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肝恶性肿瘤包括原发性肝癌和转移性肝癌[1],热消融技术因创伤小、安全性高、定位准确等优点成为目前临床非手术治疗肝癌常用的方法之一。已有相关指南建议对3 cm或更小的肝脏恶性肿瘤进行射频消融(RFA)[2-4]。然而,局部消融治疗难以确保单次治疗后肿瘤病变完全坏死。文献[5]报道肝癌局部消融后局部肿瘤进展(local tumor progression,LTP)的发生率较高,可达5.7%~39.0%,是影响局部消融效果的主要因素之一。肝脏RFA后与LTP相关的独立预测因子包括消融边缘不足、肿瘤大小、包膜下位置和血管接近度、肿瘤类型、高血清透明质酸和肝炎病毒载量。微波消融(MWA)已经在肝癌治疗中取得了成熟的发展[6-7]。具有内部冷循环系统的消融针可以实现更大的消融区域,这将MWA指征从 < 3 cm的病灶扩展到5 cm及更大的病灶[8]。此外,与RFA相比,MWA显示出更高的热效率[9]。与RFA后相比,这些特征可能导致肝脏MWA后不同LTP发生率和危险因素的潜在可能性。我们的研究目的是分析MWA治疗肝癌后局影响肿瘤进展的危险因素,对改善疗效有重要的临床意义。
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本组73例共102个病灶,MWA后1个月复查增强CT,99个病灶实现完全灭活,有效率97.06%。随访观察期间,有16个(15.68%)病灶发生LTP。本组病例LTP发生时间为治疗后3~24个月,中位时间为10个月。
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结果显示,肿瘤大小、肿瘤边界是否清晰、是否邻近大血管、肿瘤血流灌注程度对LTP发生的影响有统计学意义(P < 0.05~P < 0.01),病人年龄、肿瘤类型以及肝脏Child-Pugh分级对LTP发生的影响无统计学意义(P>0.05)(见表 1)。
影响因素 病灶数 LTP病灶数/个 LTP发生率/% χ2 P 年龄/岁 ≤60 40 7 17.50 0.16 >0.05 >60 62 9 14.52 肿瘤大小/cm ≤3 81 9 11.11 6.23 < 0.05 >3 21 7 33.33 肿瘤边界 清晰 56 5 8.93 4.30 < 0.05 不清晰 46 11 23.91 肿瘤类型 原发性 69 8 11.59 2.70 >0.05 转移性 33 8 24.24 邻近大血管 是 16 7 43.75 14.22 < 0.01 否 86 9 10.47 肝脏Child-Pugh分级 A级 72 9 12.50 1.15 >0.05 B级 30 7 23.33 血流灌注程度 高 49 12 24.49 5.53 < 0.05 低 53 4 7.55 表 1 影响LTP的单因素分析
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将影响LTP的单因素分析中有统计学意义的4个因素进行多因素logistic回归分析, 结果显示,肿瘤>3 cm及肿瘤邻近大血管为影响LTP的独立危险因素(P < 0.05)(见表 2)。
自变量 B Waldχ2 P OR(95%CI) 肿瘤大小>3 cm 0.836 9.108 < 0.05 2.836(1.752~10.703) 肿瘤边界不清晰 -1.620 6.223 >0.05 0.455(0.116~9.868) 邻近大血管 1.237 15.336 < 0.05 4.804(1.241~18.599) 血流灌注程度高 -0.690 1.062 >0.05 0.572(0.122~4.583) 表 2 局部肿瘤进展影响因素logistic回归分析
微波消融治疗肝癌后局部肿瘤进展的危险因素分析
Analysis of the risk factors of local tumor progression after liver cancer patients treated with microwave ablation
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摘要:
目的分析行超声引导经皮微波消融术(MWA)后肝癌病人影响局部肿瘤进展(LTP)发生的危险因素。 方法选择采用MWA治疗的肝癌病人73例共102个病灶为研究对象,对病人的临床资料和术后随访影像学检查资料进行回顾性分析。 结果LTP总发生率为15.68%(16/102);单因素分析显示,LTP与病人年龄、肿瘤类型及肝脏Child-Pugh分级无关(P>0.05),与肿瘤大小、肿瘤边界是否清晰、肿瘤是否邻近大血管和肿瘤血流灌注程度有关(P < 0.05~P < 0.01);进一步多因素logistic回归分析显示,肿瘤大小>3 cm及肿瘤邻近大血管是LTP的独立危险因素(P < 0.05)。 结论肿瘤大小>3 cm和邻近大血管是MWA治疗肝癌后发生LTP的独立危险因素,临床治疗中应采取相应措施和策略,从而提高MWA疗效。 Abstract:ObjectiveTo analyze the risk factors of local tumor progression(LTP) after liver cancer patients treated with ultrasound-guided percutaneous microwave ablation(MWA). MethodsA total of 102 lesions in 73 cases of liver cancer treated with MWA were investigated.The clinical data of the patients and postoperative following-up imaging examination data were retrospectively analyzed. ResultsThe total incidence rate of LTP was 15.68%(16/102).The results of univariate analysis showed that the LTP was not related to the age, tumor type, and Child-Pugh classification of liver(P>0.05), and related to the tumor size, clear tumor boundary, tumor adjacence to large blood vessels and tumor blood perfusion degree(P < 0.05 to P < 0.01).The results of further multivariate logistic regression analysis showed that the tumor size >3 cm and tumor adjacence to large blood vessels were the independent risk factors of LTP(P < 0.05). ConclusionsThe tumor size >3 cm and adjacence to large blood vessels are the independent risk factors of LTP after liver cancer patients treated with MWA.The corresponding measures and strategies should be taken to improve the efficacy of MWA in clinic. -
