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中华医学超声杂志(电子版) ›› 2022, Vol. 19 ›› Issue (09) : 962 -967. doi: 10.3877/cma.j.issn.1672-6448.2022.09.016

介入超声影像学

手术与经皮消融治疗复发性肝母细胞瘤的疗效比较
蒋宏1, 王瑗琪2, 肖晗3, 梁锐明4, 陈淑玲3, 周路遥3, 陈华东1, 钟志海1, 匡铭5, 刘钧澄1,()   
  1. 1. 510080 广州,中山大学附属第一医院小儿外科
    2. 510080 广州,中山大学附属第一医院肝外科
    3. 510080 广州,中山大学附属第一医院超声介入科
    4. 510080 广州,中山大学附属第一医院临床研究中心
    5. 510080 广州,中山大学附属第一医院肝外科;510080 广州,中山大学附属第一医院超声介入科;510080 广州,中山大学附属第一医院肿瘤中心;510080 广州,中山大学附属第一医院精准研究中心
  • 收稿日期:2020-06-28 出版日期:2022-09-01
  • 通信作者: 刘钧澄
  • 基金资助:
    广州市健康医疗协同创新重大专项(201704020215)

Efficacy of re-hepatectomy versus percutaneous ablation in treatment of recurrent hepatoblastoma

Hong Jiang1, Yuanqi Wang2, Han Xiao3, Ruiming Liang4, Shuling Chen3, Luyao Zhou3, Huadong Chen1, Zhihai Zhong1, Ming Kuang5, Juncheng Liu1,()   

  1. 1. Department of Pediatric Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
    2. Department of Liver Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
    3. Division of Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
    4. Clinical Trials Unit, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
    5. Department of Liver Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China; Division of Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China; Cancer Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China; Precision Medicine Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2020-06-28 Published:2022-09-01
  • Corresponding author: Juncheng Liu
引用本文:

蒋宏, 王瑗琪, 肖晗, 梁锐明, 陈淑玲, 周路遥, 陈华东, 钟志海, 匡铭, 刘钧澄. 手术与经皮消融治疗复发性肝母细胞瘤的疗效比较[J/OL]. 中华医学超声杂志(电子版), 2022, 19(09): 962-967.

Hong Jiang, Yuanqi Wang, Han Xiao, Ruiming Liang, Shuling Chen, Luyao Zhou, Huadong Chen, Zhihai Zhong, Ming Kuang, Juncheng Liu. Efficacy of re-hepatectomy versus percutaneous ablation in treatment of recurrent hepatoblastoma[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(09): 962-967.

目的

比较手术与经皮消融在复发性肝母细胞瘤(HB)患儿中的疗效。

方法

回顾性分析于2013年1月至2019年3月在中山大学附属第一医院接受手术(14例)或经皮消融(8例)治疗的22例复发性HB患儿。利用t检验、Wilcox秩和检验、χ2检验等方法比较2组患儿的基线指标或并发症发生率的差异,绘制首次复发治疗后患儿的生存曲线,并利用Log-rank检验比较2组患儿的3年总体生存率及无事件生存率的差异。

结果

2组患儿的基线指标比较差异均无统计学意义(P均>0.05)。消融组和手术组患儿的3年总体生存率分别为75.0%和78.6%(P=0.814),3年无事件生存率分别为50.0%和40.0%(P=0.880)。并发症发生率手术组较消融组更高(78.6% vs 25.0%),差异具有统计学意义(χ2=6.044,P=0.026)。2组患儿均无严重并发症发生。

结论

经皮消融治疗复发性HB安全有效,与二次手术相比预后无明显差异。

Objective

To compare the efficacy of re-hepatectomy and percutaneous ablation in the treatment of recurrent hepatoblastoma (HB).

Methods

We retrospectively analyzed 22 recurrent HB patients who received re-hepatectomy (n=14) or percutaneous ablation (n=8) at the First Affiliated Hospital of Sun Yat-sen University from January 2013 to March 2019. The baseline characteristics and rate of complications were compared by the t-test, Wilcoxon test, or χ2-test according to the data type. Survival curves of children after first relapse treatment were drawn, and 3-year overall survival and event-free survival in the two groups were compared using the log-rank test.

