超声引导下原发性肝癌微波消融术后复发风险因素初步分析
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摘要
目的探讨超声引导下原发性肝癌微波消融(MWA)术后影响复发的单因素分析。方法选择超声引导下行经皮MWA治疗术后87例肝癌患者(107个病灶),其中男性72例,女性15例;年龄34～79岁,平均年龄56.3岁。观察病灶消融后疗效,随访5～73个月,计算术后复发率。选取Kaplan-Meier法统计患者无瘤生存时间。采用卡方检验比较影响肿瘤MWA术后复发的风险因素。结果肿瘤总复发率是45.98%。肿瘤直径<3 cm 92个病灶,其中36个病灶复发;肿瘤直径≥3 cm 15个病灶,其中10个病灶复发;两者比较,差异有统计学意义(χ~2=3.990,P=0.046 <0.05)。单发病灶71例中,复发31例;多发病灶16例中,复发9例;两者比较,差异无统计学意义(χ~2=0.833,P=0.36> 0.05)。病灶位于肝内普通位置,靠近膈面、大血管、肝表面、胆囊的复发率分别是37.50%、33.33%、37.50%、66.67%、100.00%。肝细胞癌-高分化复发率是57.14%,肝细胞癌-中分化复发率是63.16%,两者差异无统计学意义(χ~2=0.122,P=0.727> 0.05)。复发组中位无瘤生存时间12个月,未复发组中位无瘤生存时间19个月;两者比较,差异有统计学意义(χ~2=5.463,P=0.019 <0.05)。肝细胞癌-高分化中位无瘤生存时间17个月,肝细胞癌-中分化中位无瘤生存时间12个月,两者差异有统计学意义(χ~2=5.064,P=0.024 <0.05)。结论肿瘤直径和病灶靠近肝表面或胆囊时会使肝癌MWA术后复发风险增加,肿瘤分化程度未显示对术后复发风险有直接影响,但肝细胞癌-高分化比肝细胞癌-中分化无瘤生存时间更长。
Objective To investigate recurrent risk factors of primary liver cancer after ultrasound-guided microwave ablation(MWA). Methods A total of 87 liver cancer patients(107 lesions) underwent ultrasound-guided percutaneous MWA were enrolled, which included 72 males and 15 females, aged 34-79 years old with mean age of 56.3 years old. The curative effect was observed, and 5-73 months followed up recurrence rate was calculated. The Kaplan-Meier method was used to calculate disease-free survival time, and χ~2 test to compare risk factors for recurrence of tumor after MWA. Results The whole recurrence rate of liver cancer was 45.98 %. Of the 92 lesions of tumor diameter < 3 cm, 36 lesions recurred. Of the 15 lesions of tumor diameter ≥ 3 cm, 10 lesions recurred. The difference was statistically significant(χ~2= 3.990, P = 0.046 < 0.05). There were 31 recurrence in 71 cases of single lesions and 9 recurrence in 16 multiple lesions, the difference was no statistically significant(χ~2= 0.833, P = 0.36 > 0.05). The recurrence rate was 37.50 %, 33.33 %, 37.50 %, 66.67 % and 100.00 %, respectively for lesions located in normal position of liver, near diaphragm, large blood vessel, liver surface and gallbladder. The recurrence rate of well-differentiated hepatocellular carcinoma was 57.14 %, moderately-differentiated hepatocellular carcinoma was 63.16 %, the difference was no statistically significant(χ~2= 0.122, P = 0.727 > 0.05). The median disease-free survival time in recurrent group was 12-month and 19-month in non-recurrent group, the difference was statistically significant( χ~2=5.463, P = 0.019 < 0.05). The median disease-free survival time in well-differentiated hepatocellular carcinoma was 17-month and 12-month in moderately-differentiated hepatocellular carcinoma, the difference was statistically significant( χ~2=5.064, P = 0.024 < 0.05). Conclusion It is demonstrated that the tumor diameter and tumors near liver surface or gallbladder could increase the recurrence risk after MWA. The tumor differentiation degree dose not have direct effect on recurrence risk after operation, but well-differentiated hepatocellular carcinoma has longer disease-free survival time than moderately-differentiated hepatocellular carcinoma.
