射频消融与手术再切除治疗复发性肝癌的比较

Comparison of the Effects of Percutaneous Radiofrequency Ablation and Surgical Re-resection on Postoperative Recurrence of Hepatocellular Carcinoma

    摘要
  • 摘要: 目的: 比较射频消融和手术再切除治疗原发性肝癌手术切除后复发癌患者的临床疗效。 方法: 分析比较2002年5月至2007年10月76例原发性肝癌手术切除后复发癌患者射频消融(n=45)和手术再切除(n=31)的临床疗效,引入COX比例风险模型初步分析探讨影响再复发和复发后患者生存期的可能因素。 结果: 消融组与再手术组比较,肿瘤完全清除率分别为88.9%和100%(P=0.147),1、2、3、5年复发率分别为45.2%、71.6%、80.1%、86.7%和39.6%、60.9%、77.6%、83.2%(P=0.711),1、2、3、5年复发后生存率分别为81.8%、60.1%、40.3%、24.2%和82.9%、64.7%、46.4%、34.8%(P=0.599)。复发间期(复发癌距初次手术切除的时间)及复发癌结节个数是影响再手术切除和消融治疗后再复发的危险因素(P=0.035,P=0.005),复发癌结节个数及再复发时间是影响复发后患者生存期的危险因素(P=0.006,P=0.000)。消融组并发症的发生率为13.3%,再手术组为29.0%(P=0.091)。消融组患者无需输血而再手术组需输血的比率为35.5%(P=0.000)。住院时间消融组为7.0天±0.8天,较之再手术组21.9天±1.6天明显缩短(P=0.000)。 结论: 对于原发性肝癌切除术后复发癌患者射频消融术亦可以获得与手术再切除相当的长期生存率,而且具有微创、经济、重复性好的优势,适合于复发癌患者的治疗。

     

    Abstract: Objective : To compare the clinical results of percutaneous radiofrequency ablation (PRFA) with those ofsurgical re-resection (SRR) in patients with postoperative recurrence of hepatocellular carcinoma (RHCC). Methods : Clinical data from 76 RHCC patients seen in our hospital from May 2002 to October 2007 were retro-spectively reviewed. According to the treatment they received, the patients were divided into two groups: theSRR group (n=31) and the PRFA group (n=45). Survival time, tumor-free survival time, hospitalization timeand treatment-related complications were compared between the two groups. We employed the Cox propor-tional hazards model to analyze the risk factors for re-recurrence and decreased survival time after repeatedhepatectomy. Results : The rate of complete elimination of tumor was similar in the two groups (100% vs.88.9%, P=0.147). The 1-, 2-, 3- and 5- year recurrence rates were 39.6%, 60.9%, 77.6%, and 83.2%, respec-tively, in the SRR group. The 1-, 2-, 3- and 5- year re-recurrence rates were 45.2%, 71.6%, 80.1%, and86.7%, respectively, in the PRFA group, not significantly different from those of the SRR group (P=0.711). The1-, 2-, 3- and 5- year survival rates after recurrence were 82.9%, 64.7%, 46.4%, and 34.8%, respectively, inthe SRR group and 81.8%, 60.1%, 40.3%, and 24.2%, respectively, in the PRFA group (P=0.599). The riskfactors for re-recurrence after re-resection or ablation included the time period between the first surgical resec-tion and the recurrence and the number of recurrent cancer nodes. The number of recurrent cancer nodesand the timing of re-recurrence were prognostic factors for patient survival. The incidence of treatment-relatedcomplications in the SRR group was slightly higher than that in the PRFA group, with no significant differencedetected (29.0% vs. 13.3%, P=0.091). Compared with the SRR group, the PFRA group needed fewer bloodtransfusions (0% vs. 35.3%, P=0.000) and less hospitalization time (7.0d±0.8d vs. 21.9d±1.6d, P=0.000). Conclusion : PRFA can achieve local therapeutic effects and overall survival time equivalent to those of surgi-cal re-resection. PRFA is more cost-effective, less invasive and should be considered an eligible treatment forrecurrent HCC.

     

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