Results

There were no significant differences in baseline characteristics between the two groups. The 3-year overall survival rate in the ablation group and re-hepatectomy group was 75.0% and 78.6% (P=0.814), and the 3-year event-free survival rate was 50.0% and 40.0%, respectively (P=0.880). No severe complications occurred in either group. The rate of complications was significantly higher in the surgery group than in the ablation group (78.6% vs 25.0%, χ2=6.044, P=0.026).

Conclusion

Percutaneous ablation for recurrent HB is safe and effective, with no significant difference in prognosis compared with secondary surgery.

表1 2组复发性肝母细胞瘤患儿的基线临床指标
项目 总体(n=22) 手术组(n=14) 消融组(n=8) 统计值 P
患病年龄[月,MQR)] 33.5(20.8,62.5) 34.5(22,60) 28(14.5,61) Z=-0.683 0.525
性别[例(%)] χ2=0.105 0.746
12(54.5) 8(57.1) 4(50.0)
10(45.5) 6(42.9) 4(50.0)
原发诊断时AFP水平[×103ng/ml,MQR)] 793.4(370.9,800.0) 800.0(387.5,800.0) 571.1(199.9,897.3) Z=-0.586 0.558
原发PRETEXT分级[例(%)] χ2=2.112 0.348
3(13.6) 3(21.4) 0(0)
11(50.0) 6(42.9) 5(62.5)
8(36.4) 5(35.7) 3(37.5)
原发新辅助化疗[例(%)] χ2=1.985 0.159
3(13.6) 3(21.4) 0(0)
19(86.4) 11(78.6) 8(100)
原发治疗结束后AFP水平[ng/ml,MQR)] 12.5(9.5,18.5) 14.9(9.1,21.3) 12.1(9.5,15.5) Z=-0.068 0.946
首次治疗与第一次复发间隔时间(月,
x¯
±s
14.5±7.6 15.8±8.9 12.2±4.2 t=1.072 0.296
复发时AFP水平[ng/ml,MQR)] 301.0(49.3,1461.7) 666.4(52.4,1579) 164.9(43.6,944.8) Z=-0.797 0.426
复发肿瘤位置[例(%)] χ2=2.794 0.425
肝内局部复发 9(40.9) 5(35.7) 4(50.0)
肝内远处复发 3(13.6) 1(7.1) 2(25.0)
肝外远处复发 9(40.9) 7(50.0) 2(25.0)
肝内+肝外复发 1(4.5) 1(7.1) 0(0)
复发肿瘤数目[例(%)] χ2=0.037 0.848
1 16(72.7) 10(71.4) 6(75.0)
>1 5(22.7) 3(21.4) 2(25.0)
复发最大肿瘤直径[cm,MQR)] 1.5(1.0,2.4) 1.9(1.0,2.8) 1.4(1.1,1.5) Z=-1.088 0.276
图1 复发性肝母细胞瘤患儿首次复发治疗后Kaplan-Meier生存曲线。图a为消融组和手术组总体生存曲线比较(P=0.814),图b为消融组和手术组无事件生存曲线比较(P=0.880)
图2 肝母细胞瘤患儿复发后应用消融和手术治疗前后影像学表现。图a为消融组患儿首次复发时超声及超声造影图像,箭头所示可见S4段肿瘤直径约1.14 cm,图b为患儿消融后复查超声及超声造影图像,箭头所示可见消融范围约3.71 cm×2.56 cm;图c为手术组患儿首次复发时CT增强图像,箭头所示S5段肿瘤直径约为2.8 cm,图d为患儿行肝肿瘤切除术后复查CT增强图像,箭头所示肿瘤位置已被完整切除
表2 2组肝母细胞瘤患儿治疗后再次复发的位置及治疗方式[例(%)]
表3 2组肝母细胞瘤患儿治疗后并发症发生情况(例)
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