Peng Zhen-Wei, Zhang Yao-Jun, Chen Min-Shan, Liang Hui-Hong, Li Jin-Qing, Zhang Ya-Qi, Lau Wan Y
Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-Sen University, 651 Dongfeng Road East, Guangzhou 510060, China.
Surg Oncol. 2008 Jul;17(1):23-31. doi: 10.1016/j.suronc.2007.08.002. Epub 2007 Sep 14.
This study aimed to determine the risk factors of survival in patients with hepatocellular carcinoma (HCC) undergoing percutaneous radiofrequency ablation (PRFA).
Between August 1999 and May 2005, 281 patients (250 males and 31 females) who were 33-80 years old (mean 65.3 years) received PRFA only or PRFA in combination with percutaneous ethanol injection (PEI) in our center. Patients were treated with PRFA or PEI by a percutaneous approach with ultrasound (US) guidance and were evaluated at regular intervals to determine disease recurrence and survival. The survival curves were constructed by the Kaplan-Meier method and compared by the log-rank test. The relative significance of the variables in the risk factors of overall survival was assessed by multivariate Cox proportional hazards regression analysis.
At the end of the study, 189 patients were alive, and 92 were dead. Median survival was 48.7 months. The overall 1-, 3-, and 5-year survival rates were 89%, 54%, and 43%, respectively. The overall 1-, 3-, and 5-year survival rates for small tumor (size < or = 3cm) were 97.8%, 65.7%, 58.6%, respectively, for medium tumor (size 3.1-5cm) 94.1%, 57.1%, 37.1%, respectively, and for large tumor (size >5cm) 62.8%, 40.3%, 0%, respectively. Survival of patients treated with PRFA was dependent on tumor size (p<0.001; risk ratio [RR] 9.6, 95% CI 5.2-17.8), number of tumors (p=0.003; RR 1.6, 95% CI 1.2-2.0), combination with PEI (p=0.01; RR 0.6, 95% CI 0.4-0.9), Child-Pugh class (p=0.002; RR 2.0, 95% CI 1.3-3.0) and safety margin (p=0.0026; RR 0.6, 95% CI 0.4-0.9).
PRFA is an effective treatment for HCC. This study showed after PRFA, tumor size, number of tumors, combination with PEI, safety margin, and Child-Pugh class were independent risk factors of survival.
本研究旨在确定接受经皮射频消融（PRFA）的肝细胞癌（HCC）患者的生存危险因素。
1999年8月至2005年5月，281例年龄在33 - 80岁（平均65.3岁）的患者（250例男性和31例女性）在本中心接受单纯PRFA或PRFA联合经皮乙醇注射（PEI）治疗。患者在超声（US）引导下经皮接受PRFA或PEI治疗，并定期评估以确定疾病复发和生存情况。采用Kaplan-Meier法构建生存曲线，并通过对数秩检验进行比较。通过多变量Cox比例风险回归分析评估各变量在总生存危险因素中的相对重要性。
研究结束时，189例患者存活，92例死亡。中位生存期为48.7个月。总体1年、3年和5年生存率分别为89%、54%和43%。小肿瘤（大小≤3cm）的总体1年、3年和5年生存率分别为97.8%、65.7%、58.6%，中肿瘤（大小3.1 - 5cm）分别为94.1%、57.1%、37.1%，大肿瘤（大小＞5cm）分别为62.8%、40.3%、0%。接受PRFA治疗患者的生存情况取决于肿瘤大小（p＜0.001；风险比[RR]9.6，95%可信区间[CI]5.2 - 17.8）、肿瘤数量（p = 0.003；RR 1.6，95%CI 1.2 - 2.0）、与PEI联合使用（p = 0.01；RR 0.6，95%CI 0.4 - 0.9）、Child-Pugh分级（p = 0.002；RR 2.0，95%CI 1.3 - 3.0）和安全切缘（p = 0.0026；RR 0.6，95%CI 0.4 - 0.9）。
PRFA是治疗HCC的有效方法。本研究表明，PRFA术后，肿瘤大小、肿瘤数量、与PEI联合使用、安全切缘和Child-Pugh分级是生存的独立危险因素。
