高强度聚焦超声、氩氦刀冷冻消融及射频消融治疗小肝癌疗效对比
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摘要
目的比较高强度聚焦超声(HIFU)、氩氦刀冷冻消融、射频消融(RFA)3种局部消融疗法治疗小肝癌的疗效、安全性及经济性。方法回顾性分析2009年12月至2014年9月在郑州大学第一附属医院接受局部消融治疗的176例小肝癌患者临床资料。其中男142例,女34例;平均年龄(55±11)岁。患者均签署知情同意书,符合医学伦理学规定。HIFU治疗组57例,氩氦刀冷冻消融治疗组54例,RFA治疗组65例。3组住院费用比较采用方差分析,术后疗效、并发症发生率的比较采用χ~2检验。生存分析采用Kaplan-Meier法和Log-rank检验。结果 HIFU组、氩氦刀组、RFA组术后1个月肿瘤完全消融率分别为90%、89%、94%,AFP下降率分别76%、72%、83%,差异无统计学意义(χ~2=1.086,1.417;P>0.05)。HIFU组皮肤Ⅲ度烧伤1例,氩氦刀组针道出血1例、急性肾损伤2例,RFA组腹腔出血1例。3组D～F级严重并发症发生率差异无统计学意义(χ~2=1.893,P>0.05)。HIFU组1、2、3年总体生存率分别为87.8%、72.4%、59.4%,氩氦组87.7%、77.7%、58.9%,RFA组93.6%、77.4%、60.4%,3组差异无统计学意义(χ~2=0.315,P>0.05)。HIFU组1、2、3年无瘤生存率分别为81.2%、66.3%、46.4%,氩氦组80.7%、64.2%、55.1%,RFA组84.5%、72.1%、52.1%,3组差异无统计学意义(χ~2=5.382,P>0.05)。HIFU组、氩氦刀组、RFA组住院费用分别为(3.0±1.2)、(3.2±1.2)、(3.6±1.3)万元,差异有统计学意义(F=7.72,P<0.05)。结论 3种消融方式对于治疗小肝癌均是安全、有效的,治疗费用上HIFU更具优势。
Objective To compare the clinical efficacy, safety and economic benefit of highintensity focused ultrasound(HIFU), argon-helium cryoablation and radiofrequency ablation(RFA) in the treatment of small liver cancer. Methods Clinical data of 176 patients with small liver cancer undergoing local ablation in the First Affiliated Hospital of Zhengzhou University from December 2009 to September2014 were retrospectively analyzed. Among them, 142 patients were male and 34 female, aged(55±11) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. 57 patients were assigned in HIFU group, 54 in argon-helium group and 65 in RFA group. The hospitalization expenses was compared among three groups with analysis of variance, and the postoperative efficacy and incidence of complications were compared with Chi-square test. Survival analysis was conducted with Kaplan-Meier and Log-rank test. Results At postoperative 1 month, the complete tumor ablation rates were 90%, 89% and 94%, and the AFP reduction rates were 76%, 72% and 83% in HIFU, argon-helium and RFA groups, respectively, where no significant difference was observed among three groups(χ~2=1.086, 1.417;P>0.05). Grade Ⅲ skin burn was noted in 1 case in HIFU group, 1 case of needle bleeding and 2 cases of acute kidney injury in argon-helium group, and 1 case of abdominal bleeding in RFA group. No significant difference was observed in the incidence of D-F grade severe complications among three groups(χ~2=1.893,P>0.05). The 1-, 2-, 3-year overall survival rates were 87.8%, 72.4%, 59.4% in HIFU group, and were 87.7%,77.7%, 58.9% in argon-helium group, 93.6%, 77.4%, 60.4% in RFA group, where no significant difference was observed among three groups(χ~2=0.315, P>0.05). The 1-, 2-, 3-year tumor-free survival rates were81.2%, 66.3%, 46.4% in HIFU group, which did not significantly differ from 80.7%, 64.2%, 55.1% in argonhelium group, and 84.5%, 72.1%, 52.1% in RFA group(χ~2=5.382, P>0.05). The hospitalization expenses were respectively(3.0±1.2)×104,(3.2±1.2)×104 and(3.6±1.3)×104 Yuan in HIFU, argon-helium and RFA groups,where significant difference was observed among three groups(F=7.72, P<0.05). Conclusions Three kinds of ablation are safe and efficacious in the treatment of small liver cancer. HIFU requires less hospitalization expenses compared with argon-helium cryoablation and RFA.
