超声引导下微波消融治疗结直肠癌肝转移患者的疗效及影响因素

摘要/Abstract

摘要： 目的评估超声引导下微波消融(MWA)治疗结直肠癌肝转移(CRLM)患者的疗效,并探讨影响其预后的关键因素。方法回顾性分析2022年6月至2024年6月北京大学首钢医院收治的120例接受超声引导下MWA治疗的CRLM患者的临床资料。评估指标包括完全消融率、并发症发生率、局部肿瘤进展率、无进展生存期及总生存期。采用Kaplan-Meier法计算生存率,Log-rank检验进行单因素分析,Cox比例风险模型进行多因素分析以确定独立预后因素。结果全组共消融225个病灶,首次完全消融率为96.0%,主要并发症发生率为2.5%。中位随访18.5个月后,局部肿瘤进展率为8.3%,中位无进展生存期(PFS)为14.0个月。至末次随访,中位总生存期未达到,1年累积总生存率为92.3%。多因素分析显示,未接受全身化疗、肝转移瘤数量≥3个、最大肿瘤直径>3 cm是患者PFS缩短的独立危险因素。结论超声引导下MWA是治疗CRLM安全且有效的局部治疗手段。积极联合全身化疗并有效控制肝内肿瘤负荷,是改善患者预后的关键。

关键词: 超声, 微波消融, 结直肠癌肝转移

Abstract: Objective To evaluate the efficacy of ultrasound-guided microwave ablation (MWA) in treating patients with colorectal cancer liver metastases (CRLM) and to investigate the key factors influencing prognosis. Methods A retrospective analysis was conducted on the clinical data of 120 CRLM patients who underwent ultrasound-guided MWA at Peking University Shougang Hospital between June 2022 and June 2024. Outcome measures included the complete ablation rate, complication rate, local tumor progression (LTP) rate, progression-free survival (PFS), and overall survival (OS). Survival rates were calculated using the Kaplan-Meier method. Univariate analysis was performed using the Log-rank test, and multivariate analysis was conducted using a Cox proportional hazards regression model to identify independent prognostic factors. Results A total of 225 lesions were ablated in all patients. The initial complete ablation rate was 96.0%, and the major complication rate was 2.5%. After a median follow-up of 18.5 months, the LTP rate was 8.3%, and the median PFS was 14.0 months. The median OS was not reached by the end of the follow-up period, with a 1-year cumulative OS rate of 92.3%. Multivariate analysis identified failure to receive systemic chemotherapy, the presence of ≥3 liver metastases, and a maximum tumor diameter >3 cm as independent risk factors for shortened PFS. Conclusion Ultrasound-guided MWA is a safe and effective local treatment modality for CRLM. Active combination with systemic chemotherapy and effective control of intrahepatic tumor burden are key to improving patient prognosis.

Key words: Ultrasound, Microwave ablation, Colorectal liver metastases

李猛, 王晓东, 陈新, 卢玉菡, 庄妍, 侯东东. 超声引导下微波消融治疗结直肠癌肝转移患者的疗效及影响因素[J]. 肝脏, 2026, 31(6): 834-837.

Li Meng, Wang Xiaodong, Chen Xin, Lu Yuhan, Zhuang Yan, Hou Dongdong. The efficacy and influencing factors of ultrasound-guided microwave ablation in the treatment of patients with colorectal cancer liver metastasis[J]. Chinese Hepatolgy, 2026, 31(6): 834-837.

/ 推荐

参考文献

[1] 中国医师协会外科医师分会, 中华医学会外科学分会胃肠外科学组, 中华医学会外科学分会结直肠外科学组, 等. 结直肠癌肝转移诊断和综合治疗指南(2025版)[J]. 中华消化外科杂志, 2025, 24(8): 943-968.
[2] Engstrand J, Nilsson H, Strömberg C, et al. Colorectal cancer liver metastases-a population-based study on incidence, management and survival[J]. BMC Cancer, 2018, 18(1): 78.
[3] Chen N, Pu C, Zhao L,et al. Chimeric antigen receptor T cells targeting CD19 and GCC in metastatic colorectal cancer: a nonrandomized clinical trial[J]. JAMA Oncol, 2024, 10(11): 1532-1536.
[4] 杨利平, 于杰, 李勤英, 等. 超声引导下微波消融对复发性肝癌长期疗效的影响因素研究[J]. 肝脏, 2024, 29 (2): 189-192.
[5] Krul M F, Gerritsen S L, Vissers F L, et al. Radiofrequency versus microwave ablation for intraoperative treatment of colorectal liver metastases[J]. Eur J Surg Oncol, 2022, 48(4): 834-840.
[6] Sarioglu A G, Wehrle C J, Akgun E, et al. Radiofrequency ablation versus microwave ablation for colorectal liver metastases: long-term results of a retrospective cohort surgical experience[J]. Hepatobiliary Surg Nutr, 2024, 13(5): 759-770.
[7] Mimmo A, Pegoraro F, Rhaiem R, et al. Microwave ablation for colorectal liver metastases: a systematic review and pooled oncological analyses[J]. Cancers (Basel), 2022, 14(5): 1305.
[8] 郭仁芬, 柴芳, 邢孔浪, 等. 重组人血管内皮抑素结合多西紫杉醇动脉介入治疗结直肠癌肝转移的临床效果[J]. 肝脏, 2024, 29(6): 657-661.
[9] Czauderna C, Luley K, von Bubnoff N, et al. Tailored systemic therapy for colorectal cancer liver metastases[J]. Int J Mol Sci, 2021, 22(21): 11780.
[10] 韩磊, 武雪亮, 郭飞, 等. 微波消融在潜在可切除的结直肠癌伴同时性多发肝转移中的临床应用[J]. 中国医学科学院学报, 2024, 46(2): 161-168.
[11] Sendi H, Yazdimamaghani M, Hu M, et al. Nanoparticle delivery of miR-122 inhibits colorectal cancer liver metastasis[J]. Cancer Res. 2022, 82(1): 105-113.
[12] 潘宇, 周荷英, 秦远红, 等. 结直肠癌肝转移患者微波消融术后肝内无进展生存期列线图模型及其预测价值[J]. 介入放射学杂志, 2023, 32(11): 1088-1095.
[13] Ocuin L M. Invited commentary: biology remains the ultimate arbiter of survival in metastatic colorectal cancer. Invited commentary on "Multiple colorectal liver metastases resection can offer long-term survival. The concept of a chronic neoplastic disease."[J]. Surgery, 2023, 173(4): 991-992.
[14] Li X, Wang Z, Jiao C, et al. Hepatocyte SGK1 activated by hepatic ischemia-reperfusion promotes the recurrence of liver metastasis via IL-6/STAT3[J]. J Transl Med, 2023, 21(1): 121.

