手术切除与射频消融治疗血管周围型单发小肝癌临床疗效分析  

Comparison of clinical efficacy of liver resection and radiofrequency ablation for peripheral single small hepatocellular carcinoma

作　　者：张海涛[1] 贾哲 马超[1] 张其坤[1] 武聚山[1] 郭庆良[1] 曾道炳[1] 栗光明 王孟龙[1] Haitao Zhang;Zhe Jia;Chao Ma;Qikun Zhang;Jushan Wu;Qingliang Guo;Daobing Zeng;Guangming Li;Menglong Wang(Department of General Surgery,Beijing You'an Hospital Affiliated to Capital Medical University,Clinical Diagnosis and Treatment and Research Center for Liver Cancer of Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院普通外科、首都医科大学肝癌临床诊疗及研究中心,100069

出　　处：《中华肝脏外科手术学电子杂志》2023年第5期523-527,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：北京市医院管理中心重点医学专业发展计划(ZYLX202124)。

摘　　要：目的探讨手术切除与射频消融(RFA)治疗血管周围型单发小肝癌临床疗效。方法回顾性分析2015年1月至2018年12月在首都医科大学附属北京佑安医院治疗的219例血管周围型单发小肝癌患者临床资料。其中男169例,女50例;年龄34~76岁,中位年龄55岁;肿瘤≤4 cm。121例患者行肝切除治疗(LR组),98例行RFA治疗(RFA组)。患者均签署知情同意书,符合医学伦理学规定。采用倾向性评分匹配(PSM)对患者进行1∶1匹配,分析PSM后两组术后肝内复发、肝外复发、无进展生存期(PFS)及总体生存期(OS)。生存分析采用Kaplan-Meier和Log-rank检验。结果PSM后两组各60例患者,LR组术后1、3、5、7年PFS分别为93.7%、69.0%、58.0%、53.8%,RFA组相应为89.2%、45.4%、30.1%、14.1%,LR组术后PFS明显优于RFA组(HR=1.09,P<0.05)。LR组术后1、3、5、7年OS分别为99.4%、90.5%、89.4%、87.9%,RFA组相应为98.9%、89.3%、79.1%、74.1%,LR组术后OS亦明显优于RFA组(HR=1.35,P<0.05)。LR组术后1、3、5、7年累积肝内复发率分别为5.0%、20.1%、32.6%、40.1%,而RFA组相应为12.9%、40.3%、70.3%、78.7%,差异有统计学意义(HR=3.16,P<0.05)。LR组术后1、3、5、7年累积肝外复发率分别为1.2%、4.4%、7.8%、10.5%,RFA组相应为1.6%、6.6%、13.5%、16.9%,差异无统计学意义(HR=0.47,P>0.05)。亚组分析结果显示,LR组门静脉周围型肝癌患者肝内复发、肝外复发、PFS和OS均明显优于RFA组(HR=0.24,0.68,0.25,0.22;P<0.05);而LR组肝静脉周围型肝癌患者仅肝内复发优于RFA组(HR=0.16,P<0.05)。结论对于血管周围型单发小肝癌,手术切除提供了较RFA更好的长期肿瘤控制和OS,特别是对于门静脉周围型肝癌的患者,如果具备手术切除的条件,应将手术切除作为首选。Objective To compare the clinical efficacy of liver resection(LR)and radiofrequency ablation(RFA)in the treatment of peripheral single small hepatocellular carcinoma.Methods Clinical data of 219 patients with peripheral single small hepatocellular carcinoma admitted to Beijing You'an Hospital Affiliated to Capital Medical University from January 2015 to December 2018 were retrospectively analyzed.Among them,169 patients were male and 50 female,aged from 34 to 76 years,with a median age of55 years.The tumor diameter was≤4 cm.121 patients underwent liver resection(LR group)and 98 patients received RFA treatment(RFA group).The informed consents of all patients were obtained and the local ethical committee approval was received.All patients were subject to 1:1 propensity score matching(PSM).Postoperative intrahepatic recurrence,extrahepatic recurrence,progression-free survival(PFS)and overall survival(OS)after PSM were analyzed between two groups.Survival analysis was performed by Kaplan-Meier curve and Log-rank test.Results After PSM,60 patients were assigned into each group.In the LR group,the postoperative 1-,3-,5-and 7-year PFS rates were 93.7%,69.0%,58.0%and 53.8%,significantly better compared with 89.2%,45.4%,30.1%and 14.1%in the RFA group(HR=1.09,P<0.05).The postoperative 1-,3-,5-and 7-year OS rates in the LR group were 99.4%,90.5%,89.4%and 87.9%,significantly better than 98.9%,89.3%,79.1%and 74.1%in the RFA group(HR=1.35,P<0.05).The postoperative 1-,3-,5-and 7-year cumulative intrahepatic recurrence rates in the LR group were 5.0%,20.1%,32.6%and 40.1%,and 12.9%,40.3%,70.3%and 78.7%in the RFA group,and significant differences were observed(HR=3.16,P<0.05).The postoperative 1-,3-,5-and 7-year cumulative extrahepatic recurrence rates in the LR group were 1.2%,4.4%,7.8%and 10.5%,and 1.6%,6.6%,13.5%and 16.9%in the RFA group,and no significant differences were observed(HR=0.47,P>0.05).Subgroup analysis showed that intrahepatic and extrahepatic recurrence,PFS and OS rates of periportal vein hepatocellular carcinom

关 键 词：癌 肝细胞 射频消融 肝切除术 倾向性评分匹配 血管周围型肝癌 

分 类 号：R735.7[医药卫生—肿瘤]