射频消融与外部放射治疗早期肝细胞癌的远期预后:基于SEER数据库的队列研究  

Long-term prognosis of early hepatocellular carcinoma treated with radiofrequency ablation and external beam radiation:a cohort study based on SEER database

作　　者：杨俊[1] 李璐阳 李浩铭 夏添 王成 张书涵 蒲猛 马英博 刘承利 YANG Jun;LI Luyang;LI Haoming;XIA Tian;WANG Cheng;ZHANG Shuhan;PU Meng;MA Yingbo;LIU Chengli(Postgraduate Training Base,Air Force Medical Center,China Medical University,Beijing 100142,P.R.China;Graduate School of Hebei North University,Zhangjiakou,Hebei 075000,P.R.China;Department of Hepatobiliary Surgery,Air Force Medical Center,China Medical University,Beijing 100142,P.R.China)

机构地区：[1]中国医科大学空军特色医学中心研究生培养基地,北京100142 [2]河北北方学院研究生院,河北张家口075000 [3]空军军医大学空军特色医学中心肝胆外科,北京100142

出　　处：《中国普外基础与临床杂志》2025年第3期340-346,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：空军特色医学中心临床研究项目(项目编号:2021LC013)。

摘　　要：目的比较射频消融(radiofrequency ablation,RFA)和外部放射治疗(external beam radiation,XRT)对早期肝细胞癌(hepatocellular carcinoma,HCC)的临床治疗效果。方法按照制定的纳入和排除标准回顾性收集SEER(Surveillance,Epidemiology,and End Results)数据库中2010–2015年期间的早期HCC患者。纳入患者根据治疗方案的不同分为XRT组和RFA组,按年龄、性别、种族、甲胎蛋白、肝硬化和肿瘤直径进行1∶4倾向评分匹配(propensity score matching,PSM)后进行分析,比较2组患者的总生存情况,同时分析影响早期HCC患者总生存期的风险因素。检验水准α=0.05。结果本研究共收集到2861例早期HCC患者,其中行RFA者2513例、XRT者348例;经PSM后共纳入了1582例患者,其中行XRT者343例、RFA者1239例,PSM后XRT患者中肿瘤直径更大(>5 cm)者占比仍高于RFA者(P<0.001),二者在其他临床病理特征方面比较差异无统计学意义(P>0.05)。全部HCC患者中行RFA者和XRT者的Kaplan-Meier生存曲线比较,行RFA者的生存情况优于行XRT者(HR=1.65,P<0.001);按肿瘤直径进行分层分析,在肿瘤直径<3 cm、3~5 cm、>5 cm HCC患者中行RFA者和XRT者的生存曲线比较均发现行RFA者的总生存情况优于行XRT者(<3 cm:HR=1.79、P<0.001;3~5 cm:HR=1.50、P<0.001;>5 cm:HR=1.67、P=0.003)。多因素Cox回归模型中分析的结果显示,HCC患者的年龄大(≥65岁)、甲胎蛋白水平高(≥400μg/L)、肿瘤直径大(≥3 cm)、美国癌症联合委员会分期晚(Ⅱ期)是影响总生存期的风险因素(HR>1,P<0.05),采用XRT治疗是HCC患者总生存期缩短的风险因素[HR(95%CI)=1.62(1.41,1.86),P<0.001]。结论从SEER数据库中数据分析结果提示,对于美国癌症联合委员会分期Ⅰ期或Ⅱ期早期HCC患者,采用RFA治疗的远期疗效优于XRT治疗。Objective To compare the clinical therapeutic efficacy of radiofrequency ablation(RFA)and external beam radiation(XRT)in the treatment of early hepatocellular carcinoma(HCC).Methods The early HCC patients were collected in the SEER(Surveillance,Epidemiology,and End Results)database,from 2010 to 2015,according to the established inclusion and exclusion criteria.The patients were assigned into an XRT group and a RFA group according to according treatment plans.The propensity score matching(PSM)was performed at a ratio of 1∶4 based on age,gender,race,alpha-fetoprotein(AFP),cirrhosis,and tumor diameter.The overall survival of the patients of the two groups was compared,and the risk factors affecting the long-term prognosis for the early HCC patients were analyzed.Results A total of 2861 early HCC patients were collected,including 2513 in the RFA group and 348 in the XRT group.After PSM,a total of 1582 patients were enrolled,including 343 in the XRT group and 1239 in the RFA group.After PSM,the proportion of tumor with larger diameter(>5 cm)in the XRT group was still higher than that in the RFA group(P<0.001),but there were no statistically significant differences in the other clinical pathological characteristics between them(P>0.05).The Kaplan-Meier survival curves of the RFA group was better than that of the XRT group(HR=1.65,P<0.001);The stratified analysis based on the tumor diameter revealed that the survival curves of the RFA group were superior to those of the XRT group in the HCC patients with tumor diameters<3 cm,3–5 cm,and>5 cm(<3 cm:HR=1.79,P<0.001;3–5 cm:HR=1.50,P<0.001;>5 cm:HR=1.67,P=0.003).The results of the multivariate Cox regression model analysis showed that the older age(≥65 years),higher AFP level(≥400μg/L),larger tumor diameter(≥3 cm),and later AJCC stage(stage Ⅱ)were the risk factors for overall survival in the early HCC patients(HR>1,P<0.05),while the XRT treatment was a risk factor for shortening overall survival in the HCC patients[HR(95%CI)=1.62(1.41,1.86),P<0.001].Conclusion

关 键 词：肝细胞癌 射频消融 外部放射治疗 SEER数据库 预后 

分 类 号：R73[医药卫生—肿瘤]