequency ablation treatment of liver cancer employing monopolar needles: a comprehensive investigation on the efficacy of time-based switching. Comput Biol Med, 2021, 131(4):1042-1053.
[13] Fan H, Wang X, Qu J, et al. Periprocedural risk factors for incomplete radiofrequency ablation of liver metastases from colorectal cancer: a single-center retrospective analysis. Int J Hyperthermia, 2021, 38(1):985-994.
[14] Han K, Kim JH, Yang SG, et al. A Single-center retrospective analysis of periprocedural variables affecting local tumor progression after radiofrequency ablation of colorectal cancer liver metastases. Radiology, 2021, 298(1):212-218.
[15] Guo C, Liang H, Yuan W, et al. Analysis on the value of soluble intercellular adhesion molecule-1 (sICAM-1), alpha fetoprotein (AFP), and aspartate aminotransferase/platelet ratio index (APRI) in predicting the prognostic survival of patients with primary liver cancer after radiofrequency ablation. Ann Palliat Med, 2021, 10(4):4760-4767.
[16] Yang G, Wang G, Sun J, et al. The prognosis of radiofrequency ablation versus hepatic resection for patients with colorectal liver metastases: a systematic review and meta-analysis based on 22 studies. Int J Surg, 2021, 87(3):896-907.
[17] Kurilova I, Bendet A, Petre EN, et al. Factors associated with local tumor control and complications after thermal ablation of colorectal cancer liver metastases: a 15-year retrospective cohort study. Clin Colorectal Cancer, 2021, 20(2):82-95.
[18] Zhou B, He N, Hong J, et al. HIFU for the treatment of gastric cancer with liver metastases with unsuitable indications for hepatectomy and radiofrequency ablation: a prospective and propensity score-matched study. BMC Surg, 2021, 21(1):308-317.
[19] Schullian P, Laimer G, Putzer D, et al. Stereotactic radiofrequency ablation of primary liver tumors in the caudate lobe. HPB (Oxford), 2020, 22(3):470-478.
[20] Huang PJ, Chiu CC, Hsiao MH, et al. Potential of antiviral drug oseltamivir for the treatment of liver cancer. Int J Oncol, 2021, 59(6):109-122.
[21] Yu J, Kim DH, Lee J, et al. Radiofrequency ablation versus stereotactic body radiation therapy in the treatment of colorectal cancer liver metastases. Cancer Res Treat, 2022, 54(3):850-859.

超声引导下射频消融治疗小原发性肝癌疗效及死亡危险因素分析^*

Two-year survival of radiofrequency ablation for small solitary hepatocellular carcinoma: a single center study

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