手术切除和经皮射频消融治疗中等大小肝细胞癌疗效及预后影响因素对比分析
发布时间：2018-08-04 16:04
【摘要】：研究背景和目的:肝移植、手术切除和经皮射频消融是早期肝细胞癌(巴塞罗那分级标准)的根治性治疗方式,手术切除和经皮射频消融在临床工作中应用最为广泛。但是,对中等大小(直径3-5cm)肝细胞癌手术切除术和经皮射频消融治疗疗效一直存在争议。本研究通过回顾性队列分析比较手术切除和经皮射频消融治疗对单发、初治的中等大小肝细胞癌疗效。材料与方法:回顾性收集2007年01月至2011年12月在上海东方肝胆外科医院治疗的初发、单个中等大小肝细胞癌患者基本资料(符合纳入标准)。共收集了388例患者病例资料,其中手术切除组共196例,经皮射频消融组共192例,两组在肿瘤大小和其他肝脏病变情况相似。应用Kaplan-Meier生存分析方法分析两组总体生存率(Overall survival,OS)无瘤生存率(Disease free survival,DFS)。两组间生存率差异的显著性应用Log-rank检测。Cox风险模型进行单因素和多因素危分析。全面评估其远期结局及预后相关危险因素。结果:共388例患者临床基本资料被纳入本研究中。手术组196例(男性:女性=172:24,平均年龄52.9±10.5(22.0-80.0)岁),经皮射频消融组192例(男性:女性=167:25,平均年龄57.9±10.9(34.0-79.0)岁)。手术组有1例患者因肝功能衰竭围手术期死亡。手术组术后43(21.9%)例发生并发症,Clavein3级、5级并发症各9例、1例;射频消融组术后27(14.1%)(P=0.048)例出现并发症,无Clavein3级和5级并发症。手术组术后平均住院时间8.8±3.2(4-21)天,射频经皮射频消融组平均住院时间2.4±0.9(1-8)天(P0.001)。手术组相对经皮射频消融组具有更高的总体累积生存率(1、3和5年OS分别为93.8%、61.9%和41.0%VS 92.2%、55.1%和30.8%)(P=0.01)和无瘤生存率(1、3和5年DFS分别为73.2%、30.4%和16.9%VS65.6%、26.0%和8.7%)(P=0.005)。卫星灶、微血管侵犯、局部肿瘤进展、Child分级和γ-GT是影响预后的危险因素。射频消融治疗本身和肿瘤大于4cm是局部肿瘤进展的危险因素。肿瘤大于4cm和白蛋白小于35g/L是经皮射频消融组局部肿瘤进展的危险因素。肿瘤靠近大血管或胆囊是手术组局部肿瘤进展的危险因素。结论:手术切除比经皮射频消融更能为单发、初治的中等大小肝细胞癌患者带来更高的累积生存率和无瘤生存率。经皮射频消融组具有更少的住院时间和术后并发症。卫星灶、微血管侵犯、局部肿瘤进展、Child分级和γ-GT是影响预后的危险因素。射频消融治疗本身和肿瘤大于4cm是局部肿瘤进展的危险因素。
[Abstract]:Background and objective: liver transplantation, surgical resection and percutaneous radiofrequency ablation are the radical treatments for early hepatocellular carcinoma (Barcelona grading standard). Surgical resection and percutaneous radiofrequency ablation are most widely used in clinical work. However, the efficacy of surgical resection and percutaneous radiofrequency ablation for moderate size (3-5cm) hepatocellular carcinoma has been controversial. A retrospective cohort analysis was conducted to compare the efficacy of surgical resection and percutaneous radiofrequency ablation in the treatment of single, newly treated medium sized hepatocellular carcinoma (HCC). Materials and methods: from January 2007 to December 2011, the basic data of patients with single medium size hepatocellular carcinoma (HCC) were collected retrospectively from January 2007 to December 2011 in Shanghai Oriental Hepatobiliary surgery Hospital. A total of 388 cases were collected, including 196 cases in the surgical resection group and 192 cases in the percutaneous radiofrequency ablation group. The size of the tumor and other liver lesions in the two groups were similar. The Overall survival rate (Disease free survival rate) was analyzed by Kaplan-Meier survival analysis. The difference of survival rate between the two groups was analyzed by univariate and multivariate risk analysis using Log-rank. Cox risk model. Comprehensive evaluation of its long-term outcome and prognostic risk factors. Results: a total of 388 patients were included in this study. 196 patients (male: female: 172: 24, mean age 52.9 卤10.5 (22.0-80.0) and 192 patients (male: female: 167: 25, mean age 57.9 卤10.9 (34.0-79.0) years) were treated with percutaneous radiofrequency ablation. In the operation group, one patient died of liver failure during perioperative period. In the operation group, complications were found in 43 cases (21.9%) and in the radiofrequency ablation group (9 cases, 1 case, respectively), while in the radiofrequency ablation group (27 cases, 14.1%) (0.048%), there were no complications in grade Clavein3 and grade 5. The average hospitalization time was 8.8 卤3.2 (4-21) days in the operation group and 2.4 卤0.9 (1-8) days in the radiofrequency catheter ablation group (P0.001). The overall cumulative survival rate was higher in the operation group than that in the percutaneous radiofrequency ablation group (93.81.9% and 55.1% and 30.8%, respectively) (P < 0.01) and the tumor-free survival rate (DFS = 73.4% and 16.9VS65.65.6m, 26.0% and 8.7%, respectively) in the operation group and 41.0%VS 92.2%, 55.1% and 30.8%, respectively. Satellite foci, microvascular invasion, local tumor progression, Child grade and 纬-GT were risk factors for prognosis. Radiofrequency ablation itself and tumor larger than 4cm are risk factors for local tumor progression. Tumor larger than 4cm and albumin less than 35g/L are risk factors of local tumor progression in percutaneous radiofrequency ablation. Tumor proximity to large vessels or gallbladder is a risk factor for tumor progression in the surgical group. Conclusion: surgical resection is more effective than percutaneous radiofrequency ablation in the treatment of medium sized hepatocellular carcinoma (HCC) with higher cumulative and tumor-free survival rates. The percutaneous radiofrequency ablation group had less hospital stay and postoperative complications. Satellite foci, microvascular invasion, local tumor progression, Child grade and 纬-GT were risk factors for prognosis. Radiofrequency ablation itself and tumor larger than 4cm are risk factors for local tumor progression.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.7
