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Influence of Two Needle Placements on the Local Efficacy of Radiofrequency Ablation for Hepatic Carcinoma
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摘要:
目的 比较采用平行双针法与单纯双针法两种布针模式行超声引导下射频消融术治疗肝癌的局部疗效。 方法 回顾性分析2014年1月至2018年12月于北京大学肿瘤医院行射频消融治疗的肝癌患者临床资料。根据射频消融布针模式分为平行双针组、单纯双针组。射频消融治疗后1个月，行增强CT或MRI检查测量消融范围(长径、宽径及厚径)并计算肿瘤灭活率。对患者随访，观察肿瘤局部进展情况。 结果 共281例(370个病灶)符合纳入及排除标准的患者入选本研究，经倾向评分匹配法校正后最终纳入分析111例(111个病灶)，其中平行双针组37例(37个病灶)，单纯双针组74例(74个病灶)。平行双针组消融厚径大于单纯双针组(均值差=0.39，95% CI:-0.63~-0.15, P=0.002)，两组消融长径、宽径差异均无统计学意义(均值差=0.07，95% CI:-0.33~0.20，P=0.631；均值差=-0.03，95% CI:-0.20~0.24，P=0.844)。两组治疗后1个月肿瘤灭活率均为100%；中位随访时间6个月，平行双针组肿瘤局部进展率低于单纯双针组(2.70%比16.22%，P=0.037)。 结论 两种布针模式射频消融均具有较好的肿瘤灭活率，平行双针法可能更易形成较大的消融范围，以完全覆盖肿瘤组织，从而降低肿瘤局部进展率。 Abstract:Objective To explore the local efficacy of two different ways of needle placement in the treatment of hepatic carcinoma with radiofrequency ablation. Methods Data of patients with hepatic carcinoma treated with radiofrequency ablation from January 2014 to December 2018 in Peking University Cancer Hospital were retrospectively analyzed. Based on the way of needle placement, the patients were divided into parallel placement group and simple placement group. Contrast-enhanced CT or MRI was performed to measure the coagulation range (long diameter, short diameter and thick diameter) and the tumor inactivation one month after the treatment of radiofrequency ablation. The local tumor progression rate was calculated at the follow-ups. Results A total of 281 patients (370 lesions) who met the inclusion and exclusion criteria were included in this study. Of whom, 111 cases (111 lesions) were finally included and analyzed after correction by the method of propensity score matching. 37 cases (37 lesions) were in the parallel placement group and 74 cases (74 lesions) were in the simple placement group. The thickness of the parallel placement group was significantly larger than that of the simple placement group (mean difference=0.39, 95% CI: -0.63--0.15, P=0.002). There were no significant difference in the long diameter and short diameter between the two groups (mean difference=0.07, 95% CI: -0.33-0.20, P=0.631; mean difference=-0.03, 95% CI: -0.20-0.24, P=0.844). The tumor inactivation rate was 100% in both groups one month after treatment. The local tumor progression rate of the parallel placement group was lower than that of the simple placement group(2.70% vs 16.22%, P=0.037) at the median follow-up time of 6 months. Conclusions A good tumor-inactivation rate was obtained in both two groups. The parallel placement could form a larger coagulation area and reduce the local tumor progression compared to the simple placement. -
Key words:
- radiofrequency ablation /
- hepatic carcinoma /
- parallel placement /
- simple placement
作者贡献： 赵堃负责数据分析及文稿撰写，严昆参与课题设计及论文修改，严昆、杨薇、吴薇、张仲一、王凇、陈敏华负责病例资料的采集及布针方案的选择。利益冲突： 无 -
表 1 两组倾向评分匹配前后一般资料比较
指标 单纯双针组 平行双针组 标准差异 男性[匹配前，n(%)] 179(73.4) 25(67.6) 0.190 男性[匹配后，n(%)] 51(68.9) 26(70.3) 0.025 年龄(匹配前，x±s，岁) 63.85±10.04 60.12±10.32 0.256 年龄(匹配后, x±s，岁) 59.44±11.48 59.81±10.30 0.032 病理类型[匹配前，n(%)] 0.096 原发性肝癌 117(48.0) 19(51.4) 肝转移癌 127(52.0) 18(48.6) 病理类型[匹配后，n(%)] 0.039 原发性肝癌 36(48.6) 17(45.9) 肝转移癌 38(51.4) 20(54.1) 病灶最大径(匹配前，x±s，cm) 1.60±0.44 2.01±0.45 0.935 病灶最大径(匹配后，x±s，cm) 1.88±0.42 1.91±0.39 0.044 针距(匹配前，x±s，cm) 1.08±0.27 1.20±0.21 0.576 针距(匹配后，x±s，cm) 1.13±0.28 1.23±0.22 0.057 
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表 2 两组匹配后消融参数比较(x±s，cm)
指标 单纯双针组(n=74) 平行双针组(n=37) 均值差(95% CI) P值 消融长径 3.32±0.66 3.39±0.68 0.07(-0.33~0.20) 0.631 消融宽径 2.45±0.58 2.42±0.48 -0.03(-0.20~0.24) 0.844 消融厚径 2.69±0.58 3.08±0.62 0.39(-0.63~-0.15) 0.002
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