超声引导下射频消融术与微创切除术治疗小肝癌的远期预后比较

Comparison of long-term outcomes between ultrasound-guided radiofrequency ablation and minimally invasive hepatectomy for small hepatocellular carcinoma

摘要:

目的 比较超声引导下射频消融术与微创切除术治疗小肝癌的疗效。方法 选取2015年3月—2018年4月海南省中医院接受治疗的80例小肝癌患者，根据自愿原则分为消融组和切除组，每组40例。消融组接受超声引导下射频消融术治疗，切除组接受微创切除术。比较两组肝功能［谷丙转氨酶（ALT）、总胆红素（TBIL）、谷草转氨酶（AST）］、肿瘤标志物［癌胚抗原（CEA）、磷脂酰肌醇蛋白聚糖3（GPC3）、甲胎蛋白（AFP）］、循环肿瘤细胞（CTC）和肝细胞生长因子（HGF）、并发症、术后复发率及生存率。结果 两组患者术前ALT、AST、TBIL水平比较，差异无统计学意义（P >0.05）。消融组术后ALT、AST、TBIL水平低于切除组（P <0.05）。两组患者手术前与手术后CEA、GPC3、AFP水平比较，差异无统计学意义（P >0.05）。两组患者术前HGF、CTC水平比较，差异无统计学意义（P >0.05）。消融组术后HGF、CTC水平低于切除组（P <0.05）。消融组术后并发症发生率低于切除组（P <0.05）。两组患者术后3年总生存率、术后3年复发率比较，差异无统计学意义（P <0.05）。结论 与微创切除术比较，超声引导下射频消融治疗小肝癌在减少肝功能损伤、术后并发症方面具有一定优势，且可在一定程度上降低HGF和CTC水平，两者具有相似的远期预后效果。

Abstract:

Objective To compare the long-term outcomes of ultrasound-guided radiofrequency ablation and minimally invasive hepatectomy for small hepatocellular carcinoma.Methods A total of 80 patients with small hepatocellular carcinoma who were treated in our hospital from June 2015 to May 2018 were included in the study. The patients underwent either ultrasound-guided radiofrequency ablation (ablation group) or minimally invasive hepatectomy (resection group) as they might wish, with 40 cases in each group. The liver function [alanine aminotransferase (ALT), total bilirubin (TBIL) and aspartate aminotransferase (AST)], tumor markers [carcinoembryonic antigen (CEA), Glycan-3 (GPC3) and alpha-fetoprotein (AFP)], circulating tumor cells (CTC), hepatocyte growth factor (HGF), postoperative complications, recurrence rate and survival rate were compared between the two groups.Results There was no difference in preoperative ALT, AST and TBIL levels between the two groups (P > 0.05). The postoperative levels of ALT, AST, and TBIL in the ablation group were lower than those in the resection group (t =4.620, 2.880 and 2.477; P = 0.000, 0.005 and 0.015). Both preoperative and postoperative levels of CEA, GPC3, and AFP were not different between the groups (t = 0.211, 0.149 and 0.518; P =0.833, 0.882 and 0.606). The postoperative levels of HGF and CTC in the ablation group were lower than those in the resection group (t = 2.549 and 3.014, P =0.013 and 0.003), but with no difference in levels of HGF and CTC before the operations (P > 0.05). The overall incidence of postoperative complications in ablation group (5.00%) was significantly lower than that in resection group (20.00%) (χ² = 4.114, P = 0.043). There was no significant difference in 3-year survival rate and 3-year recurrence rate between the two groups (χ² = 0.092 and 0.157, P =0.762 and 0.692).Conclusions Compared with minimally invasive hepatectomy in the treatment of small hepatocellular carcinoma, ultrasound-guided radiofrequency ablation has certain advantages in reducing liver function damage and postoperative complications, and can improve HGF and CTC levels to a certain extent, yet with similar long-term outcomes.