中华医学超声杂志（电子版）
中華醫學超聲雜誌（電子版）
중화의학초성잡지（전자판）
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2015年
6期
453-461
,共9页
罗敏%时美欣%张巍%张羽%杨秀华%丁红
囉敏%時美訢%張巍%張羽%楊秀華%丁紅
라민%시미흔%장외%장우%양수화%정홍
肝肿瘤%消融技术%治疗结果
肝腫瘤%消融技術%治療結果
간종류%소융기술%치료결과
Liver neoplasms%Ablation techniques%Treatment outcome
目的：分析影响超声引导下射频消融术（RFA）治疗肝细胞癌（HCC）预后的相关因素。方法收集2008年5月至2012年6月哈尔滨医科大学附属第一医院进行RFA治疗且随访资料完整的HCC患者104例，共147个病灶。随访36个月，记录HCC患者生存情况，采用超声造影监测RFA术后HCC患者局部复发的情况。采用Kaplan-Meier法及Log-rank检验对影响HCC患者RFA术后预后的因素进行单因素分析，对单因素分析与HCC患者RFA术后预后有关的因素再采用Cox比例风险回归模型进行多因素分析。结果104例HCC患者RFA术后半年、1、2、3年生存率分别为96.1%、92.0%、80.0%、53.3%，中位生存时间19个月，RFA术后1年局部复发率为13.6%。单因素分析结果显示术前肝功能Child-Pugh分级、首发癌、术后肝内产生新发病灶、消融范围、首选RFA治疗等因素与HCC患者RFA术后生存率有关（χ2=7.119，P=0.008；χ2=20.485，P=0.000；χ2=14.160，P=0.000；χ2=11.825， P=0.001；χ2=7.979，P=0.005）；多因素分析结果显示术前肝功能Child-Pugh分级、首发癌、术后肝内产生新发病灶为影响HCC患者RFA术后生存率的独立因素（P=0.001；P=0.005；P=0.003）。单因素分析结果显示，病毒标记物、首发癌、背景肝、肿瘤直径、肿瘤边界、邻近脏器或大血管、消融范围、首选RFA治疗等因素与HCC患者RFA术后1年局部复发率有关（χ2=7.234，P=0.007；χ2=9.083， P=0.003；χ2=7.791，P=0.005；χ2=13.042，P=0.000；χ2=20.657，P=0.000；χ2=58.615，P=0.000；χ2=6.681，P=0.010）；多因素分析结果显示，肿瘤边界、消融范围为影响HCC患者RFA术后1年局部复发率的独立因素（P=0.017；P=0.002）。结论影响HCC患者RFA术后生存率的独立因素是术前肝功能Child-Pugh分级、首发癌、术后肝内产生新发病灶，影响HCC患者RFA术后1年局部复发率的独立因素是肿瘤边界、消融范围。为了提高HCC患者生存期、减少局部复发应对高危人群建立良好的观察随访制度，治疗中采取多学科合作方式及规范的治疗方案。
目的：分析影響超聲引導下射頻消融術（RFA）治療肝細胞癌（HCC）預後的相關因素。方法收集2008年5月至2012年6月哈爾濱醫科大學附屬第一醫院進行RFA治療且隨訪資料完整的HCC患者104例，共147箇病竈。隨訪36箇月，記錄HCC患者生存情況，採用超聲造影鑑測RFA術後HCC患者跼部複髮的情況。採用Kaplan-Meier法及Log-rank檢驗對影響HCC患者RFA術後預後的因素進行單因素分析，對單因素分析與HCC患者RFA術後預後有關的因素再採用Cox比例風險迴歸模型進行多因素分析。結果104例HCC患者RFA術後半年、1、2、3年生存率分彆為96.1%、92.0%、80.0%、53.3%，中位生存時間19箇月，RFA術後1年跼部複髮率為13.6%。單因素分析結果顯示術前肝功能Child-Pugh分級、首髮癌、術後肝內產生新髮病竈、消融範圍、首選RFA治療等因素與HCC患者RFA術後生存率有關（χ2=7.119，P=0.008；χ2=20.485，P=0.000；χ2=14.160，P=0.000；χ2=11.825， P=0.001；χ2=7.979，P=0.005）；多因素分析結果顯示術前肝功能Child-Pugh分級、首髮癌、術後肝內產生新髮病竈為影響HCC患者RFA術後生存率的獨立因素（P=0.001；P=0.005；P=0.003）。單因素分析結果顯示，病毒標記物、首髮癌、揹景肝、腫瘤直徑、腫瘤邊界、鄰近髒器或大血管、消融範圍、首選RFA治療等因素與HCC患者RFA術後1年跼部複髮率有關（χ2=7.234，P=0.007；χ2=9.083， P=0.003；χ2=7.791，P=0.005；χ2=13.042，P=0.000；χ2=20.657，P=0.000；χ2=58.615，P=0.000；χ2=6.681，P=0.010）；多因素分析結果顯示，腫瘤邊界、消融範圍為影響HCC患者RFA術後1年跼部複髮率的獨立因素（P=0.017；P=0.002）。結論影響HCC患者RFA術後生存率的獨立因素是術前肝功能Child-Pugh分級、首髮癌、術後肝內產生新髮病竈，影響HCC患者RFA術後1年跼部複髮率的獨立因素是腫瘤邊界、消融範圍。為瞭提高HCC患者生存期、減少跼部複髮應對高危人群建立良好的觀察隨訪製度，治療中採取多學科閤作方式及規範的治療方案。
목적：분석영향초성인도하사빈소융술（RFA）치료간세포암（HCC）예후적상관인소。방법수집2008년5월지2012년6월합이빈의과대학부속제일의원진행RFA치료차수방자료완정적HCC환자104례，공147개병조。수방36개월，기록HCC환자생존정황，채용초성조영감측RFA술후HCC환자국부복발적정황。채용Kaplan-Meier법급Log-rank검험대영향HCC환자RFA술후예후적인소진행단인소분석，대단인소분석여HCC환자RFA술후예후유관적인소재채용Cox비례풍험회귀모형진행다인소분석。결과104례HCC환자RFA술후반년、1、2、3년생존솔분별위96.1%、92.0%、80.0%、53.3%，중위생존시간19개월，RFA술후1년국부복발솔위13.6%。단인소분석결과현시술전간공능Child-Pugh분급、수발암、술후간내산생신발병조、소융범위、수선RFA치료등인소여HCC환자RFA술후생존솔유관（χ2=7.119，P=0.008；χ2=20.485，P=0.000；χ2=14.160，P=0.000；χ2=11.825， P=0.001；χ2=7.979，P=0.005）；다인소분석결과현시술전간공능Child-Pugh분급、수발암、술후간내산생신발병조위영향HCC환자RFA술후생존솔적독립인소（P=0.001；P=0.005；P=0.003）。