射频消融、肝切除和肝移植治疗小肝癌预后的多因素分析  

Multivariate Prognostic Factors Analysis of Radiofrequency Ablation,Surgical Resection and Live Transplantation on Patients with Small Hepatocellular Carcinoma

作　　者：姚红兵[1] 肖芳[2] 黄高[1] 文明波[1] 熊锐华[2] 李桂花[1] 杨志坚[1] 练远书 

机构地区：[1]解放军181医院肝胆胰外科,广西桂林541002 [2]解放军181医院肿瘤中心,广西桂林541002

出　　处：《华南国防医学杂志》2014年第5期452-454,457,共4页Military Medical Journal of South China

摘　　要：目的探讨影响射频消融(radiofrequency ablation,RFA)、肝切除和肝移植治疗小肝癌预后的相关因素。方法回顾性分析作者医院2005-08/2009-09月收治的167例原发性小肝癌患者的临床资料;其中86例手术切除、58例RFA和23例肝移植。单因素分析采用Kaplan-Meier法,Cox比例风险模型进行预后多因素分析。结果手术切除组、RFA组和肝移植组1、2、3年肝内累积复发率分别为11.6%、20.9%、27.9%,12.1%、25.0%、34.5%和8.7%、17.4%、21.7%;1、2、3年的生存率分别为91.9%、83.7%、74.4%,91.3%、77.6%、67.2%和95.7%、87.0%、78.3%。单因素分析发现三种小肝癌治疗方法的预后与治疗前血清甲胎蛋白(alpha fetoprotein,AFP)>400 ng/ml、肿瘤近血管、直径>3 cm、Child分级这几个因素有关(P<0.05)。Cox多因素分析显示治疗前血清AFP>400 ng/ml、肿瘤近血管、直径>3 cm、Child分级是影响小肝癌预后的重要因素(P<0.05)。结论 RFA、肝切除和肝移植治疗直径≤5 cm的小肝癌均可获得比较良好的近远期疗效。治疗前血清AFP>400 ng/ml、肿瘤近血管、Child分级是影响预后的重要因素。Objective To explore the prognostic factors of radiofrequency ablation （RFA）, hepatic resection and live transplantation on patients with small hepatoeellular carcinoma. Methods Between August 2005 to September 2009, 167 patients with small HCC were divided into surgical resection group （n = 86）, RFA group （n = 58） and live transplan- tation （n = 23） . Kaplan-Meier analysis was used to calculate single factor analysis. A multi-parameter analysis was done by the Cox regression model to explore the relationship among the prognosis and the clinical factors. Results The 1-, 2- and 3- year recurrence rates were 11.6%, 20. 9% and 27. 9% in surgical resection group, 12.1%, 25.0% and 34. 5% in RFA group and 8. 7%, 17. 4% and 21.7% in liver transplantation group. The 1-, 2- and 3- year survival rates were 91.9%, 83. 7% and 74. 4% in surgical resection group, 91.3%, 77. 6% and 67. 2% in RFA group and 95.7%, 87. 0% and 78. 3 % in liver transplantation group. Kaplan-Meier analysis and Cox regression model indicated that AFP^400 ng/ ml, tumor proximity to intrahepatic vessels and Child-pugh class were adverse factors that affecting the prognosis of pa- tients with small hepatocellular carcinoma （P〈0. 05）. Conclusion For small HCC （≤5 cm）, RFA, hepatic resection and live transplantation can provide effective short and long-term outcomes. AFP〉400 ng/ml, tumor proximity to intra- hepatic vessels and Child-pugh class are important factors affecting the prognosis of patients with small hepatocellular car- cinoma.

关 键 词：肝癌 预后 肝切除 射频消融 肝移植 

分 类 号：R735.7[医药卫生—肿瘤]