[Abstract]:Background and objective: liver transplantation, surgical resection and percutaneous radiofrequency ablation are the radical treatments for early hepatocellular carcinoma (Barcelona grading standard). Surgical resection and percutaneous radiofrequency ablation are most widely used in clinical work. However, the efficacy of surgical resection and percutaneous radiofrequency ablation for moderate size (3-5cm) hepatocellular carcinoma has been controversial. A retrospective cohort analysis was conducted to compare the efficacy of surgical resection and percutaneous radiofrequency ablation in the treatment of single, newly treated medium sized hepatocellular carcinoma (HCC). Materials and methods: from January 2007 to December 2011, the basic data of patients with single medium size hepatocellular carcinoma (HCC) were collected retrospectively from January 2007 to December 2011 in Shanghai Oriental Hepatobiliary surgery Hospital. A total of 388 cases were collected, including 196 cases in the surgical resection group and 192 cases in the percutaneous radiofrequency ablation group. The size of the tumor and other liver lesions in the two groups were similar. The Overall survival rate (Disease free survival rate) was analyzed by Kaplan-Meier survival analysis. The difference of survival rate between the two groups was analyzed by univariate and multivariate risk analysis using Log-rank. Cox risk model. Comprehensive evaluation of its long-term outcome and prognostic risk factors. Results: a total of 388 patients were included in this study. 196 patients (male: female: 172: 24, mean age 52.9 卤10.5 (22.0-80.0) and 192 patients (male: female: 167: 25, mean age 57.9 卤10.9 (34.0-79.0) years) were treated with percutaneous radiofrequency ablation. In the operation group, one patient died of liver failure during perioperative period. In the operation group, complications were found in 43 cases (21.9%) and in the radiofrequency ablation group (9 cases, 1 case, respectively), while in the radiofrequency ablation group (27 cases, 14.1%) (0.048%), there were no complications in grade Clavein3 and grade 5. The average hospitalization time was 8.8 卤3.2 (4-21) days in the operation group and 2.4 卤0.9 (1-8) days in the radiofrequency catheter ablation group (P0.001). The overall cumulative survival rate was higher in the operation group than that in the percutaneous radiofrequency ablation group (93.81.9% and 55.1% and 30.8%, respectively) (P < 0.01) and the tumor-free survival rate (DFS = 73.4% and 16.9VS65.65.6m, 26.0% and 8.7%, respectively) in the operation group and 41.0%VS 92.2%, 55.1% and 30.8%, respectively. Satellite foci, microvascular invasion, local tumor progression, Child grade and 纬-GT were risk factors for prognosis. Radiofrequency ablation itself and tumor larger than 4cm are risk factors for local tumor progression. Tumor larger than 4cm and albumin less than 35g/L are risk factors of local tumor progression in percutaneous radiofrequency ablation. Tumor proximity to large vessels or gallbladder is a risk factor for tumor progression in the surgical group. Conclusion: surgical resection is more effective than percutaneous radiofrequency ablation in the treatment of medium sized hepatocellular carcinoma (HCC) with higher cumulative and tumor-free survival rates. The percutaneous radiofrequency ablation group had less hospital stay and postoperative complications. Satellite foci, microvascular invasion, local tumor progression, Child grade and 纬-GT were risk factors for prognosis. Radiofrequency ablation itself and tumor larger than 4cm are risk factors for local tumor progression.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.7
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