【作者】 何璇；

【导师】 黄俊辉；

【作者基本信息】 中南大学 ， 肿瘤学， 2009， 硕士

【摘要】 目的:探讨影响大肝癌射频消融临床疗效的因素。方法:收集2001年6月至2005年9月某肿瘤医院经射频消融治疗（RFA）的大肝癌51例;RFA前超声引导下行肝穿刺活检取样,采用POWERVISION^TM免疫组织化学S-P法检测肝癌热休克蛋白-70（HSP-70）的表达情况;全部病例采用RITA射频肿瘤消融系统1500型治疗机治疗,功率150w,RF发生器频率为460kHz。术后随访患者生存情况。应用SPSS11.5统计软件进行统计分析肝癌HSP-70、肝癌临床分期、肿瘤灭活状态、肝功能（child-pugh）分级、AFP含量、肿瘤分布等因素与大肝癌RFA的临床疗效的关系。结果:1、51例大肝癌经射RFA治疗后完全灭活率54.9%（28例）,部分灭活率45.1%（23例）。RFA治疗后完全灭活者半年、一年、二年及三年生存率分别为54.9%、31.3%、13.7%和9.8%。部分灭活者半年、一年、二年和三年生存率分别是41.1%、15.8%、9.8%和0%,完全灭活病例的疗效明显优于部分灭活病例的疗效,肿瘤灭活率越高,RFA效果越好,p＜0.05。2、51例原发性肝癌HSP-70的阳性表达指数高于2的78.43%,正常肝组织中的HSP-70阳性表达指数高于2的46.7%,肝癌组织HSP-70的表达明显高于正常肝组织中的表达,P＜0.05。在HSP-70表达指数≤2的19例中,RFA治疗后半年、一年、二年和三年的生存率分别为100.0%、47.37%、36.84%和15.79%;表达指数＞2的32例患者,RFA治疗后半年、一年、二年和三年生存率分别是93.80%、46.88%、15.63%和3.92%,HSP-70表达指数越高则RFA疗效越差,反之,疗效越好,RFA治疗的疗效与HSP-70表达指数有关,P＜0.05。3、41例Ⅱ-Ⅲ期肝癌患者RFA治疗后半年、一年、二年和三年的生存率分别是80.3%、41.1%、23.5%和9.8%,10例Ⅳ期肝癌RFA治疗后半年、一年、二年和三年的生存率为15.6%、5.9%、0%及0%,临床分期越晚,RFA治疗效果越差,p＜0.05。4、肿瘤分布1个肝段者37例,多肝段14例,RFA治疗后半年、一年、二年和三年的生存率与肿瘤分布部位无关,p＞0.05,。5、AFP＜20μg/L为7例,20μg/L～500μg/L为29例,＞500μg/L为15例,随着AFP水平的升高,RFA治疗效果越差,p＜0.05。6、肝功能A级25例,B级25例,C级1例,肝功能分级与RFA疗效有关,p＜0.05。结论:一、RFA可作为大肝癌治疗的一种补充手段,在无手术指证或不愿意接受手术治疗的肝癌患者只要条件允许,可选择RFA治疗。二、肝癌组织内HSP-70的表达水平、肝癌临床分期、肝功能分级、肿瘤灭活情况、AFP表达情况是影响大肝癌RFA治疗效果的因素。肝内肿瘤分布的位置对RFA治疗效果无明显影响。由HSP-70表达水平、肝癌临床分期、肝功能分级、肿瘤灭活情况、AFP表达情况可以预测RFA治疗大肝癌的疗效。更多还原

【Abstract】 Objective: To explore factors that can influence the clinical effect of radiofrequency ablation（RFA） of liver cancer.Methods: 51 liver cancer cases that were treated with RFA were collected from cancer hospital between Jun. 2001 and Sept. 2005; liver biopsy was conducted with the help of ultrasound before RFA, HSP-70 expression was determined by POWERVISION^TM immunohistochemistry S-P method; all cases used RITA 1500 RFA machine: Power: 150W; Frequency: 460 kHz. The survival was followed up after the operation. The relationship among HSP-70 of live cancer, clinical classification of live cancer, inactive state of tumor, classification of live function, expression of AFP, tumor distribution and clinical effect of live cancer RFA were analyzed by SPSS11.5 statistical software.Results:1. The ratio of complete inactivation from 51 liver cancer cases treated with RAF is 54.9%（28 cases）, while the ratio of partial inactivation is 45.1%（23 cases）. The survival rate of complete inactivation after RFA in half a year, one year, two years and three years are 54.9%、31.3%、13.7% and 9.8% respectively. The survival rate of partial inactivation after RFA in half a year, one year, two years and three years are 41.1%、15.8%、9.8% and 0% respectively. The effect of complete inactivation is better than that of partial inactivation. The higher of tumor inactivation ratio, the better effect of RFA, P<0.05.2. HSP-70 positive expression index of 78.43% from 51 liver cancer patients is higher than 2. HSP-70 positive expression index of 46.7% from normal live tissue is higher than 2. The expression of HSP-70 in live cancer is higher than in normal live tissue, P<0.05. In 19 cases whose index of HSP-70 expression are less than 2, the survival rate are 100.0%, 47.37%, 36.84% and 15.79 respectively after RFA half year, one year, two years and three years; In 32 patients whose expression index is more than 2, the survival rate are 93.80%, 46.88%, 15.63% and 3.92% respectively after RFA half year, one year, two years and three years. The higher HSP-70 expression index, the worse the effect of RFA. There is relationship between the effect of RFA and The expression index of HSP-70.3. The survival rate of 41 liver cancer patients stagedⅡ-Ⅲwho were treated by RFA in half a year, one year, two years and three years are 80.3%、41.1%、23.5% and 9.8%, and survival rate of 10 liver cancer patients staged IV who were treated by RFA in half a year, one year, two years and three years are 15.6%、5.9%、0% and 0%. The higher of liver cancer clinical classification is, the worse of effect of RFA is, P<0.05.4. 37 patient with the tumor distributed in one hepatic segment, and 14 with the tumor distributed in multi-hepatic segments, the survival rate is unrelated with tumor distribution after treated with RFA half a year, one year, two years and three years, p<0.05.5. The expression of AFP in 7 patients is less than 20μg/L （except negative patients） , in 29 patients is between 20μg/L and 500μg/L, and in 15 patients is more than 500μg/L, the effect of RFA is getting worse as AFP gets higher, p<0.05.6. Liver function of 25 patients is A degree, of 25 patients is B degree and of 1 patient is C degree. Child-Pugh is related to the effect of RFA,p<0.05.Conclusion:1. RFA can be an additional therapy of liver cancer. RFA treatment can be chosen when the liver cancer patients have no indications of operation or the patient is not willing to operation.2. HSP-70 expression level of liver cancer, clinical classification of liver cancer, inactive state of tumor, classification of liver function, the expression of AFP are the factors that affect influence the clinical effect of RFA of liver cancer. Tumor distribution have no relationship with the effect of RFA of liver cancer. The effect of RFA of liver cancer can be predicted from HSP-70 expression level of liver cancer, clinical classification of liver cancer, inactive state of tumor, classification of liver function, the expression of AFP.更多还原