经皮微波消融术治疗合并肝硬化的原发性小肝癌患者生存分析  

Survival analysis of percutan eous microwave ablation for patients with small hepatocellular carcinoma with underlying liver cirrhosis

作　　者：廖凌峰 薛建章 李士坤 Liao Lingfeng;Xue Jianzhang;Li Shikun(Department of Oncology,Central Hospital,Xinyang 464000,Henan Province,China)

机构地区：[1]河南省信阳市中心医院肿瘤内科,464000 [2]河南省信阳市中心医院消化科,464000

出　　处：《实用肝脏病杂志》2018年第2期257-260,共4页Journal of Practical Hepatology

基　　金：河南省星火计划项目(编号:09YY0058)

摘　　要：目的探讨经皮微波消融术(PMCT)治疗合并肝硬化的原发性小肝癌患者的疗效。方法2005年1月~2014年7月我院收治的108例合并肝硬化的原发性小肝癌患者,采用PMCT治疗40例,采用开腹肿瘤切除治疗68例。采用Cox回归分析影响患者术后生存的相关因素。结果治疗后3年,PMCT治疗患者总生存和无复发生存率分别为60.0%和40.0%,与手术切除治疗组的58.8%和38.2%比,无显著性差异(P>0.05);单因素分析结果显示死亡患者肝功能分级为B级、血清甲胎蛋白水平高和白蛋白水平低者与生存患者存在显著性差异(P<0.05);多因素Cox回归模型分析显示肝功能分级(HR=1.81,95%CI:0.97~3.38)、血清AFP(HR=1.83,95%CI:0.99~3.37)和白蛋白水平(HR=1.81,95%CI:0.98~3.36)为影响合并肝硬化的原发性小肝癌患者预后的独立危险因素(P<0.05)。结论采用PMCT治疗合并肝硬化的原发性小肝癌患者生存率与手术切除治疗者结果相似,患者预后与肝功能、血清AFP水平和白蛋白水平相关。Objective To investigate the efficacy of percutaneous microwave ablation(PMCT)in the treatment of patients with hepatocellular carcinoma with underlying liver cirrhosis.Methods 108 patients with small hepatocellular carcinoma between January 2005 and July 2014 in our hospital were recruited in this study,and 40 patients were treated with PMCT and 68 were with hepatectomy.The Cox regression analysis was applied to analyze the factors associated with postoperative survival.Results There was no significant difference as respect to total survival(60%vs.58.8%)and recurrence-free survival rates(40.0%vs.38.2%)between the patients subjected to PMCT or surgical resection at the end of three-year follow-up;univariate analysis showed the Child-Pugh class,serum alpha-fetoprotein and albumin levels at baseline in fatal patients were significantly poorer or lower than those in survival patients(P<0.05);multivariate cox regression analysis showed that Child-Pugh class(HR=1.81,95%CI:0.97～3.38),serum alpha-fetoprotein(HR=1.83,95%CI:0.99～3.37)and albumin levels(HR=1.81,95%CI:0.98～3.36)were the independent factors for prognosis of patients with hepatocellular carcinoma with underlying liver cirrhosis(P<0.05).Conclusion The survival rate of patients with small hepatocellular carcinoma and cirrhosis treated with PMCT is similar to that of those received surgical resection.The prognosis is correlated with liver function,serum alpha-fetoprotein and albumin levels.

关 键 词：原发性肝癌 肝硬化 经皮微波消融术 预后 

分 类 号：R735.7[医药卫生—肿瘤]