肝内血管对肝细胞癌微波消融疗效的影响:基于倾向性匹配评分研究  

Effect of intrahepatic blood vessels on the efficacy of microwave ablation in treating hepatocellular carcinoma:a study based on propensity score matched method

作　　者：刘冲 何金瞳 李天 隋凯达 张洲博 张丹洋 邵海波[1] LIU Chong;HE Jintong;LI Tian;SUI Kaida;ZHANG Zhoubo;ZHANG Danyang;SHAO Haibo(Department of Interventional Radiology,Affiliated First Hospital of China Medical University,Shenyang,Liaoning Province 110001,China)

机构地区：[1]中国医科大学附属第一医院介入科,沈阳110001

出　　处：《介入放射学杂志》2021年第7期667-673,共7页Journal of Interventional Radiology

摘　　要：目的探索肝内血管(>3 mm)对毗邻血管周围的肝细胞癌微波消融(MWA)疗效的影响。方法回顾性分析2015年1月至2018年12月采用MWA治疗的肝癌患者126例(共199个肿瘤)。根据肝内肿瘤是否毗邻肝内血管将肿瘤分为毗邻组和非毗邻组:毗邻直径>3 mm的肝静脉、门静脉或腔静脉血管的肿瘤被定义为毗邻组,共37例40个瘤灶;距离直径>3 mm的肝静脉、门静脉或腔静脉10 mm以上的肿瘤定义为非毗邻组,共89例159个瘤灶。为避免其他因素干扰,排除距离肝被膜、胆囊、胃肠道5 mm以内的肿瘤。1∶2倾向性匹配评分(PSM)被用以平衡两组选择性偏倚及混杂影响。分析和比较两组肿瘤MWA后技术有效率、肿瘤局部进展率(LTP)及并发症差异有无统计学意义。结果毗邻组40个瘤灶,非毗邻组80个瘤灶被成功匹配并纳入分析。整体技术有效率为86.7%(104/120),毗邻组和非毗邻组技术有效率分别为35/40(87.5)%和69/80(86.2)%(P=0.849)。多因素分析提示毗邻血管对MWA后技术有效率无显著影响(OR=0.907,95%CI=0.258-3.192,P=0.693)。中位随访时间为13.8个月,整体LTP率为23.1%(24/104)。毗邻组和非毗邻组1年、2年累计局部进展率分别为8.0%、27.0%和9.0%、31.0%。多因素分析显示两组LTP率差异无统计学意义(HR=0.874,95%CI=0.363-2.108,P=0.765)。两组并发症差异无统计学意义(P=0.492)。结论MWA治疗毗邻或非毗邻肝内血管的病灶,其技术有效率和局部进展率无明显差别。肝内血管(>3 mm)对MWA治疗肝细胞癌的疗效无显著影响,并未表现出显著的热沉降效应。Objective To explore the effect of intrahepatic vessels(>3 mm)on the curative efficacy of microwave ablation(MWA)in treating hepatocellular carcinoma(HCC)adjacent to theses vessels.Methods The clinical data of 126 patients with HCC(199 tumor lesions in total),who received MWA during the period from January 2015 to December 2018,were retrospectively analyzed.When a lesion was adjacent to a hepatic vein(diameter>3 mm),or a portal vein(diameter>3 mm),or the vena cava,this lesion was defined as an vessel-adjacent lesion,based on which 40 HCC lesions(37 patients)were classified into vessel-adjacent group.When a lesion was more than 10 mm away from a hepatic vein(diameter>3 mm),or a portal vein(diameter>3 mm),or the vena cava,this lesion was defined as an non-vessel-adjacent lesion,based on which159 HCC lesions(89 patients)were classified into non-vessel-adjacent group.In order to avoid interference by other factors,all the lesions which were located within 5 mm from hepatic capsule,gallbladder,gastrointestinal tract were excluded in this study.The 1∶2 propensity score matching(PSM)was employed to balance selectivity bias and confounding effects in both groups.The primary technique efficacy rate,local tumor progression(LTP)rate and incidence of post-MWA complications were analyzed and the data were compared between the two groups.Results Forty HCC lesions of the vessel-adjacent group and 80 HCC lesions of the non-vesseladjacent group were successfully matched and included in the analysis.The total primary technique efficacy rate was 86.7%(104/120),which in the vessel-adjacent group and the non-vessel-adjacent group were 87.5%(35/40)and 86.2%(69/80)respectively(P=0.849).Multivariate analysis indicated that adjacent vessels had no significant effect on the primary technique efficacy rate(OR=0.907,95%CI=0.258-3.192,P=0.693).The median follow-up time was 13.8 months,the overall LTP rate was 23.1%(24/104).The 1-year,2-year cumulative LTP rates in the vessel-adjacent group and in the non-vessel-adjacent group were 8.0%,27.

关 键 词：微波消融 肝细胞癌 局部肿瘤进展 肝内血管 

分 类 号：R735.7[医药卫生—肿瘤]