Objective To compare the clinical efficacy, safety and economic benefit of highintensity focused ultrasound(HIFU), argon-helium cryoablation and radiofrequency ablation(RFA) in the treatment of small liver cancer. Methods Clinical data of 176 patients with small liver cancer undergoing local ablation in the First Affiliated Hospital of Zhengzhou University from December 2009 to September2014 were retrospectively analyzed. Among them, 142 patients were male and 34 female, aged(55±11) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. 57 patients were assigned in HIFU group, 54 in argon-helium group and 65 in RFA group. The hospitalization expenses was compared among three groups with analysis of variance, and the postoperative efficacy and incidence of complications were compared with Chi-square test. Survival analysis was conducted with Kaplan-Meier and Log-rank test. Results At postoperative 1 month, the complete tumor ablation rates were 90%, 89% and 94%, and the AFP reduction rates were 76%, 72% and 83% in HIFU, argon-helium and RFA groups, respectively, where no significant difference was observed among three groups(χ~2=1.086, 1.417;P>0.05). Grade Ⅲ skin burn was noted in 1 case in HIFU group, 1 case of needle bleeding and 2 cases of acute kidney injury in argon-helium group, and 1 case of abdominal bleeding in RFA group. No significant difference was observed in the incidence of D-F grade severe complications among three groups(χ~2=1.893,P>0.05). The 1-, 2-, 3-year overall survival rates were 87.8%, 72.4%, 59.4% in HIFU group, and were 87.7%,77.7%, 58.9% in argon-helium group, 93.6%, 77.4%, 60.4% in RFA group, where no significant difference was observed among three groups(χ~2=0.315, P>0.05). The 1-, 2-, 3-year tumor-free survival rates were81.2%, 66.3%, 46.4% in HIFU group, which did not significantly differ from 80.7%, 64.2%, 55.1% in argonhelium group, and 84.5%, 72.1%, 52.1% in RFA group(χ~2=5.382, P>0.05). The hospitalization expenses were respectively(3.0±1.2)×104,(3.2±1.2)×104 and(3.6±1.3)×104 Yuan in HIFU, argon-helium and RFA groups,where significant difference was observed among three groups(F=7.72, P<0.05). Conclusions Three kinds of ablation are safe and efficacious in the treatment of small liver cancer. HIFU requires less hospitalization expenses compared with argon-helium cryoablation and RFA.
引文
[1]王黎君,殷鹏,刘韫宁,等.1990年与2013年中国人群肝癌疾病负担研究[J].中华流行病学杂志,2016,37(6):758-762.
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[6]宋立文,韩雪,李菲.原发性肝细胞癌微创联合治疗进展[J].医学信息,2014(22):666-667.
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[10]Diana M,Schiraldi L,Liu YY,et al.High intensity focused ultrasound(HIFU)applied to hepato-bilio-pancreatic and the digestive system-current state of the art and future perspectives[J].Hepatobiliary Surg Nutr,2016,5(4):329-344.
[11]Daher S,Massarwa M,Benson AA,et al.Current and future treatment of hepatocellular carcinoma:an updated comprehensive review[J].J Clin Transl Hepatol,2018,6(1):69-78.
[12]Littrup PJ,Aoun HD,Adam B,et al.Percutaneous cryoablation of hepatic tumors:long-term experience of a large U.S.series[J].Abdom Radiol,2016,41(4):767-780.
[13]Shiina S,Tateishi R,Arano T,et al.Radiofrequency ablation for hepatocellular carcinoma:10-year outcome and prognostic factors[J].Am J Gastroenterol,2012,107(4):569-577.
[14]Bertot LC,Sato M,Tateishi R,et al.Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors:a systematic review[J].Eur Radiol,2011,21(12):2584-2596.
[15]Facciorusso A,Serviddio G,Muscatiello N.Local ablative treatments for hepatocellular carcinoma:an updated review[J].World JGastrointest Pharmacol Ther,2016,7(4):477-489.
[16]鄢金柱,翁鸿,张超,等.经皮射频消融与微波消融治疗肝细胞癌有效性与安全性比较的Meta分析[J].临床肝胆病杂志,2018,34(5):1025-1032.
