术前形态学分型在单发结节型小肝癌射频消融治疗中的作用  

Role of preoperative morphologic classification in solitary small hepatocellular carcinoma treated by RFA

作　　者：周铁[1] 伏旭[1] 何健[2] 毛谅[1] 仇毓东[1] 

机构地区：[1]南京大学医学院附属南京鼓楼医院肝胆胰脾外科,南京210008 [2]南京大学医学院附属南京鼓楼医院医学影像科,南京210008

出　　处：《国际外科学杂志》2015年第10期675-679,F0003,共6页International Journal of Surgery

基　　金：江苏省卫生厅医学重点人才项目（No.RC2011003）

摘　　要：目的 探讨小肝癌术前影像学形态分型在射频消融疗效分析和治疗决策中的价值.方法 回顾性分析2008年1月-2012年12月南京大学医学院附属鼓楼医院行射频消融治疗的73例小肝癌患者的临床资料.根据术前动态增强薄层CT扫描图像进行形态学分型,分为以下三种类型：结节型（1型）、结节突起型或融合型（2型）和浸润型（3型）.比较各种类型患者的临床病理因素并用统计学方法进行分析.采用门诊及电话方式进行随访,随访时间截至2014年8月或患者死亡.结果 73例小肝癌患者中1型24例,2型35例,3型14例,比例分别为：32.9％,47.9％,19.2％.3型肝细胞癌术前AFP显著高于其他类型.三种类型患者无瘤生存期分别为（37.2±3.3）个月、（20.9±4.0）个月、（14.4±4.9）个月,形态不规则型肝癌（2型、3型）射频消融治疗预后较形态规则型肝癌（1型）预后差.三种类型患者的总生存时间分别为：（72.5±4.7）个月,（66.2±7.3）个月,（31.2±5.3）个月,3型肝细胞癌预后最差.单因素分析结果显示：肿瘤大体形态分型,术前AFP、肿瘤大小是影响HCC患者预后的相关因素（P＜0.05）.多因素分析结果显示：肿瘤大体形态分型3型是影响肝细胞癌患者预后的独立危险因素（P＜0.05）.结论 术前影像学形态分型是影响小肝癌患者预后的独立危险因素,有助于小肝癌患者治疗方法的选择.Objective To invcstigate the value of preoperative imaging morphologic classification in solitary small hepatocellular carcinoma treated by RFA.Methods The clinical data of 73 patients with small hepatocellular carcinoma who rcccivcd radiofrequency ablation at the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2008 to December 2012 were analyzed retrospectively.The lesions were classified into three types according to gross appearance in preoperative contrast-enhanced computed tomography （CT）：single nodular type （type 1）;single nodular with extranodular growth type or confluent multinodular type （type 2）;infiltrating type （type 3）.Thc clinicopathological features of patients with 3 types of tumors were compared by statistical methods.Patients were followed up via outpatient examination and telephone interview up to August 2014 or death.Results There were 24 cases of type 1,35 cases of type 2,14 cases of type 3,and the proportion were 20.2%,32.9%,47.9%,19.2%,respectively.The preoperative alpha-fetoprotein of type 3 was significantly higher than othcr types.The disease-free survival time of the three types were （37.2 ± 3.3） months,（20.9 ± 4.0） months,（14.4 ±4.9） months.The prognosis of the irregular types （type 2,type 3） is poor than the regular types （type 1）.The overall survival time were （72.5 ± 4.7） months,（66.2 ± 7.3） months,（31.2 ± 5.3） months.The type 3 was the worst.The results of univariate analysis showed that morphologic classification,preoperative AFP,tumor size were related factors affecting the prognosis of patients （P 〈 0.05）.The results of multivariate analysis showed that morphologic classification was the independent risk factors affecting the prognosis of patients （P 〈 0.05）.Conclusion The preoperative imaging morphologic classification is the independent risk factors affecting the prognoses of patients with small HCC,which is help to choose the best treatment for patients with small hepatocel

关 键 词：形态学分型 癌 肝细胞 预后 治疗结果 

分 类 号：R541.71[医药卫生—心血管疾病]