Key words:
- liver neoplasms /
- microwave ablation /
- local tumor progression
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表 1 影响LTP的单因素分析
影响因素 病灶数 LTP病灶数/个 LTP发生率/% χ2 P 年龄/岁 ≤60 40 7 17.50 0.16 >0.05 >60 62 9 14.52 肿瘤大小/cm ≤3 81 9 11.11 6.23 < 0.05 >3 21 7 33.33 肿瘤边界 清晰 56 5 8.93 4.30 < 0.05 不清晰 46 11 23.91 肿瘤类型 原发性 69 8 11.59 2.70 >0.05 转移性 33 8 24.24 邻近大血管 是 16 7 43.75 14.22 < 0.01 否 86 9 10.47 肝脏Child-Pugh分级 A级 72 9 12.50 1.15 >0.05 B级 30 7 23.33 血流灌注程度 高 49 12 24.49 5.53 < 0.05 低 53 4 7.55 表 2 局部肿瘤进展影响因素logistic回归分析
自变量 B Waldχ2 P OR(95%CI) 肿瘤大小>3 cm 0.836 9.108 < 0.05 2.836(1.752~10.703) 肿瘤边界不清晰 -1.620 6.223 >0.05 0.455(0.116~9.868) 邻近大血管 1.237 15.336 < 0.05 4.804(1.241~18.599) 血流灌注程度高 -0.690 1.062 >0.05 0.572(0.122~4.583) -
[1] SIEGEL RL, MILLER D, JEMAL A. Cancer statistics, 2017[J]. CA Cancer J Clin, 2017, 67(1): 7. doi: 10.3322/caac.21387 [2] EI-SERAG HB. Advances in the management of hepatocellular carcinoma[J]. Clin Adv Hematol Oncol, 2017, 9(8): 2 [3] MCGHANA JP, DODD GD 3rd. Radiofrequency ablation of the liver: current status[J]. AJR AM J Roentgenol, 2001, 176(1): 3. doi: 10.2214/ajr.176.1.1760003 [4] KIM GA, SHIM JH, KIM MJ, et al. Radiofrequency ablation as an alternative to hepatic resection for single small hepatocellular carcinomas[J]. Brit J Surg, 2016, 103(1): 126. . [5] ALLAIRE M, REKIK S, MUMANA A, et al. Determinants of long term survival and recurrence patterns after radiofrequency ablation for hepatocellular carcinoma developed on cirrhosis[J]. J Hepatol, 2017, 66(1): S446. [6] XU Y, SHEN Q, LIU P, et al. Microwave ablation for the treatment of hepatocellular carcinoma that met up-to-seven criteria: feasibility, local efficacy and long-term outcomes[J]. Eur Radiol, 2017, 27(9): 3877. doi: 10.1007/s00330-017-4740-0 [7] WANG T, LU XJ, CHI JC, et al. Microwave ablation of hepatocellular carcinoma as first-line treatment: long term outcomes and prognostic factors in 221 patients[J]. Sci Rep, 2016, 6: 32728. doi: 10.1038/srep32728 [8] THAMTORAWAT S, HICKS RM, Yu J, et al. Preliminary outcome of microwave ablation of hepatocellular carcinoma: breaking the 3-cm barrier?