结直肠癌转移性肝癌与原发性肝癌热消融疗效比较

摘要

目的 探讨经皮热消融治疗结直肠癌转移性肝癌(metastatic liver carcinoma,MLC)与原发性肝癌(hepatocellular carcinoma,HCC)局部疗效的差异.方法 回顾性比较热消融治疗MLC 69例108个病灶,HCC 70例92个病灶的局部疗效、并发症和安全边缘.结果 MLC组与HCC组肿瘤完全消融率分别为88.0％和91.3％(P=0.44),局部进展率分别为13.0％和14.1％(P=0.81),中位局部进展时间分别为7.5个月和3.6个月(P=0.36),主要并发症发生率分别为4.3％和2.9％(P=0.68).安全边缘相同时,MLC组和HCC组的残留率和局部进展率相近.MLC组内,安全边缘≤0.5 cm亚组残留率远高于安全边缘＞0.5 cm亚组(P＜0.001)；HCC组内,安全边缘≤0.5 cm亚组局部进展率高于安全边缘＞0.5 cm亚组(P=0.03).结论 热消融治疗MLC和HCC局部疗效相似,其治疗肝肿瘤安全、有效.安全边缘达到0.5 cm对减少肿瘤残留和局部进展非常重要.%Objective To investigate the differences of local therapeutic efficacy between colorectal liver metastases and hepatocellular carcinoma with the treatment of ultrasound guided percutaneous thermal ablation.Methods From July 2004 to December 2011,under the same inclusion criteria,108 nodules of colorectal liver metastases in 69 patients,the tumor diameter ranged 0.7-6.6 cm [the average diameter was (2.3 ± 1.2) cm],and 92 nodules of hepatocellular carcinoma in 70 patients,the tumor diameter ranged 0.9-7.0 cm [the average diameter was (2.6 ± 1.3) cm],were percutaneously treated with thermal ablation guided by ultrasonography.Comparative analysis of clinical outcomes was performed retrospectively including the complete ablation rates (tumor residual rates),the local tumor progression rates,the local tumor progression time,complications related to treatment and safety margin.Results The complete ablation rate was 88.0％ in colorectal liver metastases group versus 91.3％ in hepatocellular carcinoma group (P =0.44),and the local tumor progression rate was 13.0 ％ versus 14.1 ％ (P =0.81),the median of local tumor progression time was 7.5 months versus 3.6 months (P =0.36).The ablation-related major complications were occurred in 3 patients with colorectal liver metastases,and in 2 patients with hepatocellular carcinoma (P =0.68).With the same safety margin,the tumor residual rates and local tumor progression rates of two groups were similar to each other.The comparison of intra-group showed,when using 0.5 cm as a cut-off point of safety margin to divide the two groups,the tumor residual rate of safety margin ≤0.5 cm subgroup was much higher than safety margin＞0.5 cm subgroup in colorectal liver metastases group.And in hepatocellular carcinoma group the local tumor progression rate of safety margin ≤0.5 cm subgroup was higher than safety margin＞0.5 cm subgroup.Conclusions The complete ablation rates (tumor residual rates),the local tumor progression rates,the local tumor progression time and complications related to treatment between patients with colorectal liver metastases and hepatocellular carcinoma were equivalent,and thermal ablation is a safe and effective technique for the treatment of the two liver tumors.A safety margin at least 0.5 cm is important to reduce the residual and local progression of tumor.