专题研究(Monographic Study)

经皮微波消融治疗较大原发性肝癌的可行性及疗效研究

Published at: 2016年第25卷第1期

许贇 1 , 王能 1 , 沈强 1 , 盛月红 1 , 钱国军 1
1 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.1005-6947.2016.01.007
基金:
国家“十二五”医学重大专项基金资助项目 2012IX0002016
国家“十二五”医学重大专项基金资助项目 2012IX0002016

摘要

目的:评估经皮微波消融(PMWA)治疗较大原发肝癌(HCC)的可行性和疗效。方法:回顾性收集2007 年1 月—2010 年1 月49 例接受了超声引导下PMWA 手术不可行的较大HCC(5~6 cm)患者的临床与随访资料。分析患者肿瘤完全消融率、严重并发症发生率,治疗后的总体生存(OS)和无瘤生存(DFS)情况,以及OS 影响因素。结果:49 例患者中首次肿瘤完全消融率为85.7%,二次消融后所有患者均达到完全消融率。严重并发症发生率为8.1%。截至随访结束(中位随访时间48 个月),41 例(87.5%)出现了肝内复发;平均生存时间(54.4±32.0)个月;1、3、5 年OS 分别为87.8%、63.3%、39.1%。平均DFS 时间为(35.8±30.6)个月,1、3、5 年DFS 率分别为69.4%、40.9%、21.8%。单因素分析显示术前乙肝病毒定量阳性和甲胎蛋白(AFP)高水平是影响OS 的不良因素(均P<0.05),多因素分析显示术前AFP 高水平是OS 的独立影响因素(HR=1.730,95% CI=1.135~2.635,P=0.011)。结论:PMWA 是较大肝癌安全可行且有效的治疗方式,但术后复发的治疗仍需探索。术前AFP 高水平是PMWA 术后OS 的独立影响因素。


Efficacy and feasibility of percutaneous microwave ablation for relatively large hepatocellular carcinoma

Abstract

Objective: To investigate the efficacy and feasibility of percutaneous microwave ablation (PMWA) in treatment of relatively large hepatocellular carcinoma (HCC). Methods: The clinical and follow-up data of 49 patients with unresectable and relatively large (5~6 cm) HCC who underwent ultrasound-guided PMWA from January 2007 to January 2010 were reviewed. The complete ablation (CA) rate, incidence of severe complications, overall survival rate (OS), and disease-free survival rate (DFS) as well as prognostic factors for OS of the patients were analyzed. Results: Of the 49 patients, the CA rate after initial PMWA was 85.7%, and CA was achieved in all cases after a second session of PMWA. The incidence of severe complications was 8.1%. At the end of follow-up (median follow-up time was 48 months), intrahepatic recurrence occurred in 41 cases (87.5%), the average survival time was (54.4±32.0) months, and the 1-, 3- and 5-year OS was 87.8%, 63.3% and 39 .1%, respectively; the average DFS time was (35.8±30.6) months and the 1-, 3- and 5-year DFS was 69.4%, 40.9% and 21.8%, respectively. Univariate analysis showed that preoperative positive quantitative HBV DNA and high level of alpha fetoprotein (AFP) were unfavorable factors for OS (both P<0.05), and multivariate analysis showed that preoperative high AFP level was independent influential factor for OS (HR=1.730, 95% CI=1.135–2.635, P=0.011). Conclusion: PMWA is a safe, feasible and effective treatment for relatively large HCC. However, the treatment of recurrence remains a challenge. High preoperative AFP level is independent factor of the OS after PMWA.


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引用

引用本文: 贇 许, 能 王, 强 沈, 月红 盛, 国军 钱. 经皮微波消融治疗较大原发性肝癌的可行性及疗效研究[J]. 中国普通外科杂志, 2016, 25(1): 39-44.
Cite this article as: XU Yun, WANG Neng, SHEN Qiang, SHENG Yuehong, QIAN Guojun . Efficacy and feasibility of percutaneous microwave ablation for relatively large hepatocellular carcinoma[J]. Chin J Gen Surg, 2016, 25(1): 39-44.