巩固性重复射频消融对甲胎蛋白阴性肝细胞癌射频消融后局部肿瘤进展的疗效  

Consolidative repeat radiofrequency ablation for aipha-fetoprotein negative hepatoeellular carcinoma： does it have a role in local tumor control

作　　者：孙文兵[1] 柯山[1] 丁雪梅[1] 曹保信[2] 麻增林[2] 高君[1] 王劭宏[1] 孔健[1] 

机构地区：[1]首都医科大学附属北京朝阳医院西区肝胆外科,100043 [2]首都医科大学附属北京朝阳医院放射科,100043

出　　处：《中华肝胆外科杂志》2011年第3期194-199,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：基金项目：国家自然科学基金（30872490）;北京市卫生系统高层次卫生技术人才培养项目（2009-3-11）;吴阶平医学科研基金（320.6750.07131） 致谢 感谢首都医科大学公共卫生与家庭医学院流行病学与卫生统计学系彭晓霞博士对该研究的设计及统计学分析的指导与帮助

摘　　要：目的探讨甲胎蛋白（AFP）阴性肝细胞癌（HCC）患者在射频消融（RFA）获得影像学完全消融后，以安全边界（SM）≥1cm为目标的巩固性重复RFA（CRRFA）对于局部肿瘤进展的影响。方法课题组在2002年7月至2009年7月间，共收治152例完全消融的AFP阴性HCC。其中，影像学分析显示肿瘤周边部分区域SM〈1cm者110例，所有区域SM≥1cm者42例。在SM〈1cm的110例患者中，59例在首次RFA后6个月内接受了CRRFA，其余51例选择了临床观察随访。然后，据此将符合纳入标准的病例分为窄SM—CRRFA组（n=41）和窄SM-单次RFA组（n=37）。此外，还从42例SM≥1．0cm者，选择符合纳入标准的病例纳入宽SM-单次RFA组（n=30）。对三组患者的局部无瘤生存率进行了比较。结果窄SM—CRRFA组1年、2年、3年、4年和5年局部无瘤生存率分别为97．1％、90．9％、69．6％、47．2％和33．0％；窄SM-单次RFA组分别为85．9％、66．5%、43．5％、15．8％和0．0％；宽SM-单次RFA组分别为92．7％、83．7％、59．3％、36．9％和9．2％。三组间局部无瘤生存率差异有统计学意义（x2=14．789，P=0．001）。两两比较结果显示，窄SM—CRRFA组和宽SM-单次RFA组的累积局部无瘤生存率均明显高于窄SM-单次RFA组（x2分别为9．353和5．375，P值分别为0．002和0．020）；窄SM—CRRFA组与宽SM-单次RFA组局部无瘤生存率差异无统计学意义（x2=1．785，P=0．182）。结论对于直径3～5cm的AFP阴性HCC，RFA治疗后SM≥1cm是影响局部肿瘤控制效果的重要因素；对于SM〈1cm者，CRRFA可显著提高局部无瘤生存率。Objective To retrospectively evaluate the role of consolidative repeat radiofrequency ablation （CRRFA） based on safety margin （SM） analyses in local tumor control for alpha-fetoprotein （AFP） negative hepatocellular carcinoma （HCC） patients who had been shown to have radiological compiete ablation （CA） with radiofrequency ablation （RFA）. Methods From July 2002 to July 2009, 152 AFP negative HCC patients who were shown to have radiological CA with RFA therapy were retrospectively analyzed. Among them, 110 patients had a SM of less than 1 cm and the other 42 patients had a SM of 1 cm or more. Among 110 patients with SM less than 1 cm, fifty nine patients accepted CRRFA within 6 months after the first RFA and 51 did not. From these patients, a narrow SM- CRRFA group （n=41） and a narrow SM-single RFA group （n= 37） were enrolled respectively. The wide SM-single RFA group （n= 30） was enrolled from the 42 patients with a SM of 1 cm or more. The LTP （local tumor progression）-free survival rate of the 3 groups were compared with a log-rank test. Results One-, two-, three-, four-, and five-year LTP-free survival rates respectively were 97.1%, 90.9%, 69.6%, 47.2%, and 33.0% in the narrow SM-CRRFA patients. 85.9%, 66.5%, 43.5%, 15.8%, and 0.0%, in the narrow SM-single RFA patients, and were 92.7%, 83.7%, 59.3%, 36.9%, and 9.2% in the wide SM-single RFA patients. There were statistically significant differences （X2 = 14. 789, P=0. 001） between the groups. Conclusions An ablation zone with an SM of 1 cm or greater was the most important factor for local control of AFP negative HCC ranging from 3 to 5 cm in diameter. For these patients with a SM of less than 1 cm, CRRFA improved the overall local control outcomes.

关 键 词：肝细胞癌 射频消融 甲胎蛋白 安全边界 局部肿瘤进展 

分 类 号：R735.7[医药卫生—肿瘤]