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目的确定进行射频消融和全身化疗的结直肠癌肝转移病人的长期(10年)生存率。材料与方法研究获得单位伦理委员会批准。1997年—2006年间,99例病人共202个小结直肠癌肝转移灶[0.8～4.0cm;平均(2.2±1.1)cm]进行了超声导向下采用内部冷却电极的经皮射频消融治疗,同时进行全身化疗。所选病例包括不适合手术(n=80)和拒绝手术(n=19)的病人。射频消融后采用对比增强CT和(或)MRI检查进行3～10年的随访(随访3、5、7和10年的病例数分别为99、67、49和25)。评价局部有效率和长期生存率。对于每个结束点生成Kaplan-Meier曲线,采用对数秩检验评价统计学的差异性。结果首次和再次治疗的成功率分别为93.1%(188/202)和100%(14/14)。11.9%(24/202)的转移灶出现局部进展,其中54.2%(13/24)进行再次治疗。再次治疗病人的生存率较没有再次治疗者明显增加(P<0.001)。在随访中,发现了125个新的肝转移灶,其中32.8%(41/125)接受了射频消融治疗。1、3、5、7和10年的总体生存率分别为98.0%、69.3%、47.8%、25.0%和18.0%(中位数为53.2个月)。主要并发症的发生率为1.3%(2/156),没有出现与治疗相关的死亡。撰写本文时32.3%(32/99)的病人还活着,67.7%(67/99)的病人已经死亡,平均随访时间为72个月。结论全身化疗联合射频消融治疗,能局部控制大部分的结直肠癌肝转移灶。此大样本病人的3～10年生存率,基本上与文献报道的大部分手术者的生存率相当。
Objective To determine the long-term (10-year) survival of patients with liver metastases from colorectal cancer undergoing radiofrequency ablation and systemic chemotherapy. Material and method research was approved by the unit ethics committee. Between 1997 and 2006, 99 patients with 202 small colorectal cancer liver metastases [0.8-4.0 cm (mean, 2.2 ± 1.1) cm] underwent ultrasound-guided percutaneous radiofrequency ablation with internal cooling electrodes, Systemic chemotherapy. Selected cases included patients who were unsuitable for surgery (n = 80) and those who refused surgery (n = 19). Radiofrequency ablation followed by contrast-enhanced CT and / or MRI for 3 to 10 years (99, 67, 49 and 25 at 3, 5, 7 and 10 years of follow-up). Evaluation of local efficiency and long-term survival. Kaplan-Meier curves were generated for each end point and the statistical differences assessed using log-rank test. Results The success rates of first and second treatment were 93.1% (188/202) and 100% (14/14), respectively. Localized progression occurred in 11.9% (24/202) of the metastases, with 54.2% (13/24) re-treated. The survival rate of patients who were re-treated was significantly higher than that of those without re-treatment (P <0.001). At follow-up, 125 new liver metastases were found, of whom 32.8% (41/125) underwent radiofrequency ablation. Overall survival rates at 1, 3, 5, 7, and 10 years were 98.0%, 69.3%, 47.8%, 25.0%, and 18.0%, respectively (median: 53.2 months). The major complication rate was 1.3% (2/156), with no treatment-related deaths. At the time of writing, 32.3% (32/99) of the patients were alive and 67.7% (67/99) of the patients were dead with an average follow-up of 72 months. Conclusions Systemic chemotherapy combined with radiofrequency ablation can locally control most of colorectal cancer liver metastases. This large sample of patients 3 to 10 years survival rate, basically reported in the literature and most surgeons survival rate comparable.