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目的探讨高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗进展期肝癌的近期和远期疗效。方法151例失去手术治疗机会或不愿意接受手术治疗的进展期原发性肝癌患者接受以HIFU为中心的序贯治疗,30例同期仅接受对症支持治疗的进展期肝癌患者作为对照组。两组患者一般情况及肿瘤分期等具可比性。治疗前后及随访期间定期观察患者的疼痛症状评分(Karnofsky评分),肿瘤指标(AFP、CA199),影像学改变及应答率、生存期、生存质量改变。结果与对照组相比,HIFU组患者的影像学、AFP及症状评分均明显好转(P<0.05)。HIFU组患者的显效和有效率分别为28.5%和60.3%;对照组分别为0%和16.7%;总体有效率HIFU组(88.8%)明显高于对照组(16.7%),P<0.01。HIFU组患者的1年、2年生存率(分别为50%、30.9%)均明显高于对照组(分别为3.6%、0%),P<0.01。HIFU组患者接受治疗后3个月的生存质量评分为83.1±8.0,明显优于治疗前评分67.7±5.9及同期对照组评分69.0±8.5(P<0.05)。HIFU治疗期间无严重并发症发生。结论HIFU是治疗进展期肝癌安全、有效的治疗方法。
Objective To investigate the short-term and long-term effects of high intensity focused ultrasound (HIFU) on advanced liver cancer. Methods One hundred and fifteen patients with advanced primary liver cancer who lost their chances of surgery or were unwilling to undergo surgery were followed up with HIFU-centered sequential therapy and 30 patients with advanced hepatocellular carcinoma who received symptomatic supportive therapy at the same period as control group. Two groups of patients in general and tumor stage comparable. The pain scores (Karnofsky score), tumor markers (AFP, CA199), imaging changes and response rate, survival and quality of life of the patients were observed regularly before and after treatment and during follow-up. Results Compared with the control group, the imaging, AFP and symptom scores of HIFU group were significantly improved (P <0.05). The effective rate of HIFU group was 28.5% and 60.3% respectively; the control group was 0% and 16.7% respectively; the overall effective HIFU group (88.8%) was significantly higher than that of the control group (16.7%), P <0.01. The 1-year and 2-year survival rates (50%, 30.9%, respectively) in HIFU group were significantly higher than those in control group (3.6% and 0% respectively), P <0.01. The quality of life at 3 months after treatment in the HIFU group was 83.1 ± 8.0, significantly better than the pre-treatment score of 67.7 ± 5.9 and the control group of the same period score of 69.0 ± 8.5 (P <0.05). No serious complications occurred during HIFU treatment. Conclusion HIFU is a safe and effective treatment for advanced hepatocellular carcinoma.