[J]. J Vasc interv Radiol, 2016, 27(5): 623. doi: 10.1016/j.jvir.2016.01.011 [9] VOGL TJ, FARSHID P, NAGUIB NN, et al. Ablation therapy of hepatocellular carcinoma: a comparative study between radiofrequency and microwave ablation[J]. Abdom Imaging, 2015, 40(6): 1829. doi: 10.1007/s00261-015-0355-6 [10] GERBES A, ZOULIM F, TILG H, et al. Gut roundtable meeting paper: selected recent advances in hepatocellular carcinoma[J]. Gut, 2018, 67(2): 380. doi: 10.1136/gutjnl-2017-315068 [11] BUSCARINI L, ROSSI S, FORNARI F, et al. Laparoscopic ablation of liver adenoma by radiofrequency electrocauthery[J]. Gastrointest Endosc, 1995, 41(1): 68. doi: 10.1016/S0016-5107(95)70279-2 [12] GAO J, WANG SH, DING XM, et al. Radiofrequency ablation for single hepatocellular carcinoma 3 cm or less as first-line treatment[J]. World J Gastroentero, 2015, 21(17): 5287. doi: 10.3748/wjg.v21.i17.5287 [13] YU J, LIANG P, YU X L, et al. Local tumour progression after ultrasound-guided microwave ablation of liver malignancies: risk factors analysis of 2529 tumours[J]. Eur Radiol, 2015, 25(4): 1119. doi: 10.1007/s00330-014-3483-4 [14] MA S, DING M, LI J, et al. Ultrasound-guided percutaneous microwave ablation for hepatocellular carcinoma: clinical outcomes and prognostic factors[J]. J Cancer Res Clin, 2017, 143(1): 131. doi: 10.1007/s00432-016-2266-5 [15] OKUSAKA T, OKADA S, UENO H, et al. Satellite lesions in patients with small hepatocellular carcinoma with reference to clinicopathologic features[J]. Cancer, 2002, 95(9): 1931. doi: 10.1002/cncr.10892 [16] HUANG L, DODD GD 3RD, LANCTOT AC. Radiofrequency ablation of the liver: effect of variation of portal venous blood flow on lesion size in an in vitro perfused bovine liver[J]. Acad Radiol, 2012, 19(8): 1018. doi: 10.1016/j.acra.2012.04.004 [17] DODD GD 3RD, DODD NA, LANCTOT AC, et al. Effect of variation of portal venous blood flow on radiofrequency and microwave ablations in a blood-perfused bovine liver model[J]. Radiology, 2013, 267(1): 129. doi: 10.1148/radiol.12120486 [18] HU H, CHEN GF, YUAN W, et al. Microwave ablation with chemoembolization for large hepatocellular carcinoma in patients with cirrhosis[J]. Int J Hyperthermia, 2018, 34(8): 1351. doi: 10.1080/02656736.2018.1462536 [19] SMOLOCK AR, CRISTESCU MM, HINSHAW A, et al. Combination transarterial chemoembolization and microwave ablation improves local tumor control for 3- to 5-cm hepatocellular carcinoma when compared with transarterial chemoembolization alone[J]. Abdom Radiol(NY), 2018, 43: 2497. doi: 10.1007/s00261-018-1464-9 [20] REN H, LIANG P, YU X, et al. Treatment of liver tumors adjacent to hepatichilum with percutaneous microwave ablation combined with ethanol injection: A pilot study[J]. Int J Hyperthermia, 2011, 27(3): 249. doi: 10.3109/02656736.2011.552086 [21] NISHIKAWA H, INUZUKA T, TAKEDA H, et al. Percutaneous radio-frequency ablation therapy for hepatocellular carcinoma: a proposed new grading system for the ablative margin and prediction of local tumor progression and its validation[J]. J Gastroenterol, 2011, 46(12): 1418. doi: 10.1007/s00535-011-0452-4 [22] CHEN XX, CHENG JW, HUANG A, et al. The effect of antiviral therapy on patients with hepatitis B virus-related hepatocellular carcinoma after curative resection: a systematic review and meta-analysis[J]. Onco Targets Ther, 2017, 10: 5363. doi: 10.2147/OTT.S150281