| Purpose:This study aims to investigate the effect,the safety and prognostic factors of CT-guided percutaneous microwave ablation(MWA)for hepatocellular carcinoma(HCC),so that it can help improve the survival of the patients with liver cancer.Methods:We retrospectively analyzed 210 patients with hepatocellular carcinoma underwent CT guided microwave ablation therapy between January 2013 and January 2017 at our institution.A total of 196 cases of HCC were included in the standard.It was defined that high risk lesions which the distance between the tumor border to Glisson's capsule,hepatic portal,diaphragmatic apex,pericardium,gallbladder,gastrointestinal tract,large vessels was measured within 5mm by CT or MRI.and they were divided into high-risk areas and non high risk areas according to the tumor location.30 patients with high-risk areas(high-risk group)and 30 patients with non high-risk areas(non high-risk group)were selected from the whole group.Imaging examination(enhanced CT or MRI)1~2 months after MWA were used to reexamine.The tumors were considered as ablated completely if the target lessions is not enhanced.10 factors which potentially affecting the survival were analyzed and the tumor ablation rate,total survival rate and complications were compared in the non high-risk group and the high risk group.SPSS 17.0 was used for statistical analysis.Categorical variables were compared by chi-squared test or Fisher,s accurate probability test.The continuous variables were compared by t test or rank sum test.The Kaplan-Meier method was used to the survival analysis.The Cox risk ratio model were applied for single factor analysis and multivariate analysis of prognostic factors.P<0.05 was considered as significantly changes.Results:1.The success rate of microwave ablation was 100%.A complete ablation rate was 90.3%.The survival rates of primary hepatocellular carcinoma at 1 years,2 years,3years and 4 years were 87.1%,72%,60% and 54.8%.2.The complete ablation rates in non high-risk groups and high risk groups were 93.3% and 86.7%,respectively.The survival rates of 1,2,3,and 4 years in non high-risk groups and high risk groups were 90%,73.3%,65.2%,65.2% and 83.3%,66.5%,57.3%,57.3%,respectively.The incidence of severe complications in non high-risk groups and high risk groups were 3.3% and 6.7%,respectively.There was no significant difference in the complete ablation rate,survival rate and incidence of complications in the two groups(P=0.667,P=0.425,P<0.05).3.Preliminary screening of the factors which potentially affect the survival,single factor analysis showed that number of tumors,diameter of tumor,BCLC stage,Child-Pugh classification,hepatitis or not,cirrhosis,preoperative Alpha-Fetoprotein(AFP)were significant factors of survival for hepatocellular carcinoma after MWA(P<0.05).Univariate analysis showed that the independent factors affecting the survival of patients with hepatocellular carcinoma include the number of tumors,diameter of tumor,cirrhosis and Child-Pugh classification.4.The mainly complications associated with MWA include fever,hepatalgia,nausea and vomiting,biloma,bleeding and the incidence rate of serious was only 3.0%.No death related to the therapy.Conclusions:1.CT-guided precise microwave ablation is a safe and effective treatment for hepatocellular carcinoma,which is a recommended treatment.2.The independent prognostic factor of the patients with HCC were the number of tumors,diameter of tumor,cirrhosis and Child-Pugh classification.Not more than 3 tumors,tumor diameter less than 3cm,without liver cirrhosis and Child-Pugh grade A were more likely to have long-term survival. |
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