射频消融治疗外科切除术后结直肠癌肝转移的临床应用价值

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英文篇名：Clinical Value of Radiofrequency Ablation for Recurrent Colorectal Liver Metastases After Hepatectomy 作者：张仲一 ; 严昆 ; 吴薇 ; 杨薇 ; 姜彬彬 ; 陈敏华 英文作者：Zhang Zhongyi;Yan Kun;Wu Wei;Yang Wei;Jiang Binbin;Chen Minhua;Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Department of Ultrasound,Peking University Cancer Hospital &Institue; 关键词：结直肠肿瘤 ; 肝转移 ; 射频消融 ; 预后因素 英文关键词：Colorectal cancer;;Liver metastasis;;Radiofrequency ablation;;Prognostic factor 中文刊名：ZGCY 英文刊名：Chinese Journal of Ultrasound in Medicine 机构：北京大学肿瘤医院暨北京市肿瘤防治研究所超声科恶性肿瘤发病机制及转化研究教育部重点实验室; 出版日期：2019-02-16 出版单位：中国超声医学杂志 年：2019 期：v.35;No.340 基金：“北京市科学技术委员会”资助(No.Z151100004015186) 语种：中文; 页：ZGCY201902016 页数：4 CN：02 ISSN：11-2110/R 分类号：55-58

摘要

目的探讨经皮超声引导下射频消融(RFA)治疗结直肠癌肝转移(CRLM)外科切除术后肝内复发癌的临床疗效。方法回顾性分析外科切除术后肝内复发并接受经皮RFA治疗的CRLM患者46例(68个病灶),平均年龄为(58.8±10.8)岁(39～81岁)。肝脏切除术中切除肝转移病灶平均数目为(3.7±2.8)个(1～12个)。肝切除术后发现肝内新生病灶的时间为(6.3±7.0)个月(1～35个月)。结果 RFA治疗后肿瘤灭活率为97.1%(66/68),肿瘤局部复发率为5.9%(4/68),肝内新生转移发生率为78.3%(36/46)。患者1、3、5年总体生存率为91.3%、41.5%、28.3%,6个月、1年肝内无进展生存率分别为50.0%、34.8%。单因素分析结果显示,手术切除病灶数>3灶(P=0.044)、CEA水平(P=0.035)和肿瘤最大径>3cm (P=0.017)是影响患者生存率的潜在危险因素。多因素Cox模型回归分析结果显示,肿瘤最大径>3cm (P=0.24,HR=2.476,95%CI:1.129～5.429)是患者生存率的独立影响因素。严重并发症的发生率为2.2%(1/46)。结论 RFA治疗CRLM外科切除术后肝内复发是安全和有效的。肝脏肿瘤最大径≤3cm的患者接受RFA治疗预后较好。
        Objective To explore clinical outcome of percutaneous ultrasound-guided radiofrequency ablation(RFA)for recurrent colorectal liver metastases after hepatectomy.Methods A total of 46 patients with 68 recurrent colorectal liver metastases after hepatectomy who underwent percutenous ultrasound-guided RFA were retrospectively analysed.The mean age was(58.8±10.8)years old(range 39-81 yos).The mean resected tumor number was(3.7±2.8)(range 1-12).The intrahepatic tumor recurrence time was(6.3±7.0)months(range 1-35 months).Results The overall ablation success rate was 97.1%(66/68)after RFA.The local recurrent rate was 5.9%(4/68).The new metastasis rate was 78.3%(36/46).The overall survival rates at 1-,3-and 5-year were 91.3%,41.5%and28.3%,respectively.The hepatic progression-free survival at 6 months and 1 year were 50.0%and 34.8%.Resected liver metastases number>3(P=0.044),serum CEA(P=0.035)and tumor size>3 cm(P=0.17)were potential risk factors for survival rates by univariate analyses.Tumor size>3 cm was an independent prognostic factor by Cox multivariate model(P=0.24,HR=2.476,95%CI:1.129～5.429).The major complication rate was 2.2%(1/46).Conclusions RFA is a safe and effective therapeutic option for recurrent colorectal liver metastases after hepatectomy,especially for those with tumor size≤3 cm.

引文

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