단인소분석결과현시，병독표기물、수발암、배경간、종류직경、종류변계、린근장기혹대혈관、소융범위、수선RFA치료등인소여HCC환자RFA술후1년국부복발솔유관（χ2=7.234，P=0.007；χ2=9.083， P=0.003；χ2=7.791，P=0.005；χ2=13.042，P=0.000；χ2=20.657，P=0.000；χ2=58.615，P=0.000；χ2=6.681，P=0.010）；다인소분석결과현시，종류변계、소융범위위영향HCC환자RFA술후1년국부복발솔적독립인소（P=0.017；P=0.002）。결론영향HCC환자RFA술후생존솔적독립인소시술전간공능Child-Pugh분급、수발암、술후간내산생신발병조，영향HCC환자RFA술후1년국부복발솔적독립인소시종류변계、소융범위。위료제고HCC환자생존기、감소국부복발응대고위인군건립량호적관찰수방제도，치료중채취다학과합작방식급규범적치료방안。
Objective To evaluate the prognostic factors of hepatocellular carcinoma (HCC) patients with treatment of ultrasound-guided pereutaneous radiofrequency ablation (RFA).Methods A total of 104 patients with 147 HCC tumors who had 36-month regular follow-up after percuatenous RFA therapy in the First Affi liated Hospital of Harbin Medical University between May 2008 tand June 2012 were included in this study. Contrast-enhanced ultrasound (CEUS) was the main method in evaluating the therapeutic effect of RFA. Kaplan-Meier model and Log-rank test were used in univariate analysis, and Cox regression model was used in multivariate analysis to identify the independent factors on therapeutic effect of RFA.Results The 0.5-, 1-, 2-, 3-year overall survival rates after RFA were 96.1%, 92.0%, 80.0%, 53.3% respectively, and the mediansurvival time was 19 months. 1-year local recurrence rate was 13.6%. The univariate analysis showed that Child-Pugh classifi cation, original lesion condition, intrahepatic recurrence, ablative area, and RFA priority were related to survival rate (χ2=7.119,P=0.008;χ2=20.485,P=0.000;χ2=14.160,P=0.000;χ2=11.825, P=0.001;χ2=7.979,P=0.005). The Child-Pugh classifi cation, original lesion condition, intrahepatic recurrence were identified as independent prognostic factors of survival rate (P=0.001;P=0.005;P=0.003). The univariate analysis showed that virus marker, original lesion condition, hepatic background, tumor diameter, tumor boundary, relation with adjacent organ and vessels, ablative area, RFA priority weresignifi cantly related to local recurrence rate (χ2=7.234,P=0.007;χ2=9.083,P=0.003;χ2=7.791,P=0.005;χ2=13.042,P=0.000;χ2=20.657,P=0.000;χ2=58.615,P=0.000;χ2=6.681,P=0.010). The ablative area and tumor boundary were identified as independent prognostic factors of local recurrence rate (P=0.017;P=0.002).Conclusions Child-Pugh classifi cation, original lesion condition, intrahepatic recurrence were identifi ed as independent prognostic factors of survival. And ablative area and tumor boundary were identified as independent prognostic factors of local rcurrence rate. In order to improve patient`s survival and reduce local recurrence in high-risk cases, it is importantant to establish appropriate follow-up plan and multidisciplinary cooperation framework within a standard treatment procedure.
