腹腔镜射频消融治疗不可切除的肝细胞癌：长期随访。
Laparoscopic radiofrequency ablation of unresectable hepatocellular carcinoma: long-term follow-up.
机构信息
General Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.
出版信息
HPB (Oxford). 2008;10(5):315-20. doi: 10.1080/13651820802247102.
BACKGROUND
Hepatocellular carcinoma (HCC) has seen a dramatic rise in the USA over the last 30 years. Unresectable disease is present in 80-90% of patients, for which radiofrequency ablation (RFA) is an option. The aim of this study is to report the long-term survival after laparoscopic RFA.
METHODS
This is a prospective analysis of 104 patients who underwent 122 ablations for unresectable HCC from April 1997 to December 2006 at a tertiary care center. Overall survival (OS) and disease-free survival (DFS) were calculated using Kaplan-Meier curves, excluding 11 patients who subsequently underwent liver transplantation. Patients were analyzed using Child-Pugh classification, Barcelona Clinic Liver Cancer (BCLC) staging and various clinical parameters.
RESULTS
Median (range) data: age 63 years (41-81), lesion size 3.5 cm (1-10), number of lesions 1 (1-5), AFP 26.5 ng/ml (3.7-43588.5) and time from diagnosis to RFA 2 months (mos) (1-42). The median Kaplan-Meier survival for all patients was 26 mos (OS) while DFS was 14 mos. Univariate analysis demonstrated improved OS for the absence vs. presence of ascites (31 vs. 15 mos, p=0.003), Bilirubin <2 mg/dl vs. > or = 2 mg/dl (27 vs. 19 mos, p=0.01), AFP <400 vs. > or = 400 (29 vs. 13 mos, p<0.0001) and Child-Pugh Grade (A = 28, B = 15, C = 5 mos, p=0.01). Significant factors for improved DFS: absence vs. presence of ascites (16 vs. 5 mos, p=0.02), Bilirubin <2 vs. > or = 2 (14 vs. 5 mos, p=0.0278), AFP <400 vs. > or = 400 (15 vs. 4 mos, p=0.0025), Child-Pugh Grade (A = 16, B = 10, C = 3 mos, p=0.03). Patient age, largest tumor size, number of lesions, INR and albumin did not reach clinical significance. Three and five-year actual survival rates are 21% and 8.3%, respectively.
CONCLUSIONS
Our study suggests that RFA may have a positive impact on survival for unresectable HCC. It also determines which patients fare best after RFA, by determining predictive factors that improve their survival.
背景
在过去的 30 年中，美国的肝细胞癌（HCC）发病率急剧上升。80-90%的患者患有不可切除的疾病，对于这些患者，射频消融（RFA）是一种选择。本研究旨在报告腹腔镜 RFA 后的长期生存情况。
方法
这是对 1997 年 4 月至 2006 年 12 月在一家三级医疗中心接受不可切除 HCC 治疗的 104 例患者的 122 例消融术的前瞻性分析。使用 Kaplan-Meier 曲线计算总生存率（OS）和无病生存率（DFS），排除 11 例随后接受肝移植的患者。使用 Child-Pugh 分类、巴塞罗那临床肝癌（BCLC）分期和各种临床参数对患者进行分析。
结果
中位（范围）数据：年龄 63 岁（41-81），病灶大小 3.5cm（1-10），病灶数 1（1-5），AFP 26.5ng/ml（3.7-43588.5），RFA 诊断至治疗的时间为 2 个月（mos）（1-42）。所有患者的中位 Kaplan-Meier 生存时间为 26mos（OS），DFS 为 14mos。单因素分析显示，腹水的有无（31 vs. 15 mos，p=0.003）、胆红素<2mg/dl 与>或=2mg/dl（27 vs. 19 mos，p=0.01）、AFP<400 与>或=400（29 vs. 13 mos，p<0.0001）和 Child-Pugh 分级（A=28，B=15，C=5 mos，p=0.01）改善 OS。DFS 的显著改善因素：有无腹水（16 vs. 5 mos，p=0.02）、胆红素<2 与>或=2（14 vs. 5 mos，p=0.0278）、AFP<400 与>或=400（15 vs. 4 mos，p=0.0025）、Child-Pugh 分级（A=16，B=10，C=3 mos，p=0.03）。患者年龄、最大肿瘤大小、病灶数、INR 和白蛋白未达到临床意义。实际 3 年和 5 年生存率分别为 21%和 8.3%。
结论
本研究表明，RFA 可能对不可切除 HCC 的生存有积极影响。它还通过确定改善生存的预测因素，确定了哪些患者在 RFA 后预后最好。
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