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目的探讨影响射频消融(radiofrequency ablation,RFA)、肝切除和肝移植治疗小肝癌预后的相关因素。方法回顾性分析作者医院2005-08/2009-09月收治的167例原发性小肝癌患者的临床资料;其中86例手术切除、58例RFA和23例肝移植。单因素分析采用Kaplan-Meier法,Cox比例风险模型进行预后多因素分析。结果手术切除组、RFA组和肝移植组1、2、3年肝内累积复发率分别为11.6%、20.9%、27.9%,12.1%、25.0%、34.5%和8.7%、17.4%、21.7%;1、2、3年的生存率分别为91.9%、83.7%、74.4%,91.3%、77.6%、67.2%和95.7%、87.0%、78.3%。单因素分析发现三种小肝癌治疗方法的预后与治疗前血清甲胎蛋白(alpha fetoprotein,AFP)>400 ng/ml、肿瘤近血管、直径>3 cm、Child分级这几个因素有关(P<0.05)。Cox多因素分析显示治疗前血清AFP>400 ng/ml、肿瘤近血管、直径>3 cm、Child分级是影响小肝癌预后的重要因素(P<0.05)。结论 RFA、肝切除和肝移植治疗直径≤5 cm的小肝癌均可获得比较良好的近远期疗效。治疗前血清AFP>400 ng/ml、肿瘤近血管、Child分级是影响预后的重要因素。
Objective To investigate the factors influencing the prognosis of small hepatocellular carcinoma (HCC) by radiofrequency ablation (RFA), hepatectomy and liver transplantation. Methods The clinical data of 167 patients with primary small hepatocellular carcinoma who were admitted to our hospital from January 2005 to August 2009 were retrospectively analyzed. Among them, 86 patients underwent resection and 58 patients underwent RFA and 23 underwent liver transplantation. Univariate analysis using Kaplan-Meier method, Cox proportional hazards model prognostic multivariate analysis. Results The cumulative recurrence rates of hepatic tissue in the resection group, RFA group and liver transplantation group at 1, 2 and 3 years were 11.6%, 20.9%, 27.9%, 12.1%, 25.0%, 34.5% and 8.7%, 17.4% and 21.7% The survival rates at 1, 2 and 3 years were 91.9%, 83.7%, 74.4%, 91.3%, 77.6%, 67.2% and 95.7%, 87.0% and 78.3%, respectively. Univariate analysis showed that the prognosis of three kinds of small hepatocellular carcinoma was related to the levels of serum alpha fetoprotein (AFP)> 400 ng / ml, tumor near blood vessels, diameter> 3 cm and Child classification (P < 0.05). Cox multivariate analysis showed that before treatment serum AFP> 400 ng / ml, tumor near blood vessels, diameter> 3 cm, Child classification is an important factor affecting the prognosis of small hepatocellular carcinoma (P <0.05). Conclusion RFA, liver resection and liver transplantation for small hepatocellular carcinoma less than 5 cm in diameter can achieve relatively good short-term and long-term effects. Pretreatment serum AFP> 400 ng / ml, tumor near blood vessels, Child classification is an important factor affecting the prognosis.