高强度聚焦超声治疗老年原发性肝癌的有效性及安全性临床观察  

Clinical observation on the efficacy and safety of high-intensity focused ultrasound in the treatment of primary liver cancer in the elderly

作　　者：吉永烁[1] 朱君秋[1] 朱绫琳[1] 刘玉美 赵洪[1] Ji Yongshuo;Zhu Junqiu;Zhu Linglin;Liu Yumei;Zhao Hong(Department of TumorMinimally Invasive Treatment,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]复旦大学附属华东医院肿瘤微创治疗部,上海200040

出　　处：《老年医学与保健》2021年第1期94-97,117,共5页Geriatrics & Health Care

基　　金：上海市卫生计生系统重要薄弱学科建设-老年医学(2015ZB0501)。

摘　　要：目的评价高强度聚焦超声(HIFU)在老年原发性肝癌患者的有效性及安全性。方法纳入2014年1月-2016年12月期间在复旦大学附属华东医院肿瘤微创治疗部接受HIFU治疗的CNLC分期为Ⅱa期以内的老年原发性肝癌患者41例。回顾分析所有患者的临床资料、治疗疗效及不良反应,并随访患者的总体生存率(OS)。疗效根据1.1版实体瘤(RECIST)的评估标准进行评分,以不良事件通用标准4.0版(CTCAE 4.0)评估不良反应。结果患者在HIFU治疗后完全缓解和部分缓解分别为2例(4.9%)和29例(70.7%),稳定为8例(19.5%),进展为2例(4.9%)。总体缓解率为75.6%。在24个月的随访期,患者的中位生存时间为23个月;患者1年和2年生存率分别是87.8%和42.7%。多因素分析结果显示,ECOG评分1分(HR=3.71;95%CI=1.11~12.48;P=0.33)和多发病灶(HR=14.36;95%CI=1.69~46.26;P=0.015)是患者HIFU治疗预后的独立危险因素。没有≥3级不良事件。HIFU治疗过程中,少数患者(n=9,22.0%)出现皮肤发红,可自行愈合;1例出现发热;1例出现轻微的胸壁疼痛,予非甾体类药物镇痛,3 d后停药;大部分患者出现轻到中度疼痛,治疗停止后疼痛自行缓解。没有观察到皮肤烧灼伤,未发现胃肠道穿孔、出血等不良反应。结论HIFU作为一种无创的治疗方法,能够有效的控制原发性肝癌的生长,缓解患者疼痛,延长患者生存期,无明显不良反应,是老年原发性肝癌安全有效的治疗选择之一。Objective To evaluate the efficacy and safety of high-intensity focused ultrasound(HIFU)in the treatment of primary liver cancer(PLC)in the elderly.Methods 41 elderly patients with PLC with CNLC stage less thanⅡa who received HIFU treatment in Department of Tumor Minimally Invasive Treatment,Huadong Hospital Affiliated to Fudan University from January 2014 to December 2016 were included.The clinical data,therapeutic efficacy and adverse reactions of all patients were retrospectively analyzed,and the overall survival rate(OS)was followed up.Efficacy was evaluated according to the Response Evaluation Criteria in Solid Tumors(RECIST)v 1.1,and adverse reactions were evaluated according to the Common Terminology Criteria for Adverse Events v 4.0(CTCAE 4.0).Results After HIFU treatment,2 cases(4.9%)were complete remission,29 cases(70.7%)were partial remission,8 cases(19.5%)were stable,and 2 cases(4.9%)were progress.During the 24-month follow-up period,the patient’s median survival time was 23 months;the 1-year and 2-year survival rates were 87.8%and 42.7%,respectively.Multivariate analysis showed that ECOG score 1(HR=3.71;95%CI=1.11-12.48;P=0.33)and multiple lesions(HR=14.36;95%CI=1.69-46.26;P=0.015)were independent risk factors for the prognosis of elderly PLC patients who received HIFU treatment.There were no adverse events≥grade 3.During HIFU treatment,a small number of patients(n=9,22.0%)had skin redness,which could heal spontaneously;1 patient had fever;1 patient had mild chest wall pain,which was treated with non-steroidal analgesia and stopped after 3 days;most patients had mild to moderate pain,and the pain relieves spontaneously after treatment was stopped.No skin burns,gastrointestinal perforation,bleeding and other adverse reactions were observed.Conclusion As a non-invasive treatment,HIFU can effectively control the growth of PLC,relieve pain,prolong the survival time of patients,without obvious adverse reactions.It is one of the safe and effective treatment options for elderly patients with PLC.

关 键 词：老年 高强度聚焦超声 原发性肝癌 有效性 安全性 生存率 

分 类 号：R735.7[医药卫生—肿瘤]