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目的评估射频消融术(radiofrequency ablation,RFA)治疗符合米兰标准的老年肝癌患者的疗效。方法回顾性分析1999年6月至2011年6月我院行射频消融治疗的90例≥70岁符合米兰标准的原发性肝细胞癌(Hepatocellular carcinoma,HCC)病例,进行随访观察,评价其疗效,统计初次RFA术后1、2、3、4、5年无瘤生存率及总生存率,同时分析影响预后的相关因素。结果共90例病例纳入本研究。术后出现并发症31例(34.44%),无严重并发症病例及死亡病例。RFA术后中位无瘤生存时间21个月,1、2、3、4、5年无瘤生存率分别为65.56%、46.67%、33.33%、24.44%、17.78%。中位总生存时间49个月,1、2、3、4、5年总生存率分别为91.11%、80.00%、67.78%、52.22%、35.56%。在多因素分析中长期饮酒史、肝炎病毒感染、肝硬化、Child-Pugh B级、AFP>20 ng/mL、HBV-DNA>1 000 cps/mL、Cr>88.4μmol/L、合并症是影响生存率的显著危险因素。对于单发病灶,病灶直径大于3 cm者,无瘤生存率及总生存率明显较低。结论 RFA治疗符合米兰标准的老年肝癌患者,安全性高、并发症少、疗效满意;肝癌直径大于3 cm者行RFA治疗预后较差;但RFA仍是老年早期肝癌患者较好的选择。
Objective To evaluate the efficacy of radiofrequency ablation (RFA) in elderly patients with hepatocellular carcinoma who met Milan criteria. Methods Ninety patients (≥70 years) with primary hepatocellular carcinoma (HCC) who met the criteria of Milan in our hospital from June 1999 to June 2011 were retrospectively analyzed to evaluate their curative effect , Statistics of 1, 2, 3, 4, 5 years after initial RFA tumor-free survival and overall survival rate, and analyze the factors that affect the prognosis. Results A total of 90 cases were included in this study. Postoperative complications occurred in 31 cases (34.44%), no serious complications and deaths. The median tumor-free survival time was 21 months after RFA. The tumor-free survival rates at 1, 2, 3, 4 and 5 years were 65.56%, 46.67%, 33.33%, 24.44% and 17.78%, respectively. The median overall survival time was 49 months. The overall survival rates at 1, 2, 3, 4 and 5 years were 91.11%, 80.00%, 67.78%, 52.22% and 35.56%, respectively. Long-term drinking history, hepatitis virus infection, cirrhosis, Child-Pugh B level, AFP> 20 ng / mL, HBV DNA> 1000 cps / mL and Cr> 88.4 μmol / L in multivariate analysis were associated with complications Significant risk factors for survival. For single lesions, lesion diameter greater than 3 cm, tumor-free survival and overall survival was significantly lower. Conclusion RFA treatment of elderly patients with liver cancer in line with Milan standards, high safety, fewer complications, and satisfactory efficacy; the diameter of more than 3 cm of liver cancer patients with poor prognosis of RFA treatment; but RFA is still a good choice for elderly patients with early stage of liver cancer.