联合肝切除术和微波消融治疗多灶性肝细胞癌：长期结果和预后因素。
Combined hepatectomy and microwave ablation for multifocal hepatocellular carcinoma: Long-term outcomes and prognostic factors.
机构信息
Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
出版信息
Asian J Surg. 2021 Jan;44(1):186-191. doi: 10.1016/j.asjsur.2020.05.008. Epub 2020 May 27.
BACKGROUND
It remains to be clarified whether combined hepatectomy and microwave ablation for multifocal hepatocellular carcinoma (HCC) is feasible. This aim of this study was to examine the perioperative and oncological outcomes after combined hepatectomy and microwave ablation for multifocal HCC.
METHODS
This retrospective study included 81 patients who underwent combined hepatectomy and microwave ablation for multifocal HCC in our institute between June 1998 and December 2017. We analyzed overall survival (OS) and recurrence-free survival (RFS), and evaluated factors related to prognosis.
RESULTS
Median follow-up time was 45.6 months for the entire cohort. OS rates were 1-year: 96%, 3-year: 72%, and 5-year: 54%; RFS rates were 1-year: 77%, 3-year: 37%, and 5-year: 22%. The major complication rate (Clavien-Dindo classification IIIa or above) after surgery was 10%, with one patient of in-hospital mortality. Multivariate analysis revealed that des-γ-carboxy prothrombin level >200 mAU/mL and >5 tumors were independent risk factors for OS, and des-γ-carboxy prothrombin level >200 mAU/mL, > 5 tumors, and maximum tumor size >5 cm were independent risk factors for RFS.
CONCLUSIONS
Our results indicate that combined hepatectomy and microwave ablation is safe and feasible for selected patients with multifocal HCC.
背景
联合肝切除术和微波消融治疗多灶性肝细胞癌（HCC）的可行性仍需阐明。本研究旨在探讨联合肝切除术和微波消融治疗多灶性 HCC 的围手术期和肿瘤学结果。
方法
本回顾性研究纳入了 1998 年 6 月至 2017 年 12 月期间在我院接受联合肝切除术和微波消融治疗多灶性 HCC 的 81 例患者。我们分析了总生存率（OS）和无复发生存率（RFS），并评估了与预后相关的因素。
结果
全队列的中位随访时间为 45.6 个月。OS 率为 1 年：96%，3 年：72%，5 年：54%；RFS 率为 1 年：77%，3 年：37%，5 年：22%。术后主要并发症发生率（Clavien-Dindo 分类 IIIa 或以上）为 10%，有 1 例院内死亡。多变量分析显示，去γ-羧基凝血酶原水平>200 mAU/mL 和>5 个肿瘤是 OS 的独立危险因素，而去γ-羧基凝血酶原水平>200 mAU/mL、>5 个肿瘤和最大肿瘤直径>5 cm 是 RFS 的独立危险因素。
结论
我们的结果表明，对于选择的多灶性 HCC 患者，联合肝切除术和微波消融是安全可行的。
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