根治性切除与射频消融对化疗后最大径≤3 cm的结直肠癌肝转移灶的疗效对比:一项回顾性生存分析  

Radical resection versus radiofrequency ablation for colorectal cancer liver metastases with maximum diameter≤3 cm after chemotherapy:A retrospective survival analysis

作　　者：黄玉润 吴嘉 张宇华 HUANG Yurun;WU Jia;ZHANG Yuhua(The Second Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou,Zhejiang 310053,China;Institute of Basic Medicine and Cancer(IBMC),Zhejiang Cancer Hospital,Chinese Academy of Sciences,Hangzhou,Zhejiang 310022,China)

机构地区：[1]浙江中医药大学第二临床医学院,浙江杭州310053 [2]浙江省肿瘤医院中国科学院杭州医学研究所,浙江杭州310022

出　　处：《肝胆胰外科杂志》2024年第5期269-275,共7页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的研究结直肠癌肝转移(CRLM)瘤化疗后最大径≤3 cm患者接受手术或射频消融(RFA)治疗后复发和长期生存情况,探究CRLM患者化疗后≤3 cm的肝转移灶的最佳治疗方式。方法回顾性分析2012年1月至2022年12月浙江省肿瘤医院196例化疗后肝转移灶≤3 cm的CRLM患者,其中根治性切除组90例,射频消融组106例。采用Kaplan-Meier分析评估两组无复发生存率和总生存率,采用Cox回归模型评估影响生存的独立危险因素。结果患者的中位随访时间为21.5(13.0,40.0)个月。根治性切除组较射频消融组复发率低[53.3%vs 70.8%,χ^(2)=6.320,P=0.012],且根治性切除组未见治疗边缘复发,射频消融组9(8.5%)例患者出现局部治疗边缘复发。根治性切除组的3年无进展生存率明显优于射频消融组(42.4%vs 25.5%,P=0.031),两组3年总生存率差异无统计学意义(72.6%vs 67.3%,P=0.412)。多因素分析显示,手术切除是更好的无复发生存期的独立预测因素(OR=0.661,95%CI 0.459-0.952,P=0.026)。结论对于术前化疗后结直肠癌肝转移灶最大径≤3 cm的患者,手术治疗可以减少局部复发,延长无复发生存期。Objective To explore the effects of surgical resection versus radiofrequency ablation(RFA)for colorectal cancer liver metastases with maximum diameter≤3 cm after chemotherapy,to investigate the recurrence and long-term survival of colorectal cancer liver metastases(CRLM)patients.Methods A retrospective analysis was conducted on 196 CRLM patients with maximum diameter≤3 cm after chemotherapy,at Zhejiang Cancer Hospital between Jan.2012 and Dec.2022.Among the 196 CRLM patients,90 patients received surgery(the radical resection group)and 106 patients received radiofrequency ablation(the RFA group).Kaplan-Meier analysis was employed to assess recurrence-free survival and overall survival rates.The Cox regression model was used to evaluate independent prognostic factors affecting survival.Results The median follow-up time was 21.5(13.0,40.0)months.The recurrence rate in the radical resection group was lower than that in the RFA group(53.3%vs 70.8%,χ^(2)=6.320,P=0.012).No cases of local recurrence were observed in the radical resection group,whereas 9 patients(8.5%)in the RFA group experienced local recurrence.The radical resection group showed notable improved recurrence-free survival(RFS)compared to the RFA group(3-year RFS rate:42.4%vs 25.5%,P=0.031)and no significant difference in overall survival(OS)rate(3-year OS rate:72.6%vs 67.3%,P=0.412).Multivariate analysis demonstrated that surgery independently predicted better RFS(OR=0.661,95%CI 0.459-0.952,P=0.026).Conclusion For patients with CRLM≤3 cm after chemotherapy,liver resection may reduce local recurrence and prolong recurrence-free survival.

关 键 词：结直肠癌肝转移 术前化疗 根治性切除 射频消融 生存分析 

分 类 号：R735.3[医药卫生—肿瘤] R735.7[医药卫生—临床医学]