[17]Huang YZ,Zhou SC,Zhou H,et al.Radiofrequency ablation versus cryosurgery ablation for hepatocellular carcinoma:a metaanalysis[J].Hepatogastroenterology,2013,60(125):1131-1135.
[18]Weis S,Franke A,M?ssner J,et al.Radiofrequency(thermal)ablation versus no intervention or other interventions for hepatocellular carcinoma[J].Cochrane Database Syst Rev,2013(12):CD003046.
[19]Li D,Kang J,Golas BJ,et al.Minimally invasive local therapies for liver cancer[J].Cancer Biol Med,2014,11(4):217-236.
[20]徐志宾,高万勤.原发性肝癌多种微创疗法的对比研究及临床应用[J].实用放射学杂,2008,24(6):833-836.
[2]中国抗癌协会肝癌专业委员会,中华医学会肝病学分会肝癌学组,中国抗癌协会病理专业委员会,等.原发性肝癌规范化病理诊断指南(2015年版)[J].中华肝脏病杂志,2015,23(5):321-327.
[3]国家卫计委肿瘤消融治疗技术管理规范专家组.肿瘤消融治疗技术管理规范(2017年版)[J].中华医学杂志,2017,97(31):2416-2417.
[4]中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].中华肝脏病杂志,2017,25(12):886-895.
[5]李发琪,杜永洪,王智彪,等.HIFU体外块“切除”动物肝脏、肾脏和肌肉的剂量研究[J].中国超声医学杂志,2005,21(4):252-255.
[6]宋立文,韩雪,李菲.原发性肝细胞癌微创联合治疗进展[J].医学信息,2014(22):666-667.
[7]牛凤岐,朱承纲,程洋.国内高强度聚焦超声12年历程的评说[J/CD].中华医学超声杂志(电子版),2012,9(5):385-392.
[8]Cheung TT,Fan ST,Chan SC,et al.High-intensity focused ultrasound ablation:an effective bridging therapy for hepatocellular carcinoma patients[J].World J Gastroenterol,2013,19(20):3083-3089.
[9]Ng KK,Poon RT,Chan SC,et al.High-intensity focused ultrasound for hepatocellular carcinoma:a single-center experience[J].Ann Surg,2011,253(5):981-987.
[10]Diana M,Schiraldi L,Liu YY,et al.High intensity focused ultrasound(HIFU)applied to hepato-bilio-pancreatic and the digestive system-current state of the art and future perspectives[J].Hepatobiliary Surg Nutr,2016,5(4):329-344.
[11]Daher S,Massarwa M,Benson AA,et al.Current and future treatment of hepatocellular carcinoma:an updated comprehensive review[J].J Clin Transl Hepatol,2018,6(1):69-78.
[12]Littrup PJ,Aoun HD,Adam B,et al.Percutaneous cryoablation of hepatic tumors:long-term experience of a large U.S.series[J].Abdom Radiol,2016,41(4):767-780.
[13]Shiina S,Tateishi R,Arano T,et al.Radiofrequency ablation for hepatocellular carcinoma:10-year outcome and prognostic factors[J].Am J Gastroenterol,2012,107(4):569-577.
[14]Bertot LC,Sato M,Tateishi R,et al.Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors:a systematic review[J].Eur Radiol,2011,21(12):2584-2596.
[15]Facciorusso A,Serviddio G,Muscatiello N.Local ablative treatments for hepatocellular carcinoma:an updated review[J].World JGastrointest Pharmacol Ther,2016,7(4):477-489.
[16]鄢金柱,翁鸿,张超,等.经皮射频消融与微波消融治疗肝细胞癌有效性与安全性比较的Meta分析[J].临床肝胆病杂志,2018,34(5):1025-1032.
[17]Huang YZ,Zhou SC,Zhou H,et al.Radiofrequency ablation versus cryosurgery ablation for hepatocellular carcinoma:a metaanalysis[J].Hepatogastroenterology,2013,60(125):1131-1135.
[18]Weis S,Franke A,M?ssner J,et al.Radiofrequency(thermal)ablation versus no intervention or other interventions for hepatocellular carcinoma[J].Cochrane Database Syst Rev,2013(12):CD003046.
[19]Li D,Kang J,Golas BJ,et al.Minimally invasive local therapies for liver cancer[J].Cancer Biol Med,2014,11(4):217-236.
[20]徐志宾,高万勤.原发性肝癌多种微创疗法的对比研究及临床应用[J].实用放射学杂,2008,24(6):833-836.