肝肿瘤专题研究(Monographic Study of Hepatic Tumors)

经皮热消融治疗极早期肝癌的疗效及预后因素分析

Published at: 2015年第24卷第7期

许贇 1,2 , 王能 2 , 沈强 2 , 吴盼盼 1,2 , 钱国军 2
1 苏州大学研究生院,江苏 苏州 215006
2 中国人民解放军第二军医大学东方肝胆外科医院 微创一科,上海 200438
通讯作者 国军 钱 Email: qgjs@sina.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.07.006
基金:
国家“十二五”医学重大专项基金资助项目 2012ZX10002016003

摘要

目的:探讨超声引导下经皮热消融治疗极早期肝癌的临床疗效及预后相关因素。方法:回顾性分析2007 年1 月—2010 年1 月139 例极早期肝癌行超声引导下经皮热消融治疗患者资料,计算肿瘤完全消融率、总体生存率、无瘤生存率并分析预后相关影响因素。结果:全组肿瘤完全消融率97.84%;平均生存时间(70.10±28.87)个月,1、3、5 年总体生存率分别为94.90%、87.70%、73.10%;平均无瘤生存时间(44.70±24.21)个月,1、3、5 年无瘤生存率分别为90.60%、61.90%、43.20%。单因素分析和多因素分析显示,年龄≥ 60 岁、治疗后无瘤生存时间<2 年和肝外转移是影响总体生存时间的独立危险因素(均P<0.05);患有丙型肝炎和术前高AFP 水平是无瘤生存时间的不良影响因素(均P<0.05)。结论:超声引导下经皮热消融治疗是极早期肝癌安全、有效的治疗方式,但高龄、术后早期复发、肝外转移、丙型肝炎和术前高AFP 患者预后不良。


Percutaneous thermal ablation for very early stage hepatocellular carcinoma: efficacy and prognostic factors

Abstract

Objective: To evaluate the efficacy of percutaneous thermal ablation in treatment of very early stage hepatocellular carcinoma (HCC) and the prognostic factors. Methods: The clinical data of 139 patients with very early stage HCC undergoing ultrasound-guided percutaneous thermal ablation from January 2007 to January 2010 were reviewed. The complete ablation rate, overall survival rate and disease-free survival rate were determined and the influential prognost0ic factors were analyzed. Results: In whole group of patients, the complete ablation rate was 97.84%; the average survival time was (70.10±28.87) months, and the 1-, 3-, and 5-year overall survival rates was 94.90%, 87.70% and 73.10%, respectively; the average disease-free survival time was (44.70±24.21) months, and the 1-, 3-, and 5-year disease- free survival rate was 90.60%, 61.90% and 43.20%, respectively. The results of univariate and multivariate analysis showed that age more than 60 years, disease-free survival time less than 2 years and extrahepatic metastases were independent risk factors for overall survival (all P<0.05); hepatitis C infection and preoperative high AFP level were unfavorable factors for disease-free survival (all P<0.05). Conclusion: Percutaneous thermal ablation is a safe and effective treatment modality for very early stage HCC. However, patients with an old age, short-term recurrence after operation, extrahepatic metastases, high preoperative AFP level and hepatitis C infection may face poor outcomes.


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引用

引用本文: 贇 许, 能 王, 强 沈, 盼盼 吴, 国军 钱. 经皮热消融治疗极早期肝癌的疗效及预后因素分析[J]. 中国普通外科杂志, 2015, 24(7): 945-951.
Cite this article as: XU Yun, WANG Neng, SHEN Qiang, WU Panpan, QIAN Guojun . Percutaneous thermal ablation for very early stage hepatocellular carcinoma: efficacy and prognostic factors[J]. Chin J Gen Surg, 2015, 24(7): 945-951.