中国癌症杂志
中國癌癥雜誌
중국암증잡지
CHINA ONCOLOGY
2014年
2期
119-127
,共9页
花永强%陈颢%孟志强%陈震%林钧华%刘鲁明%朱晓燕%沈晔华%王鹏%高惠峰%解婧
花永彊%陳顥%孟誌彊%陳震%林鈞華%劉魯明%硃曉燕%瀋曄華%王鵬%高惠峰%解婧
화영강%진호%맹지강%진진%림균화%류로명%주효연%침엽화%왕붕%고혜봉%해청
肝脏肿瘤%射频消融%残留%危险因素
肝髒腫瘤%射頻消融%殘留%危險因素
간장종류%사빈소융%잔류%위험인소
Liver tumors%Radiofrequency ablation (RFA)%Ablation residual%Risk factors
背景与目的：射频消融(radiofrequencey ablation，RFA)是治疗原发性肝癌和部分转移性肝癌的有效的方法，本研究探讨肝脏恶性肿瘤RFA治疗后肿瘤残留的危险因素。方法：回顾性分析2010年1月-2013年3月复旦大学附属肿瘤医院收治的302例原发性肝癌和转移性肝癌患者共691个肝内病灶接受RFA治疗的临床资料，采用单因素和多因素Logistic Regression模型分析与RFA治疗后肿瘤残留有关的危险因素。结果：RFA治疗后272例(90.07%)患者的632个(91.46%)病灶完全消融，肿瘤残留率为8.54%。直径≤3 cm的肿瘤残留率为6.30%，3~5 cm为9.57%，>5 cm为28.57%；靠近肝内大血管和胆囊肿瘤残留率分别为17.14%和18.52%；联合其他局部治疗和未联合其他局部治疗的肿瘤残留率分别为7.02%和13.41%。多因素分析显示，肿瘤最大直径>5 cm(P=0.044)、靠近肝内大血管(P=0.039)和未联合其他局部治疗(P=0.001)是RFA治疗后肿瘤残留的独立危险因素。112例患者282个病灶最大直径3~5 cm，RFA治疗后肿瘤残留多因素分析显示，肿瘤靠近肝内大血管(P=0.014)、单针射频(P=0.047)和未联合其他局部治疗(P=0.023)是RFA治疗后肿瘤残留的独立危险因素。结论：超声引导的RFA治疗可以获得满意的消融效果，其中肿瘤靠近肝内大血管、肿瘤最大直径>5 cm和未联合其他局部治疗是肿瘤残留的独立危险因素，对于直径为3~5 cm的肿瘤，除靠近肝内大血管和未联合其他局部治疗外，单针射频也是肿瘤残留的独立危险因素，采用双针或多针治疗可以提高消融效率，降低肿瘤残留。
揹景與目的：射頻消融(radiofrequencey ablation，RFA)是治療原髮性肝癌和部分轉移性肝癌的有效的方法，本研究探討肝髒噁性腫瘤RFA治療後腫瘤殘留的危險因素。方法：迴顧性分析2010年1月-2013年3月複旦大學附屬腫瘤醫院收治的302例原髮性肝癌和轉移性肝癌患者共691箇肝內病竈接受RFA治療的臨床資料，採用單因素和多因素Logistic Regression模型分析與RFA治療後腫瘤殘留有關的危險因素。結果：RFA治療後272例(90.07%)患者的632箇(91.46%)病竈完全消融，腫瘤殘留率為8.54%。直徑≤3 cm的腫瘤殘留率為6.30%，3~5 cm為9.57%，>5 cm為28.57%；靠近肝內大血管和膽囊腫瘤殘留率分彆為17.14%和18.52%；聯閤其他跼部治療和未聯閤其他跼部治療的腫瘤殘留率分彆為7.02%和13.41%。多因素分析顯示，腫瘤最大直徑>5 cm(P=0.044)、靠近肝內大血管(P=0.039)和未聯閤其他跼部治療(P=0.001)是RFA治療後腫瘤殘留的獨立危險因素。112例患者282箇病竈最大直徑3~5 cm，RFA治療後腫瘤殘留多因素分析顯示，腫瘤靠近肝內大血管(P=0.014)、單針射頻(P=0.047)和未聯閤其他跼部治療(P=0.023)是RFA治療後腫瘤殘留的獨立危險因素。結論：超聲引導的RFA治療可以穫得滿意的消融效果，其中腫瘤靠近肝內大血管、腫瘤最大直徑>5 cm和未聯閤其他跼部治療是腫瘤殘留的獨立危險因素，對于直徑為3~5 cm的腫瘤，除靠近肝內大血管和未聯閤其他跼部治療外，單針射頻也是腫瘤殘留的獨立危險因素，採用雙針或多針治療可以提高消融效率，降低腫瘤殘留。
배경여목적：사빈소융(radiofrequencey ablation，RFA)시치료원발성간암화부분전이성간암적유효적방법，본연구탐토간장악성종류RFA치료후종류잔류적위험인소。방법：회고성분석2010년1월-2013년3월복단대학부속종류의원수치적302례원발성간암화전이성간암환자공691개간내병조접수RFA치료적림상자료，채용단인소화다인소Logistic Regression모형분석여RFA치료후종류잔류유관적위험인소。결과：RFA치료후272례(90.07%)환자적632개(91.46%)병조완전소융，종류잔류솔위8.54%。직경≤3 cm적종류잔류솔위6.30%，3~5 cm위9.57%，>5 cm위28.57%；고근간내대혈관화담낭종류잔류솔분별위17.14%화18.52%；연합기타국부치료화미연합기타국부치료적종류잔류솔분별위7.02%화13.41%。다인소분석현시，종류최대직경>5 cm(P=0.044)、고근간내대혈관(P=0.039)화미연합기타국부치료(P=0.001)시RFA치료후종류잔류적독립위험인소。112례환자282개병조최대직경3~5 cm，RFA치료후종류잔류다인소분석현시，종류고근간내대혈관(P=0.014)、단침사빈(P=0.047)화미연합기타국부치료(P=0.023)시RFA치료후종류잔류적독립위험인소。결론：초성인도적RFA치료가이획득만의적소융효과，기중종류고근간내대혈관、종류최대직경>5 cm화미연합기타국부치료시종류잔류적독립위험인소，대우직경위3~5 cm적종류，제고근간내대혈관화미연합기타국부치료외，단침사빈야시종류잔류적독립위험인소，채용쌍침혹다침치료가이제고소융효솔，강저종류잔류。
