经皮射频消融术与再次肝切除术治疗复发性肝细胞癌的回顾性研究

Percutaneous radiofrequency ablation versus repeat hepatectomy for recurrent hepatocellular carcinoma: a retrospective study.

作者信息

Liang Hui-Hong, Chen Min-Shan, Peng Zhen-Wei, Zhang Yao-Jun, Zhang Ya-Qi, Li Jin-Qing, Lau Wan Yee

机构信息

State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China.

出版信息

Ann Surg Oncol. 2008 Dec;15(12):3484-93. doi: 10.1245/s10434-008-0076-y. Epub 2008 Aug 5.

DOI:10.1245/s10434-008-0076-y

PMID:18679754

Abstract

BACKGROUND

Whether percutaneous radiofrequency ablation (PRFA) is as effective as repeat hepatectomy for recurrent small hepatocellular carcinoma (HCC) in the long-term remains unknown.

METHODS

We included 110 patients into this study. Each patient had fewer than three recurrent HCCs, with the largest tumor less than 5 cm in diameter. Sixty-six patients with 88 tumors were treated by PRFA and 44 patients with 55 tumors were treated by repeat hepatectomy.

RESULTS

The 1-, 2-, 3-, 4-, and 5-year overall survival rates after repeat hepatectomy and PRFA were 78.6%, 56.8%, 44.5%, 30.7%, and 27.6%, and 76.6%, 48.6%, 48.6%, 39.9%, and 39.9%, respectively (P = 0.79). The 1-, 2-, 3-, 4-, and 5-year overall survival rates after the initial hepatectomy for the two groups were 95.4%, 79.1%, 65.0%, 50.4%, and 42.9%, and 98.5%, 85.0%, 70.8%, 58.7%, and 55.6%, respectively, (P = 0.18). Subgroup analyses showed that there was no significant difference between the overall survivals of the two groups of patients when the interval of tumor recurrence from the initial hepatectomy was <or=1 year (P = 0.74) or >1 year (P = 0.69), and for recurrent tumor <or=3 cm (P = 0.62) or >3 cm (P = 0.57). Major complications happened significantly more often after repeat hepatectomy than PRFA (30 of 44 versus 2 of 66, P < 0.05). The interval of recurrence from the initial hepatectomy, the diameter of the recurrent tumor and the serum albumin level were significant prognostic factors for overall survival.

CONCLUSION

PRFA was as effective as repeat hepatectomy in the treatment of recurrent small HCC. PRFA had the advantage over repeat hepatectomy in being less invasive.

摘要

背景

经皮射频消融术（PRFA）对于复发性小肝细胞癌（HCC）的长期疗效是否等同于再次肝切除术尚不清楚。

方法

本研究纳入110例患者。每位患者复发性HCC少于3个，最大肿瘤直径小于5厘米。66例患者的88个肿瘤接受了PRFA治疗，44例患者的55个肿瘤接受了再次肝切除术治疗。

结果

再次肝切除术后和PRFA术后1年、2年、3年、4年和5年的总生存率分别为78.6%、56.8%、44.5%、30.7%和27.6%，以及76.6%、48.6%、48.6%、39.9%和39.9%（P = 0.79）。两组初次肝切除术后1年、2年、3年、4年和5年的总生存率分别为95.4%、79.1%、65.0%、50.4%和42.9%，以及98.5%、85.0%、70.8%、58.7%和55.6%（P = 0.18）。亚组分析显示，当初次肝切除术后肿瘤复发间隔≤1年（P = 0.74）或＞1年（P = 0.69），以及复发性肿瘤≤3厘米（P = 0.62）或＞3厘米（P = 0.57）时，两组患者的总生存率无显著差异。再次肝切除术后的主要并发症发生率显著高于PRFA（44例中的30例对66例中的2例，P ＜ 0.05）。初次肝切除术后的复发间隔、复发性肿瘤直径和血清白蛋白水平是总生存的显著预后因素。