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目的探讨原发性肝细胞癌(PHCC)经高强度聚焦超声(HIFU)治疗后的预后影响因素。方法回顾分析2004年6月至2007年6月期间187例PHCC患者行HIFU治疗的临床资料。男101例,女86例;年龄19～79岁,平均47.7岁;肿瘤直径为0.5～18.0 cm,平均为5.7 cm。肝功能Child-Pugh A、B、C级分别为104、52和31例。根据TNM分期,Ⅱb期45例、Ⅲa期111例、Ⅲb期31例。生存分析的单因素分析采用Kaplan-Meier及log-rank时序检验,多因素分析采用Cox比例风险模型。结果 187例经HIFU治疗后生存期为(17.3±2.5)个月,其中3个月、6个月、1年及2年的总生存率分别为79.1%、60.1%、35.7%及29.3%。单因素分析结果显示影响预后的因素为治疗前肿瘤数目(P=0.02)及大小(P=0.04)、AFP水平(P=0.04)、Child-Pugh分级(P=0.00)、TNM分期(P=0.01)、肿瘤是否转移(P=0.03),治疗后是否复发(P=0.02)以及是否规范化治疗(P=0.02);多因素分析结果提示影响预后的因素为治疗前Child-Pugh分级(P=0.009)和TNM分期(P=0.004)及规范化治疗(P=0.000)。结论生存分析结果提示及早发现肝脏肿瘤、保护肝功能、治疗前全面影像学检查,以及重视规范化治疗和辅助治疗将有助于延长PHCC患者的生存期。
Objective To investigate the prognostic factors of primary hepatocellular carcinoma (PHCC) after high intensity focused ultrasound (HIFU) treatment. Methods The clinical data of 187 HCC patients with PHCC from June 2004 to June 2007 were retrospectively analyzed. 101 males and 86 females; aged 19 to 79 years, mean 47.7 years; tumor diameter 0.5 ~ 18.0 cm, with an average of 5.7 cm. Liver function Child-Pugh A, B, C grade were 104,52 and 31 cases. According to TNM staging, there were 45 cases in stage Ⅱb, 111 cases in stage Ⅲa and 31 cases in stage Ⅲb. Survival analysis of univariate analysis using Kaplan-Meier and log-rank test, multivariate analysis using Cox proportional hazards model. Results The survival time of 187 cases treated with HIFU was (17.3 ± 2.5) months. The overall survival rates at 3 months, 6 months, 1 year and 2 years were 79.1%, 60.1%, 35.7% and 29.3%, respectively. Univariate analysis showed that the prognostic factors were the number of tumors before treatment (P = 0.02) and size (P = 0.04), AFP level (P = 0.04), Child-Pugh grading (P = 0.00) 0.01), tumor metastasis (P = 0.03), recurrence after treatment (P = 0.02) and whether standard therapy (P = 0.02) .Multivariate analysis indicated that the prognostic factors were Child-Pugh classification before treatment (P = 0.009) and TNM staging (P = 0.004) and standardized treatment (P = 0.000). Conclusions The results of survival analysis suggest that early detection of liver tumors, protection of liver function, comprehensive preoperative imaging examination, and emphasis on standardized treatment and adjuvant therapy will help prolong the survival of patients with PHCC.