摘要
目的探讨射频消融(RFA)治疗肝细胞癌(HCC)的总生存率、无局部复发生存率和无瘤生存率及其预后因素。方法192例HCC患者行超声引导下RFA治疗。男151例,女41例。平均年龄59.2岁(24～87岁)。肿瘤平均大小(3.9±1.3)cm(1.2～8.0cm)。肝功能ChildPugh分级A、B、C级分别为106、77和9例。根据UICCTNM分期,Ⅰ、Ⅱ、Ⅲ、Ⅳ期肝癌分别为57、85、44和6例。单因素分析采用KaplanMeier及Logrank时序检验,多因素采用COX比例风险模型。结果192例HCC患者治疗后1、2、3、4年总生存率为84.9%、69.1%、60.4%和52.8%;无局部复发生存率为75.1%、53.8%、43.9%和40.8%;无瘤生存率为64.3%、43.2%、37.1%和25.0%。多因素分析获得的预后因素为:(1)总生存期:ChildPugh分级,规范化方案治疗和UICCTNM分期。(2)无局部复发生存期:ChildPugh分级,UICCTNM分期。(3)无瘤生存期:UICCTNM分期,ChildPugh分级,卫星灶。其中,ChildPugh分级和UICCTNM分期在3种生存率的预后分析中均为独立预后因素。结论根据RFA治疗结果分析,HCC肿瘤进展程度(UICCTNM分期和有无卫星灶)、患者肝功能以及治疗方法(是否应用规范化方案)是影响疗效的重要因素,此结果有助于在RFA治疗前、中和后3个环节中采取相应措施,以改善生存期。
Objective To assess the survival of radiofrequency ablation （RFA） and investigate the prognostic factors affecting overall survival, local recurrence-free survival and disease-free survival in hepatocellular carcinoma （HCC）. Methods A total of 192 HCC patients underwent RFA treatment in our department and were enrolled into this study. Among them, 151 patients were males and 41 were females （ mean age, 59. 2 years, range, 24-87 years old ）. The average tumor size was （ 3.9 ± 1.3 ） cm （ range, 1.2-8.0 cm）. Of these 192 HCC patients, their Child-Pugh grade of A, B and C were 106, 77 and 9, respectively. According to UICC-TNM system, 57, 85, 44 and 6 patients were in stage Ⅰ ,Ⅱ, Ⅲ and Ⅳ respectively. Kaplan-Meier model and log-rank test were used in univariate analysis and COX regression model was used in multivariate analysis to identify prognostic factors for survival. Results The 1-, 2-, 3- and 4- year overall survival were 84.9% ,69. 1% ,60. 4% and 52. 8% , respectively. Local recurrence-free survival were 75. 1% , 53.8% , 43. 9% and 40. 8% , respectively. Disease-free survival were 64. 3% , 43.2% ,37. 1% and 25. 0%, respectively. The following factors were identified as independent prognostic factors for survival by multivariate model： （1） Overall survival： Child-Pugh classification, standard treatment protocol and UICC-TNM staging. （2） Local recurrence-free survival： Child-Pugh classification and UICC-TNM staging. （3） Disease-free survival： UICC-TNM staging, Child-Pugh classification and daughter lesion. Among these, both Child-Pugh classification and UICC-TNM staging were independent prognostic factors for three kinds of survivals. Conclusions Degree of tumor progress （ UICC-TNM stage, daughter lesion ）, treatment method （ applying of standard treatment protocol） and patients＇ liver function are the most important factors for survival after RFA. So application of proper treatment strategy before, during and after RFA should be required to improve survival.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2006年第3期169-173,共5页
Chinese Journal of Surgery
基金
北京市重大项目培育专项(Z0005190040431)
北京大学医学部"十五""211"工程重点学科建设项目(523)
关键词
癌
肝细胞
导管消融术
预后
Carcinoma, hepatocellular
Catheter ablation
Prognosis