Objective To investigate recurrent risk factors of primary liver cancer after ultrasound-guided microwave ablation(MWA). Methods A total of 87 liver cancer patients(107 lesions) underwent ultrasound-guided percutaneous MWA were enrolled, which included 72 males and 15 females, aged 34-79 years old with mean age of 56.3 years old. The curative effect was observed, and 5-73 months followed up recurrence rate was calculated. The Kaplan-Meier method was used to calculate disease-free survival time, and χ~2 test to compare risk factors for recurrence of tumor after MWA. Results The whole recurrence rate of liver cancer was 45.98 %. Of the 92 lesions of tumor diameter < 3 cm, 36 lesions recurred. Of the 15 lesions of tumor diameter ≥ 3 cm, 10 lesions recurred. The difference was statistically significant(χ~2= 3.990, P = 0.046 < 0.05). There were 31 recurrence in 71 cases of single lesions and 9 recurrence in 16 multiple lesions, the difference was no statistically significant(χ~2= 0.833, P = 0.36 > 0.05). The recurrence rate was 37.50 %, 33.33 %, 37.50 %, 66.67 % and 100.00 %, respectively for lesions located in normal position of liver, near diaphragm, large blood vessel, liver surface and gallbladder. The recurrence rate of well-differentiated hepatocellular carcinoma was 57.14 %, moderately-differentiated hepatocellular carcinoma was 63.16 %, the difference was no statistically significant(χ~2= 0.122, P = 0.727 > 0.05). The median disease-free survival time in recurrent group was 12-month and 19-month in non-recurrent group, the difference was statistically significant( χ~2=5.463, P = 0.019 < 0.05). The median disease-free survival time in well-differentiated hepatocellular carcinoma was 17-month and 12-month in moderately-differentiated hepatocellular carcinoma, the difference was statistically significant( χ~2=5.064, P = 0.024 < 0.05). Conclusion It is demonstrated that the tumor diameter and tumors near liver surface or gallbladder could increase the recurrence risk after MWA. The tumor differentiation degree dose not have direct effect on recurrence risk after operation, but well-differentiated hepatocellular carcinoma has longer disease-free survival time than moderately-differentiated hepatocellular carcinoma.
引文
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[12]CHEN Qiu-ju,PIAN Lin-ping.Analysis of treatment of small liver cancer by radiofrequency microwave ablation combined with percutaneous ethanol injection[J].Journal of Medical Forum,2015,36(4):13-19.[陈秋菊,骈林萍.热消融联合无水酒精注射治疗原发性小肝癌72例疗效分析[J].医药论坛杂志,2015,36(4):13-19.]
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[14]Kim SJ,Lee KK,Kim DG.Tumor size predicts the biological behavior and influence of operative modalities in hepatocellular carcinoma[J].Hepatogastroenterology,2010,57(97):121-126.
[15]Chen X,Zhang B,Yin X,et al.Lipiodolized transarteria chemoembolization in hepatocellular carcinoma patients after curative resection[J].J Cancer Res Clin Oncol,2013,139(5):773-781.
[16]Livaghi T,Lazzaroni S,Meloni F,et al.Risk of tumour seeding after percutaneous radiofrequency ablation for hepatocellular earcinoma[J].Br J Surg,2005,92(7):856-858.
[17]HUANG Sheng-yu,WEI Wen-xin,LI Jun,et al.The influence of histological differentiation grade on the outcome of liver resection for BCLC 0 stage hepatocellular carcinomas[J]Journal of Hepatobiliary Surgery,2015,23(2):90-94.[黄晟宇尉文新,李俊,等.细胞分化程度对极早期肝癌(BCLC 0期)根治性切除术后复发的影响[J].肝胆外科杂志,2015,23(2):90-94.]
[2]Torre LA,Bray F,Sicgel RI,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.
[3]Liang P,Dong B,Yu X,et al.Prognostic factors for survival in patients with hepatocellular carcinoma after percutaneous microwave ablation[J].Radiology,2005,235(1):299-307.
