微波消融治疗老年原发性肝癌患者的无瘤生存影响因素分析

摘要

目的 研究超声引导下微波消融治疗老年人原发性肝癌患者术后无瘤生存的影响因素,为临床预防复发提供依据.方法 选取收治的原发性肝癌患者98例,微波术后进行随访,检查是否复发.根据患者的复发情况进行临床因素分析,用Kaplan-Meier绘制无瘤生存率曲线,分析患者的年龄、性别、病灶直径、数目、慢性肝病、放疗、肝功能分级等因素是否对无瘤生存率的影响有意义,利用多因素COX回归模型对患者复发的危险因素进行分析.结果 随访结束时,73例(74.5％)复发,3例(3.1％)失访,22例(22.4％)仍未发现复发情况.微波消融术后老年患者1、3、5年的总体无癌生存率分别是60.2％、30.6％、22.7％.单因素分析显示肝功能Chail-Pugh分级、病灶直径、病灶数目、慢性肝病与微波消融术后无瘤生存率有关,差异有统计学意义(P＜0.05);Cox比例风险模型表示肝功能分级,病灶数目,慢性肝病是影响患者术后无瘤生存率的独立危险因素.结论 微波消融治疗老年人原发性肝癌后的无瘤生存率受多种因素影响,在肝功能A级,病灶数目少,无慢性肝病的条件下复发率较低,控制这些危险因素,有助于提高术后的无瘤生存率.%Objective To investigate the influencing factors of microwave ablation under ultrasonic guidance on tumor-free survival rate in treatment of primary liver cancer in order to provide basis for preventing relapse of primary liver cancer.Methods Ninety-eight patients with primary liver cancer who underwent microwave ablation in our hospital from December 2008 to December 2011 were enrolled in the study.These patients were followed up after operation to observe the relapse status.And the survival curve was drawn by Kaplan-Meier method and the different factors were statistically analyzed by means of Chi-square test.COX regression multivariate analysis was used to analyze recurrence risk factors of patient's prognosis.Results At the end of follow up,73 patients (74.5％) had recurrence and 3 patients (3.1％) were failure to follow up,moreover,22 patients (22.4％) had no relapse.The total disease free survival rates at 1 year,3 years and 5 years after ablation were 60.2％,30.6％,22.7％,respectively.The single factor analysis showed that Child-Pugh classification of liver function,tumor diameter,lesion numbers,chronic liver diseases were correlated with disease free survival rate after operation (P ＜ 0.05).The COX regression multivariate analysis showed that liver function classification,lesion numbers and chronic liver diseases were independent risk factors influencing disease free survival rate after operation.Conclusion The disease free survival rate of patients with primary liver cancer after microwave ablation is affected by various factors.In the condition of Child-Pugh grade A,single tumor lesion and no chronic liver disease,the recurrence rate is lower,therefor,to control these risk factors is beneficial to improve tumor free survival rate after operation.