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目的 探讨影响经皮射频消融(PRFA)治疗复发性肝癌预后的影响因素.方法 1999年1月至2008年12月共有82例复发性肝癌患者(单个肿瘤最大径≤7 cm;多个肿瘤者最大径≤5 cm且肿瘤数目≤3个)接受PRFA治疗,收集其临床及病理学特征等12项可能影响预后的因素作回顾性单因素与多因素分析.结果 全组患者1、3、5年生存率分别是75.8%、43.9%、34.5%(从PRFA术后算起)和95.1%、63.2%、46.6%(从初次手术算起);单因素分析显示初次肿瘤大小、复发期限长短、复发肿瘤数目、复发肿瘤大小、血清谷氨酰转肽酶(GGT)和白蛋白(ALB)水平与复发性肝癌行PRFA的预后有相关性(P<0.05);进一步行Cox模型多因素分析得出与预后相关因素为复发期限长短、复发肿瘤大小、血清GGT与ALB水平(P<0.05).结论 PRFA治疗复发性肝癌疗效确切,复发期限、复发肿瘤大小、血清GGT与ALB水平为其显著性预后影响因子.

Objective To explore the efficacy and determine the risk factors of survival for recurrent hepatocellular carcinoma( HCC) treated by percutaneous radiofrequency ablation ( PRFA). Methods From January 1999 to December 2008,82 patients with recurrent HCC, with the diameter less than 7 cm for solitary tumor, or the largest tumor less than 5 cm for multiple tumors (the number of tumors less than 3) , were treated by PRFA. The significance of 12 clinical or pathological variables in the risk factors of overall survival were assessed. Results The overall survival l-,3-,and 5-year survival rates were 75.8% ,43.9% and 34.5% (from the date of PRFA ), and 95. 1%, 63.2% and 46.6% (from initial hepatectomy ), respectively. Univariate analysis indicated that tumor size before initial hepatectomy,recurrence interval from initial hepatectomy, number of recurrent tumors, diameter of largest recurrent tumor, serum glutamy transpeptidase(GGT) and serum albumin (ALB) level were significant prognostic factors ( P <0. 05 , Kaplan-Meier Log-rank test). Multivariate analysis showed recurrence interval from initial hepatectomy,diameter of largest recurrence tumor, serum GGT and ALB level were significant prognostic ( P < 0.05). Conclusion PRFA is effective for recurrent HCC. Recurrence interval from initial hepatectomy, diameter of largest recurrent tumor,serum GGT and ALB level are significant prognostic factors.