超声引导射频消融治疗肝脏恶性肿瘤302例肿瘤残留危险因素分析

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。

Risk factors for 302 hepatic malignancies cases with residual tumor after ultrasound-guided radiofrequency ablation treatment

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: Ultrasoundguided 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 multineedle treatment can improve the ablation efficiency and reduce residual rate.