【作者】 陈敏华； 杨薇； 吴薇； 傅颖； 武金玉； 侯毅斌； 严昆；

【Author】 Min-Hua Chen*,Wei Yang,Wei Wu,Ying Fu,Jin-Yu Wu,Yi-Bin Hou,Kun Yan Department of Ultrasound,School of Oncology,Peking University,Beijing,100142

【机构】 北京大学临床肿瘤学院北京肿瘤医院超声科；

【摘要】 目的:探讨>3.5cm肝癌经皮RFA治疗方案策略及疗效。方法:近七年治疗肝癌370例,其中非手术适应症非TACE适应症>3.5cm肝癌172例176灶,按制定方案策略行超声引导经皮RFA治疗。男142例,女30例,平均年龄60.3岁(范围24-84岁)。肿瘤大小3.5-7.0cm,平均4.7±0.9cm,其中3.6-5.0cm 108灶,5.1-7.0cm 68灶。肿瘤单发116例,多发56例。肝功能Child-pugh-A 104例,B级68例。65例为手术或TACE后复发癌。采用治疗方案策略包括(1)根据数学方案计算行多灶重叠覆盖消融;(2)血供丰富肝癌采用彩超引导经皮阻断荷瘤动脉(PAA)后RFA;(3)荷瘤血管高流速大肿瘤行经皮经肝动脉栓塞(PAE)后RFA治疗模式。RFA后1月增强CT判断肿瘤早期灭活率,其后每3个月～6个月定期行增强CT检查并结合AFP检查评价疗效。结果:肿瘤早期灭活率为91.5%(161/176灶),3.5~5.0cm肿瘤为93.5%(101/108灶),5.1~7.0cm为88.2%(60/68灶),两者间无统计学差异(P=0.222)。随访3~86月,平均26个月。肿瘤局部复发率为17.6%(31/176灶),肝内新生率41.3%(71/172例)。1,3,5年总体生存率为80.4%,52.0%,37.5%。其中,3.5~5.0cm肿瘤为79.8%,57.5%,46.5%,5.1~7.0cm为81.3%,43.9%,25.4%(P=0.174)。严重并发症3.5%(6/172例),包括肠穿孔1例,腹腔出血2例,针道种植转移2例,血性胸水1例。结论:本研究制定的方案策略对经皮RFA治疗困难的较大肿瘤、富血供肿瘤可获得较高生存率及较低并发症,证实多种策略有一定临床应用价值;但>5cm肝癌具有5年生存率低于3.5～5cm肿瘤趋势,有待今后探讨更适宜的综合治疗。更多还原

【Abstract】 Objective:This study aimed to investigate the treatment strategy and outcome of RFA of >3.5 cm HCC.Methods:A total of 370 HCC patients underwent RFA in our department in the last 7 years.Among them,172 patients who had 176 >3.5cm HCC and were not candidate for surgery or TACE were enrolled in this study.There were 142 males and 30 females(mean age of 60.3±10.4 years,ranged from 24-84 years).The average tumor size was 4.7±0.9 cm in diameter(ranged from 3.5-7.0 cm).The size of 108 tumors were 3.6-5.0cm,while the remaining 68 tumors 5.1- 7.0cm.There were 116 patients with solitary tumor and 56 wit multiple tumors.104 patients had Child-pugh-A cirrhosis and 68 had Child-B cirrhosis.Established strategy for >3.5cm tumors included(1) multiple overlapping ablations based on mathematical protocol;(2) color US guided percutaneous ablation of tumor feeding artery(PAA) + RFA for HCC with rich supply;(3) percuteneous arterial embolization + RFA for HCC with high velocity flow.The patients underwent follow-up biphasic helical CT at 1 month,and then every 3-6 months after RF ablation.The ablation was considered a success if no abnormal enhancement or wash-out was detected in the treated area on the CT scan at one month.Overall survival was estimated by Kaplan-Meier analysis.Results:The ablation success rate was 91.5%(161/176 tumors) for all patients,93.5%(101/108 tumors) for 3.5-5.0cm HCC and 88.2%(60/68 tumors) for 5.1-7.0cm HCC,respectively. Follow-up period ranged from 3 to 86 months with average 26 months.The local recurrence rate was 17.6%(31/176 tumors) and intrahepatic new occurrence rate was 41.3%(71/172 cases).The 1-,3-,5- overall survival were 80.4%, 52.0%and 37.5%for all patients,were 79.8%,57.5%and 46.5%for 3.6-5.0cm HCC patients and were 81.3%,43.9% and 25.4%for 5.1-7.0cm HCC patients,respectively(P=0.174).The incidence of major complications was 3.5% (6/172 cases),including intraperitoneal hemorrhage(n = 2),hemothorax(n = 1),bowel perforation(n=1) and needle tract seeding(n = 2).Of these,only one patient suffered from colon perforation one week after RFA treatment required surgical intervention.Conclusion:The protocol presented in this study for tumor >3.5 cm can achieve a high success rate with a low local recurrence rate,and then benefit for survival.But the patients with >5 cm HCC tended have lower survival than 3.5-5.0 HCC patients,thus optimized multi-modalities treatment should be investigated for these tumors in the future.更多还原