经皮和腹腔镜微波消融治疗BCLC分期0~A期肝细胞癌患者的预后比较和对预后的影响  

Prognosis of percutaneous versus laparoscopic microwave ablation for patients with hepatocellular carcinoma of BCLC stages 0 to A

作　　者：刘晓琳 徐锋[2] 孔凡创 黄彦华 周春晖 陈静 Liu Xiaolin;Xu Feng;Kong Fanchuang;Huang Yanhua;Zhou Chunhui;Chen Jing(Department of Hepatobiliary Surgery,Jiaxing Second Hospital,Jiaxing 314000,China;Department of Hepatobiliary and Splenic Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]嘉兴市第二医院肝胆外科,嘉兴314000 [2]中国医科大学附属盛京医院肝胆脾外科,沈阳110004

出　　处：《中华肝胆外科杂志》2024年第9期646-651,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：浙江省医药卫生科技计划项目(2023RC283);嘉兴市科技计划项目(2024AD30086)。

摘　　要：目的比较巴塞罗那临床肝癌(BCLC)分期0~A期肝细胞癌患者经皮与腹腔镜微波消融的预后以及两种治疗对预后的影响。方法回顾分析2011年1月至2018年12月于嘉兴市第二医院和中国医科大学附属盛京医院接受微波消融治疗的198例BCLC分期0~A期肝细胞癌患者临床资料,其中男性149例,女性49例,年龄(57.4±9.6)岁。依据治疗方式不同198例患者分为经皮微波消融组(n=133)和腹腔镜微波消融组(n=65)。Kaplan-Meier法计算生存率,生存率比较采用log-rank检验。采用单因素和多因素Cox回归分析经皮和腹腔镜微波消融对预后的影响。结果经皮微波消融组和腹腔镜微波消融组的中位总生存期分别为54个月和77个月,术后1、3、5年累积生存率分别为95.6%、67.3%、47.4%和100.0%、79.9%、60.4%,后者术后累积生存率优于前者,差异有统计学意义(χ^(2)=4.53,P=0.033)。经皮微波消融组和腹腔镜微波消融组中位无复发生存期分别为27个月和52个月,术后1、3、5年的无复发生存率分别为67.4%、41.1%、32.8%和81.5%、58.1%、46.7%,后者术后无复发生存率优于前者,差异有统计学意义(χ^(2)=7.20,P=0.007)。多因素Cox回归分析,与腹腔镜微波消融比较,经皮微波消融的BCLC分期0~A期肝细胞癌患者死亡风险增加(HR=2.475,95%CI:1.423~4.305,P=0.001),复发风险增加(HR=1.996,95%CI:1.255~3.176,P=0.004)。结论BCLC分期0~A期的肝细胞癌患者腹腔镜微波消融治疗预后优于经皮微波消融,经皮微波消融是BCLC分期0~A期的肝细胞癌患者预后危险因素。ObjectiveTo compare the prognosis of percutaneous versus laparoscopic microwave ablation in patients with hepatocellular carcinoma(HCC)classified as Barcelona Clinic Liver Cancer(BCLC)stage 0 to A,and evaluate the impact of these two ablation modalities on treatment outcome.MethodsClinical data of 198 patients with HCC of BCLC stages 0 to A undergoing microwave ablation treatment at the Second Hospital of Jiaxing and Shengjing Hospital of China Medical University from January 2011 to December 2018 were retrospectively analyzed,including 149 males and 49 females,aged(57.4±9.6)years.Patients were divided into two groups based on the treatment modality:percutaneous microwave ablation group(n=133)and laparoscopic microwave ablation group(n=65).Survival rates were calculated using the Kaplan-Meier method,and the log-rank test was used to compare survival rates.Univariate and multivariate analyses were performed using Cox regression to assess the impacts of percutaneous and laparoscopic microwave ablation on prognosis.ResultsThe median overall survivals for the percutaneous and laparoscopic microwave ablation groups were 54 months and 77 months,respectively.The 1-,3-,and 5-year cumulative survival rates postoperatively were 95.6%,67.3%,47.4%for the percutaneous group,and 100.0%,79.9%,60.4%for the laparoscopic group,respectively,with the latter showing superior cumulative survival rates(χ^(2)=4.53,P=0.033).The median recurrence-free survival(RFS)was 27 months for the percutaneous group and 52 months for the laparoscopic group.The 1-,3-,and 5-year RFS postoperatively were 67.4%,41.1%and 32.8%for the percutaneous group,and 81.5%,58.1%,and 46.7%for the laparoscopic group,respectively,with the latter showing superior RFS,and the difference was statistically significant(χ^(2)=7.20,P=0.007).Multivariate analysis indicated that percutaneous microwave ablation was associated with an increased risk of death(HR=2.475,95%CI:1.423-4.305,P=0.001)and recurrence(HR=1.996,95%CI:1.255-3.176,P=0.004).ConclusionLaparoscopic approach wa

关 键 词：癌 肝细胞 消融技术 腹腔镜 经皮治疗 预后 

分 类 号：R735.7[医药卫生—肿瘤]