Zhang Lan, Ge Ning-Lin, Chen Yi, Xie Xiao-Ying, Yin Xin, Gan Yu-Hong, Zhang Bo-Heng, Zhang Ju-Bo, Chen Rong-Xin, Wang Yan-Hong, Ye Sheng-Long, Ren Zheng-Gang
Liver Cancer Institute, Zhongshan Hospital, Fudan University, 136 Xue Yuan Road, Shanghai, 200032, China.
Med Oncol. 2015 Mar;32(3):77. doi: 10.1007/s12032-015-0532-z. Epub 2015 Feb 20.
Radiofrequency ablation (RFA) has been used as a curative therapy for small hepatocellular carcinoma (HCC). However, relatively little is known about the long-term outcome of RFA for small HCC in a background of hepatitis B infection, which is common among the Chinese population. Between May 2001 and May 2012, 837 patients with HCC nodules ≤3 cm treated with RFA were enrolled in this study. We evaluated long-term survival rates, local tumor progression rates, complications and the prognostic factors. Among 1020 tumor nodules in 837 patients, complete ablation was achieved in 98.8% (1008/1020) and the 1-, 3-,5-, and 10-year overall survival rates were 91, 71, 54, and 33%, respectively. Multivariate analysis revealed that tumor number [P = 0.003, hazard ratio (HR) 1.523, 95% confidence interval (CI) 1.158-2.004], Child-Pugh grade (P = 0.001, HR 3.089, 95% CI 2.238-4.266), and serum-glutamyltranspeptidase level (P = 0.002, HR 1.576, 95% CI 1.251-1.985) were independent predictors of overall survival. The 1-, 3-, 5-, and 10-year recurrence-free survival rates were 74, 44, 30, and 15%, respectively. Multivariate analysis revealed that serum α-fetoprotein level (P = 0.041, HR 1.249, 95% CI 1.028-1.517) and tumor number (P = 0002, HR 1.449, 95% CI 1.143-1.836) were independent predictors of recurrence-free survival. There were no procedure-related patient deaths and major complications occurred in 0.59% (5/837) of patients. RFA achieved comparable long-term overall survival rates to those of surgical resection with fewer major complications and could therefore be considered as an alternative option for curative treatment of patients with small liver cancer.
射频消融术（RFA）已被用作小肝细胞癌（HCC）的一种治愈性疗法。然而，对于在乙型肝炎感染背景下小肝癌接受RFA治疗的长期结果，人们了解相对较少，而乙型肝炎感染在中国人群中很常见。在2001年5月至2012年5月期间，本研究纳入了837例接受RFA治疗的HCC结节≤3 cm的患者。我们评估了长期生存率、局部肿瘤进展率、并发症及预后因素。在837例患者的1020个肿瘤结节中，98.8%（1008/1020）实现了完全消融，1年、3年、5年和10年的总生存率分别为91%、71%、54%和33%。多因素分析显示，肿瘤数量[P = 0.003，风险比（HR）1.523，95%置信区间（CI）1.158 - 2.004]、Child-Pugh分级（P = 0.001，HR 3.089，95% CI 2.238 - 4.266）以及血清γ-谷氨酰转肽酶水平（P = 0.002，HR 1.576，95% CI 1.251 - 1.985）是总生存的独立预测因素。1年、3年、5年和10年的无复发生存率分别为74%、44%、30%和15%。多因素分析显示，血清甲胎蛋白水平（P = 0.041，HR 1.249，95% CI 1.028 - 1.517）和肿瘤数量（P = 0.002，HR 1.449，95% CI 1.143 - 1.836）是无复发生存的独立预测因素。没有与手术相关的患者死亡，0.59%（5/837）的患者发生了严重并发症。RFA实现了与手术切除相当的长期总生存率，且严重并发症较少，因此可被视为小肝癌患者治愈性治疗的替代选择。