[4]LüMing-de,XIE Xiao-yan,CHEN Jun-wei,et al.Ultrasoundguided ablation therapies for hepatocellular carcinoma:a comparison between microwave and radiofrequency[J].Chinese Journal of Ultrasonography,2002,11(1):7-9.[吕明德,谢晓燕,陈俊伟,等.超声引导消融治疗肝癌微波与射频的比较[J].中华超声影像学杂志,2002,11(1):7-9.]
[5]Wang Z,Liang P,Dong BW,et al.Prognostic factors and recurrence of small hepatocellular carcinoma after hepatic resection or microwave ablation:a retrospective study[J].J Gastrointest Surg,2008,12(2):327-337.
[6]HU Cai-xia,ZHENG Jia-sheng,LIN Wei,et al.Analysis of risk factors for early recurrence after microwave ablation for primary hepatocellular carcinoma[J].Journal of Clinical Hepatology,2015,31(2):228-231.[扈彩霞,郑加生,林伟,等.原发性肝癌微波消融术后早期复发危险因素分析[J].临床肝胆病杂志,2015,31(2):228-331.]
[7]Ding J,Jing X,Wang Y,et al.Thermal ablation for hepatocellular carcinoma:a large-scale analysis of long-term outcome and prognostic factors[J].Clin Radiol,2016,71(12):1270-1276.
[8]Chen X,Zhang B,Yin X,et al.Lipiodolized transarterial chemoembolization in hepatocellular carcinoma patients after curative resection[J].J Cancer Res Clin Oncol,2013,139(5):773-781.
[9]Kim SJ,Lee KK,Kim DG.Tumor size predicts the biological behavior and influence of operative modalities in hepatocellular carcinoma[J].Hepatogastroenterology,2010,57(97):121-126.
[10]Yu J,Liang P,Yu X L,et al.Local tumour progression after ultrasound-guided microwave ablation of liver malignancies:risk factors analysis of 2 529 tumours[J].Eur Radiol,2015,25(4):1119-1126.
[11]MA Si-cong,WANG Tao,DING Min,et al.UItrasoundguided percutaneous microwave ablation as first-line treatment for HCC:A study on clinical efficacy and prognostic factors[J].Chinese Hepatology,2016,21(5):355-359.[马思聪,王涛,丁敏,等.超声引导下微波消融一线治疗原发性肝癌:临床疗效以及预后影响因素[J].肝脏,2016,21(5):355-359.]
[12]CHEN Qiu-ju,PIAN Lin-ping.Analysis of treatment of small liver cancer by radiofrequency microwave ablation combined with percutaneous ethanol injection[J].Journal of Medical Forum,2015,36(4):13-19.[陈秋菊,骈林萍.热消融联合无水酒精注射治疗原发性小肝癌72例疗效分析[J].医药论坛杂志,2015,36(4):13-19.]
[13]Jia Y,Yu XL,Liang P.Microwave ablation in the treatment of hepatocellular carcinoma near diaphragm[M].Springer Netherlands,2015:131-139.
[14]Kim SJ,Lee KK,Kim DG.Tumor size predicts the biological behavior and influence of operative modalities in hepatocellular carcinoma[J].Hepatogastroenterology,2010,57(97):121-126.
[15]Chen X,Zhang B,Yin X,et al.Lipiodolized transarteria chemoembolization in hepatocellular carcinoma patients after curative resection[J].J Cancer Res Clin Oncol,2013,139(5):773-781.
[16]Livaghi T,Lazzaroni S,Meloni F,et al.Risk of tumour seeding after percutaneous radiofrequency ablation for hepatocellular earcinoma[J].Br J Surg,2005,92(7):856-858.
[17]HUANG Sheng-yu,WEI Wen-xin,LI Jun,et al.The influence of histological differentiation grade on the outcome of liver resection for BCLC 0 stage hepatocellular carcinomas[J]Journal of Hepatobiliary Surgery,2015,23(2):90-94.[黄晟宇尉文新,李俊,等.细胞分化程度对极早期肝癌(BCLC 0期)根治性切除术后复发的影响[J].肝胆外科杂志,2015,23(2):90-94.]