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目的探讨经皮热消融治疗肝细胞癌的预后影响因素。方法对接受了治愈性超声引导经皮微波或射频消融治疗的137例肝细胞癌病人,用单因素及多因素Cox模型分析可能影响累积生存率及无瘤生存率的16个预后因素。结果1、2、3、4和5年的累积生存率分别为73．9％、52．1％、42．8％、26．2％和20．1％。1、2、3和4年的无瘤生存率分别为38．1％、21．9％、18．8％和14．1％。单因素分析发现消融前血清AFP>200 ng／ml(P=0．0012)、血清白蛋白≤35 g／dl(P= 0．0000)、肝功能Child’s C级(P=0．0141)及肿瘤消融不全(P=0．0003)均可明显影响累积生存率。多因素Cox模型发现消融不全(P=0．005)是最显著的影响累积生存率的独立因素,其余依次为血清白蛋白水平(P=0．008)、AFP值(P=0．016)及Child-Pugh肝功能分级(P=0．033)。多因素Cox模型还揭示初治时为复发性肝细胞癌者(P=0．005)是独立的影响无瘤生存率的因素。结论在经皮热消融治疗肝细胞癌中局部灭瘤效果是最重要的预后影响因素,妥当掌握治愈性治疗适应证和进一步改进治疗技术是必要的。
Objective To investigate the prognostic factors of percutaneous thermal ablation in the treatment of hepatocellular carcinoma. Methods A total of 137 patients with hepatocellular carcinoma undergoing curative ultrasound-guided percutaneous microwave or radiofrequency ablation were included in the study. One-factor and multivariate Cox models were used to analyze 16 prognostic factors that may affect cumulative survival and tumor-free survival. Results The cumulative survival rates at 1, 2, 3, 4 and 5 years were 73.9%, 52.1%, 42.8%, 26.2% and 20.1%, respectively. The 1, 2, 3 and 4 year disease-free survival rates were 38.1%, 21.9%, 18.8% and 14.1% respectively. Univariate analysis showed that pre-ablation serum AFP> 200 ng / ml (P = 0.0012), serum albumin ≤35 g / dl (P = 0.0000), liver function Child’s C (P = 0.0141) Tumor ablation (P = 0.0003) can significantly affect the cumulative survival rate. Multivariate Cox model found that ablation (P = 0.005) was the most significant independent factor affecting cumulative survival rate, followed by serum albumin (P = 0.008), AFP (P = 0.016) And Child-Pugh liver function classification (P = 0.033). The multivariate Cox model also revealed that patients with recurrent hepatocellular carcinoma at the time of initial diagnosis (P = 0.005) were independent factors that affected disease-free survival. Conclusions The efficacy of percutaneous thermal ablation in the treatment of hepatocellular carcinoma is the most important factor affecting the prognosis of patients with hepatocellular carcinoma. Proper treatment of indications for curative treatment and further improvement of therapeutic techniques are necessary.