[1]	刘阳, 刘静, 李志艳, 任洪伟, 张萌萌, 刘树红, 高珅, 刘长春, 刘渊. 肝脏血管肉瘤影像与临床分析[J]. 肝脏, 2026, 31(6): 812-815.
[2]	王建斌, 梁栋. TACE联合索拉非尼及消融术序贯治疗大肝癌的临床疗效及其对术后疾病进展时间的影响[J]. 肝脏, 2026, 31(6): 822-825.
[3]	刘小兰, 王体伟. 乙型肝炎肝纤维化声像和弹性成像特征分析及其在疾病诊断和病情评估中的价值[J]. 肝脏, 2026, 31(6): 851-856.
[4]	胡璇, 吴庆. 超声引导经皮穿刺置管无水乙醇冲洗联合聚桂醇泡沫治疗单纯性肝囊肿的疗效分析[J]. 肝脏, 2026, 31(5): 664-667.
[5]	王臣, 胡春峰. 肝脏占位性病变经皮穿刺活检术取材满意度的危险因素分析[J]. 肝脏, 2026, 31(4): 517-520.
[6]	李家山, 杜运松, 马猛, 宋岩. CT动态增强扫描联合超声引导下肝穿刺活检诊断肝脏占位性病变的价值[J]. 肝脏, 2026, 31(4): 525-527.
[7]	刘婷, 杨婉莹, 陈佳锐, 涂娇, 钱嵘. 超声剪切波弹性成像、门静脉血流动力学参数对肝硬化严重程度的评估价值[J]. 肝脏, 2026, 31(3): 341-344.
[8]	庞成, 莫超艳, 黄昌发, 王友华. CT引导下微波消融术联合仑伐替尼治疗原发性肝癌的疗效[J]. 肝脏, 2026, 31(3): 375-379.
[9]	王海玉, 张美喜, 张志博, 李静, 王倩. 门静脉血流动力学联合RLR评估乙型肝炎肝硬化并发食管静脉曲张效能研究[J]. 肝脏, 2026, 31(2): 187-190.
[10]	陈津津, 胡欣, 秦菲, 蒋骏麟, 李琳. 单点剪切波弹性成像联合超声造影定量参数检测评估TIPS治疗肝硬化并发门静脉高压症的价值[J]. 肝脏, 2026, 31(2): 200-203.
[11]	郑冰, 李晓和, 郭杏春, 莫鹏. 超声引导下微波消融术治疗特殊部位肝细胞癌的可行性研究[J]. 肝脏, 2026, 31(2): 204-206.
[12]	郭凯, 周晓军, 高红英, 张之键, 李婷. 超声FibroTouch定量技术在中青年体检人群脂肪肝筛查及肝纤维化评估中的应用[J]. 肝脏, 2026, 31(2): 264-266.
[13]	李占兰, 刘国安, 刘理冠, 赖江琼. 基于灰阶超声、超声造影特征的肝硬化背景下小肝癌微血管侵犯预测模型构建[J]. 肝脏, 2026, 31(1): 23-29.
[14]	钱嵘, 张震, 王成晨, 郭明阳, 何沈岩, 陈慧冲, 涂娇, 陈婷婷, 刘婷, 裴峰. 超声肝脏脂肪分数定量评估肝脏脂肪变性的临床研究[J]. 肝脏, 2025, 30(9): 1192-1194.
[15]	尹雯, 沈荣. 动态三维超声造影对HBV相关肝细胞癌患者微波消融后临床疗效及复发的评估[J]. 肝脏, 2025, 30(9): 1249-1253.