超声引导下微波消融一线治疗原发性肝癌:临床疗效以及预后影响因素

肝脏 ›› 2016, Vol. 21 ›› Issue (5): 355-359.

超声引导下微波消融一线治疗原发性肝癌:临床疗效以及预后影响因素

马思聪, 王涛, 丁敏, 明雅南, 戚星星, 张源, 翟博

200127 上海交通大学医学院附属仁济医院肿瘤介入科(马思聪,王涛,丁敏,戚星星,张源,翟博);消化内科(明雅南)

收稿日期:2016-03-08 出版日期:2016-05-31 发布日期:2020-07-09
通讯作者: 翟博,Email: zhaiboshi@sina.com
基金资助:
国家自然科学基金项目(81472845)

Ultrasound-guided percutaneous microwave ablation as first-line treatment for HCC: A study on clinical efficacy and prognostic factors

MA Si-cong, WANG Tao, DING Min, MING Ya-nan, QI Xing-xing, ZHANG Yuan, ZHAI Bo

Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China

Received:2016-03-08 Online:2016-05-31 Published:2020-07-09

摘要/Abstract

摘要： 目的评估超声引导下微波消融一线治疗原发性肝癌的临床疗效以及预后影响因素。方法 2010年6月到2014年11月,201例首次诊断为原发性肝癌的患者在本中心接受超声引导下微波消融治疗,随访时间4~53个月。使用单因素(Kaplan-Meier模型)以及多因素(Cox 回归)分析对患者肿瘤复发以及生存的预后因素进行评估。结果肿瘤初次完全消融率为96%,部分患者接受了2次消融,总计完全消融率为99%。微波消融治疗后并发症发生率为5.6%(12/201)。患者术后平均无瘤生存时间为18个月、肝功能Child B级、肿瘤多发、肿瘤直径>5 cm、AFP>20 μg/L是影响患者术后无瘤生存时间的独立危险因素。患者平均总生存时间为38个月,与之相关的独立危险因素为肝炎病史、肿瘤多发以及肿瘤直径>5 cm。结论超声引导下微波消融一线治疗原发性肝癌是安全和有效的,肿瘤直径、数量以及患者肝功能状况是影响患者预后的主要因素。

关键词: 肝癌, 微波消融, 临床疗效, 预后

Abstract: Objective To investigate the clinical efficacy of ultrasound (US)-guided percutaneous microwave ablation as a first-line treatment for hepatocellular carcinoma (HCC), and its prognostic factors analysis.Methods From June 2010 to November 2014, 201 patients who were first diagnosed HCC and receiving US-guided microwave ablation treatment in Shanghai Renji hospital were enrolled, and followed up for 4 to 53 months. Univariate (Kaplan-Meier method) and multivariate (Cox-regression) analysis were applied to determine the prognostic factors for progression-free survival and overall survival.Results Complete ablation rate after first ablation was 96%. For some patients receiving a second ablation, the total complete ablation rate was 99%. Twelve of the 201 (5.6%) patients suffered ablation associated complications. Mean progression-free survival (PFS) of microwave ablation therapy was 18 months. In addition, liver function Child B, multiple tumors, tumor diameter > 5 cm and AFP>20 were independent risk factors associated with worse PFS. Hepatitis history, multiple tumors and tumor diameter > 5cm were independent predictors for overall survival (OS) of which mean value was 38 months.Conclusion US-guided microwave ablation as a first-line therapy for HCC is safe and efficacious. Tumor diameter, tumor number and liver status of patients might be main prognostic factors affecting PFS and OS.

Key words: HCC; Microwave ablation; Clinical efficacy; Prognosis

马思聪, 王涛, 丁敏, 明雅南, 戚星星, 张源, 翟博. 超声引导下微波消融一线治疗原发性肝癌:临床疗效以及预后影响因素[J]. 肝脏, 2016, 21(5): 355-359.

MA Si-cong, WANG Tao, DING Min, MING Ya-nan, QI Xing-xing, ZHANG Yuan, ZHAI Bo. Ultrasound-guided percutaneous microwave ablation as first-line treatment for HCC: A study on clinical efficacy and prognostic factors[J]. Chinese Hepatolgy, 2016, 21(5): 355-359.

参考文献

[1] Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin, 2005, 55: 74-108.
[2] Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65: 87-108.
[3] Lee WC, Jeng LB, Chen MF. Estimation of prognosis after hepatectomy for hepatocellular carcinoma. Br J Surg, 2002, 89: 311-316.
[4] Fan ST, Poon RT, Yeung C, et al. Outcome after partial hepatectomy for hepatocellular cancer within the Milan criteria. Br J Surg, 2011, 98: 1292-300.
[5] Choi D, Lim HK, Rhim H, et al. Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long-term results and prognostic factors in a large single-institution series. Eur Radiol, 2007, 17: 684-692.
[6] Kim YS, Lim HK, Rhim H, et al. Ten-year outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: analysis of prognostic factors. J Hepatol, 2013, 58: 89-97.
[7] Feng K, Yan J, Li X, et al. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol, 2012, 57: 794-802.
[8] Chen MS, Li JQ, Zheng Y, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg, 2006, 243: 321-328.
[9] Shi J, Sun Q, Wang Y, et al. Comparison of microwave ablation and surgical resection for treatment of hepatocellular carcinomas conforming to Milan criteria. J Gastroenterol Hepatol, 2014, 29: 1500-1507.
[10] Ni JY, Xu LF, Sun HL, et al. Percutaneous ablation therapy versus surgical resection in the treatment for early-stage hepatocellular carcinoma: a meta-analysis of 21,494 patients. J Cancer Res Clin Oncol, 2013, 139: 2021-2033.
[11] Yin XY, Xie XY, Lu MD, et al. Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors. Cancer, 2009, 115: 1914-1923.
[12] Lu MD, Yin XY, Xie XY, et al. Percutaneous thermal ablation for recurrent hepatocellular carcinoma after hepatectomy. Br J Surg, 2005, 92: 1393-1398.
[13] Martin RC, Scoggins CR, Mcmasters KM. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience. Ann Surg Oncol, 2010, 17: 171-178.
[14] Shiina S, Tateishi R, Arano T, et al. Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol, 2012, 107: 569-77; quiz 78.
[15] Veltri A, Moretto P, Doriguzzi A, et al. Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC). Eur Radiol, 2006, 16: 661-669.
[16] 陈俊卯, 刘艳华, 陈建立, 等. 无水酒精注射联合射频消融治疗射频消融困难部位的肝癌. 现代肿瘤医学, 2012, 20: 122-124.