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中华介入放射学电子杂志 ›› 2019, Vol. 07 ›› Issue (03) : 190 -196. doi: 10.3877/cma.j.issn.2095-5782.2019.03.004

所属专题: 文献

专题研究·肿瘤介入

超声引导下经皮微波消融与冷冻消融治疗高风险部位肝癌的对照研究
周亮1, 陈志贤1, 潘忠保1, 李蓉蓉1, 李书英1, 金利1, 牛立志1,()   
  1. 1. 510000 广州复大肿瘤医院微创治疗室
  • 收稿日期:2019-04-29 出版日期:2019-08-01
  • 通信作者: 牛立志

Ultrasound-guided percutaneous microwave ablation versus cryoablation for treatment of hepatocellular carcinoma on the high-risk location

Liang Zhou1, Zhixian Chen1, Zhongbao Pan1, Rongrong Li1, Shuying Li1, Li Jin1, Lizhi Niu1,()   

  1. 1. Department of Minimally Invasive Treatment, Guangzhou Fuda Cancer Hospital, Guangzhou 510000, China
  • Received:2019-04-29 Published:2019-08-01
  • Corresponding author: Lizhi Niu
  • About author:
    Corresponding author: Niu Lizhi, Email:
引用本文:

周亮, 陈志贤, 潘忠保, 李蓉蓉, 李书英, 金利, 牛立志. 超声引导下经皮微波消融与冷冻消融治疗高风险部位肝癌的对照研究[J/OL]. 中华介入放射学电子杂志, 2019, 07(03): 190-196.

Liang Zhou, Zhixian Chen, Zhongbao Pan, Rongrong Li, Shuying Li, Li Jin, Lizhi Niu. Ultrasound-guided percutaneous microwave ablation versus cryoablation for treatment of hepatocellular carcinoma on the high-risk location[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2019, 07(03): 190-196.

目的:

比较超声引导下经皮微波消融与冷冻消融治疗高风险部位肝癌的临床结局及术后并发症,并分析影响预后和术后复发的因素。

方法:

选取2014年4月至2018年3月广州复大肿瘤医院收治的120例高风险部位肝癌患者,其中64例接受微波消融治疗(微波组),56例接受冷冻消融治疗(冷冻组)。比较两组的治疗结局,主要包括生存、复发及术后并发症。用Cox回归模型分析预后和术后复发的影响因素。

结果:

微波消融组1、3、5年总生存率分别为85.8%、63.5%、63.5%,冷冻消融组为92.0%、87.4%、74.9%,两组差异无统计学意义(P=0.141)。微波消融组1、3、5年无复发生存率分别为77.8%、49.0%、49.0%,冷冻消融组分别为81.4%、58.5%、46.8%,两组差异无统计学意义(P=0.469)。微波消融组的3、6、9、12个月的局部进展率分别为3.1%、6.3%、9.4%、15.9%,高于冷冻消融组(分别为0%、0%、3.7%、19.0%),差异有统计学意义(P=0.003)。微波组的主要和次要并发症发生率(分别为6.3%、82.8%)均高于冷冻组(分别为0%、32.1%),差异有统计学意义。年龄≥65岁,直径3~5 cm及Child-Pugh分级B级是肝癌术后预后较差的危险因素;直径3~5 cm、多个肿瘤以及多次消融是消融术后复发的危险因素。

结论:

冷冻消融治疗高风险部位的肝癌具有与微波消融接近的生存结局,但具有更好的局部肿瘤控制率及更少的并发症,适合在临床中推广应用。

Objective:

The aims of this study were to compare the clinical outcomes between ultrasound-guided percutaneous microwave ablation (MWA) and cryoablation (CRA) in patients with hepatocellular carcinoma (HCC) on the high-risk location and to identify the prognostic factors associated with the two treatment methods.

Methods:

Retrospective study on 120 patients (88 men and 32 women) with one hundred and thirty-four HCCs on the high-risk location in our hospital from April 2014 to March 2018 were reviewed. Sixty-four patients underwent MWA and 56 patients underwent CRA. The treatment outcomes between the two groups were compared, including survival, recurrence, and postoperative complications., Cox regression models were used to analyze the influencing factors of prognosis and postoperative recurrence. Effect of changes in key parameters [overall survival (OS) , recurrence-free survival (RFS) and local tumor progression (LTP) ] was statistically analyzed with the log-rank test. Univariate and multivariate analysis were performed on clinicopathological variables to identify factors affecting intermediate-term outcome.