Background and purpose: Radiofrequency ablation (RFA) is one of the effective treatment methods for primary liver cancer and metastatic liver cancer. The purpose of this study was to investigate the risk factors of residual tumor after RFA for hepatic malignancies. Methods:A total number of 302 hepatic malignancies cases with 691 tumors after ultrasound-guided RFA from Jan. 2010 to Mar. 2013 were retrospectively analyzed. Single factor and multi-factor Logistic regression model were used to analyze the risk factors of residual tumor after RFA. Results:Complete ablation cases were 90.07%(272/302) for patients and 91.46%(632/691) for tumors, and the ablation residual rate was 8.54%. Ablation residual rates for tumor ≤3 cm, 3-5 cm and >5 cm in diameter were 6.30%, 9.57% and 28.57%, for tumor close to the intrahepatic vascular and gallbladder were 17.14%and 18.52%, for with and without combination with other local treatments were 7.02%and 13.41%, respectively. Multivariate analysis showed that tumor size>5 cm (P=0.044), proximity to large vessel (P=0.039) and without combination with other local treatments (P=0.001) were independent risk factors for ablation residual. Multivariate analysis showed that tumor near the intrahepatic vascular (P=0.014), single needle RFA (P=0.047) and without combination with other local treatments (P=0.023) were independent ablation residua risk factors for tumors between 3-5 cm in maximum diameter. Conclusion:Ultrasound-guided RFA can achieve satisfactory ablation effect. Tumor close to the intrahepatic vascular, tumor diameter>5 cm and without combination with other local treatment act as the independent risk factors for ablation residual. For tumors between 3-5 cm in diameter, in addition to close to intrahepatic blood vessels and without combination with other local treatment, single needle RFA is also another independent risk factor for ablation residual, and double-needle or multi-needle treatment can improve the ablation efifciency and reduce residual rate.
