肝细胞癌射频治疗总生存率及无瘤生存率探讨  

Overall survival and disease-free survival of radiofrequency ablation of hepatocellular carcinoma

作　　者：杨薇[1] 陈敏华[1] 严昆[1] 高文[1] 王艳滨[1] 廖盛日[1] 张晖[1] 霍苓[1] 黄信孚[2] 

机构地区：[1]北京大学临床肿瘤学院超声科,北京100036 [2]北京大学临床肿瘤学院肿瘤外科,北京100036

出　　处：《中国医学影像技术》2006年第1期121-124,共4页Chinese Journal of Medical Imaging Technology

基　　金：北京市重大项目培育专项基金资助(Z0005190040431);首都医学发展科研基金重点学科基金资助(ZD 199909).

摘　　要：目的 探讨肝细胞癌（HCC）射频消融（RFA）治疗后的总生存率和无瘤生存率的影响因素。方法 182例HCC患者行超声引导下RFA治疗。肿瘤平均大小（3．9±1．2）cm（范围1．2～8．0cm）。肝功能Child-Pugh分级A、B、C级分别为97、76和9例。根据TNM分期，Ⅰ-Ⅱ期，Ⅲ期，Ⅳ期肝癌分别为53、70和59例。筛选22项可能对预后产生影响的临床因素并分层，单因素分析采用Kaplain-Meier模型，多因素采用COX比例风险模型。结果 182例HCC治疗后平均总生存期及无瘤生存期分别为（45．5±2．3）和（24．9±2．1）个月。生存期的影响因素为：①总生存期：卫星灶，Child-Pugh分级和TNM分期。②无瘤生存期：肿瘤数目，卫星灶，Child-Pugh分级，按规范化方案治疗，联合TACE。其中，肝功能在两种生存率分析中均为危险度最高的影响因素。结论 生存分析结果提示，保护肝功能，治疗前全面影像学检查，重视规范化治疗和辅助治疗将有助于改善生存期。Objective To investigate the prognostic factors affecting overall survival and free-disease survival in radiofrequency ablation （RFA） of hepatocellular carcinoma （HCC）. Methods A total of 182 HCC patients underwent RFA treatment in our department and were enrolled into this study. The average tumor size was （3.94±1.2） cm （range 1.2-8.0 cm）. Ninety seven of the 182 HCC patients had Child-Pugh class cirrhosis A; 76, class B; and 9, class C. According to TNM system, 53 patients were at stage Ⅰ- Ⅱ , 70 at stage m and 59 at stage Ⅳ, respectively. A total of 22 factors, which potentially affected the outcome, were analyzed. Kaplan-Meier model and log-rank test were used in univariate analysis and COX regression model was used in multivariate analyses, to identify prognostic factors for survival. Results The mean overall survival and disease-free survival were （45.5~2.3） months and （24.9±2.1） months, respectively. The significant factors in univariate analysis were further analyzed by multivariate model and the following factors were identified as prognostic factor for survival. ① Overall survival： daughter lesion, Child Pugh classification, TNM stage. ② Disease-free survival： tumor number, daughter lesion, Child Pugh classification, standard treatment protocol, combination with TACE. Among these, Child-Pugh classification was the most risk factors for two kinds of survivals. Conclusion Based on our statistical a nalysis, careful imaging examination, protection of liver function and application of proper treatment strategy and adjuvant therapy might benefit the survival.

关 键 词：肝细胞癌 射频消融 生存分析 COX模型 

分 类 号：R735.7[医药卫生—肿瘤] R815[医药卫生—临床医学]