Results:

The cumulative OS rates at 1, 3, and 5-years were 85.8%, 63.5% and 63.5%, respectively, in MWA group, and 92.0%, 87.4% and 74.9%, respectively, in CRA group. There were no significant statistical difference (P=0.141) . The cumulative RFS rates at 1, 3, and 5-years were 77.8%, 49.0%, 49.0%, respectively, in MWA group, and 81.4%, 58.5%, 46.8%, respectively, in CRA group. There were no significant statistical difference (P=0.469) . The LTP rates at 3, 6, 9, 12 month were 3.1%, 6.3%, 9.4%, 15.9%, respectively in MWA group, which were higher than those in CRA group (0%, 0%, 3.7%, and 19.0%, respectively) with statistically significant differences (P=0.003) . The major and minor complications in MWA group (6.3%, 82.8%, respectively) were higher than those in CRA goup (0%, 32.1%, respectively) with statistically significant differences. Univariate analysis showed that age (P=0.007) , tumor size (P=0.001) , and CTP grade (P=0.003) were risk factors for OS, and multivariate analysis results showed that age ≥65 years, 3.0-5.0 cm in size and CTP grade B were independently associated with poor OS. 3~5 cm in diameter, multiple tumors and multiple ablation are risk factors for recurrence after ablation.

Conclusions:

CRA had comparable oncologic outcomes with MWA and could be a safe and effective treatment for HCC on the high-risk location.

图1 超声引导下经皮穿刺进入肿瘤内部
图2 微波消融
图3 典型病例(女性,62岁,肝癌结节位于膈顶)行冷冻消融术前术后表现
图4 典型病例(男性,56岁,肝癌结节位于近第二肝门处)行冷冻消融术前术后表现
表1 微波消融组与冷冻消融组肝癌患者的一般资料比较 [±s或例(%)]
临床特征 微波消融组(n=64) 冷冻消融组(n=56) 统计量 P
年龄(岁) 55.2±7.2 54.9±11.3 t=1.271 0.758
性别 ? ? χ2=2.278 0.785
? 18(28.1) 14(25.0) ? ?
? 46(71.9) 42(75.0) ? ?
共病 ? ? χ2=1.562 0.929
? 52(81.3) 46(82.1) ? ?
? 12(18.7) 10(17.9) ? ?
乙肝 ? ? χ2=2.336 0.821
? 20(31.3) 16(28.6) ? ?
? 44(68.7) 40(71.4) ? ?
肝硬化 ? ? χ2=0.782 0.929
? 52(81.3) 46(82.1) ? ?
? 12(18.7) 10(17.9) ? ?
KPS评分(分) 42±22 44±21 t=0.123 0.932
肿瘤直径(cm) 2.7±0.5 2.8±0.4 t=0.912 0.717
肿瘤数量 ? ? χ2=2.228 0.533
? 单发 60(93.8) 50(89.3) ? ?
? 多发 4(6.2) 6(10.7) ? ?
白蛋白(g/L) 36.2±5.1 35.4±4.7 t=1.298 0.582
总胆红素(μmol/L) 14.3±4.4 28.9±5.6 t=2.673 0.002
血小板(×109/L) 156.8±32.6 78.6±13.8 t=3.892 0.032
甲胎蛋白(ng/ml) 17.8±8.3 12.4±7.2 t=1.523 0.116
Child-Pugh分级 ? ? χ2=1.723 0.726
? A级 50(78.1) 46(82.1) ? ?
? B级 14(11.9) 10(17.9) ? ?
临近脏器 ? ? χ2=1.293 0.777
? 14(21.9) 10(17.9) ? ?
? 结肠 16(25.0) 10(17.9) ? ?
? 胆囊 6(9.3) 4(7.1) ? ?
? 肾脏 8(12.5) 8(14.2) ? ?
? 膈肌 10(15.6) 10(17.9) ? ?
? 腹壁 10(15.6) 14(25.0) ? ?
治疗次数* ? ? χ2=3.283 0.086
? 1次 64(91.4) 60(93.6) ? ?
? >1次 6(8.6) 4(6.4) ? ?
手术时间(min) 32.5±7.2 36.5±8.5 t=1.222 0.145
失血量(ml) 5.8±2.2 4.2±2.0 t=0.983 0.879
住院时间(d) 4.8±0.5 4.6±0.5 t=0.920 0.817
平均消费(元) 27256.3±352.5 247417.5±673.8 t=1.892 0.245
局部进展 48(75.0) 14(25.0) χ2=5.837 0.009
远处转移 14(19.6) 10(17.8) χ2=1.834 0.698
技术有效率* 70(100) 64(100) χ2=2.694 1.000
死亡 12(18.8) 8(14.3) χ2=1.948 0.573
图5 微波消融组与冷冻消融组的总生存率(4A)、无复发生存率(4B)及局部肿瘤进展率(4C)比较
表2 微波消融组与冷冻消融组的术后并发症比较
表3 影响消融术后生存情况的Cox回归分析
表4 影响消融术后复发的Cox回归分析
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