[肝细胞癌射频消融的生存及预后分析]
[Survival and prognostic analysis of radiofrequency ablation of hepatocellular carcinoma].
作者信息
Yang Wei, Chen Min-hua, Gao Wen, Wu Wei, Huo Ling, Dai Wei-de, Liu Wen-ying, Yan Kun
机构信息
Ultrasound Department, School of Oncology, Peking University, Beijing 100036, China.
出版信息
Zhonghua Wai Ke Za Zhi. 2006 Feb 1;44(3):169-73.
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.
目的
评估射频消融（RFA）治疗肝细胞癌（HCC）后的生存率，并探讨影响总生存、无局部复发生存和无病生存的预后因素。
方法
本研究纳入了在我科接受RFA治疗的192例HCC患者。其中，男性151例，女性41例（平均年龄59.2岁，范围24 - 87岁）。平均肿瘤大小为（3.9±1.3）cm（范围1.2 - 8.0 cm）。这192例HCC患者中，Child-Pugh分级为A、B、C级的分别有106例、77例和9例。根据UICC-TNM系统，Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期的患者分别有57例、85例、44例和6例。单因素分析采用Kaplan-Meier模型和log-rank检验，多因素分析采用COX回归模型来确定生存的预后因素。
结果
1年、2年、3年和4年的总生存率分别为84.9%、69.1%、60.4%和52.8%。无局部复发生存率分别为75.1%、53.8%、43.9%和40.8%。无病生存率分别为64.3%、43.2%、37.1%和25.0%。多因素模型确定的生存独立预后因素如下：（1）总生存：Child-Pugh分级、标准治疗方案和UICC-TNM分期。（2）无局部复发生存：Child-Pugh分级和UICC-TNM分期。（3）无病生存：UICC-TNM分期、Child-Pugh分级和子灶。其中，Child-Pugh分级和UICC-TNM分期是三种生存情况的独立预后因素。
结论
肿瘤进展程度（UICC-TNM分期、子灶）、治疗方法（标准治疗方案的应用）和患者肝功能是RFA治疗后生存的最重要因素。因此，在RFA治疗前、治疗期间和治疗后应采用适当的治疗策略以提高生存率。
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