摘要
目的:探讨微波消融治疗合并肝硬化小肝癌患者无瘤生存的影响因素,为临床筛查复发高危患者及预防复发提供依据。方法:回顾性分析2013年1月-2018年1月接受微波消融治疗的97例合并肝硬化小肝癌患者的临床资料,统计复发情况,对影响患者术后无瘤生存的相关因素进行分析。结果:97例患者术后随访11~60个月,共有57例(58.8%)患者复发,微波消融术后1、3、5年无瘤生存率分别为92.8%、61.9%、41.2%,中位无瘤生存时间为47.5个月。单因素分析显示,肿瘤数目、肝功能Child-Pugh分级、术前AFP水平、术后是否口服索拉非尼对合并肝硬化小肝癌患者微波消融术后无瘤生存率有影响(P<0.05)。多因素COX比例风险模型分析显示,肿瘤多发[RR=3.476,95%CI(1.274,9.483)]、肝功能Child-Pugh B级[RR=2.951,95%CI(1.050,8.289)]是影响合并肝硬化小肝癌患者微波消融术后无瘤生存的独立危险因素,术后口服索拉非尼[RR=0.263,95%CI(0.081,0.856)]是其保护性因素。结论:微波消融治疗合并肝硬化小肝癌的无瘤生存率受多种因素影响,肿瘤多发、肝功能Child-Pugh B级是其独立危险因素,而术后联合靶向治疗有助于提高术后无瘤生存率。
Objective: To explore the influencing factors of microwave ablation on tumor-free survival rate in treatment of small hepatocellular carcinoma with cirrhosis in order to provide basis for screening patients at high risk of relapse and preventing relapse. Method: A retrospective analysis was conducted on the clinical data of 97 patients with small hepatocellular carcinoma with cirrhosis who undergoing microwave ablation during January 2013 to January 2018. The recurrence rates were observed, and the influencing factors related to tumor-free survival were analyzed. Result: 97 patients were followed up for 11 to 60 months, and at the end of follow up, 57 patients(58.8%) had recurrence. The 1-year, 3-year, and 5-year tumor-free survival rate after microwave ablation were 92.8%, 61.9%, 41.2% respectively, and median tumor-free survival was 47.5 months. Univariate analysis revealed that the factors affecting tumor-free survival rates after microwave ablation in patients with small hepatocellular carcinoma with cirrhosis included lesion numbers, Child-Pugh score, preoperative AFP level and Sorafenib taking post operation(P<0.05). COX regression analysis showed that multiple tumor [RR=3.476, 95%CI(1.274, 9.483)], liver function Child-Pugh B [RR=2.951, 95%CI(1.050, 8.289)] were independent risk factors for tumor-free survival rates after microwave ablation in patients with small hepatocellular carcinoma with cirrhosis, and Sorafenib taking post operation [RR=0.263, 95%CI(0.081, 0.856)] was the protective factor. Conclusion: The tumor-free survival rate of patients with small hepatocellular carcinoma with cirrhosis after microwave ablation is affected by various factors, multiple tumor, liver function Child-Pugh B were independent risk factors, and targeted therapy can help to improve postoperative tumor-free survival rate.
作者
刘芳
陈强
陈灿
LIU Fang;CHEN Qiang;CHEN Can(Liaohe Oilfield Gem Flower Central Hospital,Panjin 124010,China)
出处
《中国医学创新》
CAS
2020年第2期25-29,共5页
Medical Innovation of China
关键词
微波消融
肝硬化
小肝癌
无瘤生存率
Microwave ablation
Cirrhosis
Small hepatocellular carcinoma
Tumor-free survival rate
