射频消融与肝切除术治疗 2cm 或更小的肝细胞癌：一项回顾性对比研究。

Radiofrequency ablation versus hepatic resection for the treatment of hepatocellular carcinomas 2 cm or smaller: a retrospective comparative study.

机构信息

Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-Sen University, 651 Dongfeng Rd East, Guangzhou 510060, China.

出版信息

Radiology. 2012 Mar;262(3):1022-33. doi: 10.1148/radiol.11110817.

DOI:10.1148/radiol.11110817

PMID:22357902

Abstract

PURPOSE

To compare retrospectively the effects of percutaneous radiofrequency (RF) ablation with those of hepatic resection in the treatment of hepatocellular carcinoma (HCC) measuring 2 cm or smaller.

MATERIALS AND METHODS

This study was approved by the institutional ethics committee, and all patients provided written informed consent before treatment. From December 2003 to December 2008, 145 patients with a resectable HCC measuring 2 cm or smaller were studied. Sixty-six patients had a central HCC (located at least 3 cm from the liver capsule). As an initial treatment, 71 patients were treated with percutaneous RF ablation and 74 with surgical resection. Of the patients with central HCC, 37 underwent percutaneous RF ablation and 29 underwent surgical resection. Survival curves were constructed with the Kaplan-Meier method and compared by using the log-rank test. The relative prognostic significance of the variables for predicting overall survival rates was assessed with multivariate Cox proportional hazards regression analysis. Complications were observed clinically when patients were admitted and assessed by telephone interview after patients were discharged.

RESULTS

One death was considered to be related to treatment after surgical resection. Major complications occurred significantly more often in the surgical resection group (38 of 74 patients) than in the RF ablation group (14 of 71 patients) (P = .009). The 1-, 3-, and 5-year overall survival rates were 98.5%, 87.7%, and 71.9%, respectively, with RF ablation and 90.5%, 70.9%, and 62.1% with surgical resection (P = .048). The corresponding recurrence-free survival rates were 76.4%, 65.2%, and 59.8% with RF ablation and 75.6%, 56.1%, and 51.3% with surgical resection (P = .548). At subgroup analysis of patients with central HCC, 1-, 3-, and 5-year overall survival rates were 96.6%, 93.0%, and 79.9% with RF ablation and 92.0%, 71.6%, and 61.5% with surgical resection (P = .020). The corresponding recurrence-free survival rates were 86.5%, 74.0%, and 67.0% with RF ablation and 68.0%, 40.0%, and 40.0% with surgical resection (P = .033). For patients with peripheral HCC, 1-, 3-, and 5-year overall survival rates were 97.3%, 83.3%, and 65.1% with RF ablation and 87.8%, 68.4%, and 62.9% with surgical resection (P = .464). The corresponding recurrence-free survival rates were 68.7%, 59.2%, and 54.9% with RF ablation and 82.9%, 66.6%, and 52.9% with surgical resection (P = .351).

CONCLUSION

The efficacy and safety of percutaneous RF ablation were better than those of surgical resection in patients with HCC measuring 2 cm or smaller, especially those with central HCC.

摘要

目的

回顾性比较经皮射频（RF）消融与肝切除术治疗 2cm 或更小的肝细胞癌（HCC）的效果。

材料与方法

本研究经机构伦理委员会批准，所有患者在治疗前均签署了书面知情同意书。2003 年 12 月至 2008 年 12 月，共纳入 145 例可切除的 2cm 或更小 HCC 患者。66 例患者为中央 HCC（位于距肝包膜至少 3cm 处）。初始治疗时，71 例患者行经皮 RF 消融，74 例行手术切除。37 例中央 HCC 患者行经皮 RF 消融，29 例行手术切除。采用 Kaplan-Meier 法构建生存曲线，并采用对数秩检验比较。采用多因素 Cox 比例风险回归分析评估各变量对总生存率的相对预后意义。患者住院时进行临床观察，出院后通过电话访谈进行评估。

结果

手术切除后 1 例患者死亡被认为与治疗有关。手术切除组（74 例）的主要并发症发生率明显高于 RF 消融组（71 例）（P =.009）。RF 消融组的 1、3、5 年总生存率分别为 98.5%、87.7%和 71.9%，手术切除组分别为 90.5%、70.9%和 62.1%（P =.048）。相应的无复发生存率分别为 RF 消融组 76.4%、65.2%和 59.8%，手术切除组为 75.6%、56.1%和 51.3%（P =.548）。在中央 HCC 亚组分析中，RF 消融组的 1、3、5 年总生存率分别为 96.6%、93.0%和 79.9%，手术切除组分别为 92.0%、71.6%和 61.5%（P =.020）。相应的无复发生存率分别为 RF 消融组 86.5%、74.0%和 67.0%，手术切除组为 68.0%、40.0%和 40.0%（P =.033）。对于外周 HCC 患者，RF 消融组的 1、3、5 年总生存率分别为 97.3%、83.3%和 65.1%，手术切除组分别为 87.8%、68.4%和 62.9%（P =.464）。相应的无复发生存率分别为 RF 消融组 68.7%、59.2%和 54.9%，手术切除组为 82.9%、66.6%和 52.9%（P =.351）。