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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2026, Vol. 15 ›› Issue (02) : 211 -218. doi: 10.3877/cma.j.issn.2095-3232.2026.02.011

临床研究

复发性肝细胞癌再次手术切除与射频消融临床疗效比较
吴杰嵘1, 严庆2, 胡健垣2, 陈焕伟1,2,†()   
  1. 1　524000　广东省湛江市，广东医科大学第一临床医学院
    2　528000　广东省佛山市第一人民医院肝脏胰腺外科
  • 收稿日期:2025-09-01 出版日期:2026-04-10
  • 通信作者: 陈焕伟
  • 基金资助:
    广东省科学技术奖培育项目(2020001003307); 佛山市科技创新平台项目(2016AG100561)

Comparison of clinical efficacy between reoperation and radiofrequency ablation for recurrent hepatocellular carcinoma

Jierong Wu1, Qing Yan2, Jianyuan Hu2, Huanwei Chen1,2,†()   

  1. 1 The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang 524000, China
    2 Department of Hepatobiliary and Pancreatic Surgery, the First People's Hospital of Foshan, Foshan 528000, China
  • Received:2025-09-01 Published:2026-04-10
  • Corresponding author: Huanwei Chen
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引用本文：

吴杰嵘, 严庆, 胡健垣, 陈焕伟. 复发性肝细胞癌再次手术切除与射频消融临床疗效比较[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 211-218.

Jierong Wu, Qing Yan, Jianyuan Hu, Huanwei Chen. Comparison of clinical efficacy between reoperation and radiofrequency ablation for recurrent hepatocellular carcinoma[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(02): 211-218.

目的

比较再次肝切除术（RH）和射频消融（RFA）治疗复发性肝细胞癌（肝癌）的疗效及安全性，并探究影响患者术后生存的因素。

方法

回顾性分析2017年1月至2023年12月在佛山市第一人民医院接受诊治的96例复发性肝癌患者临床资料。其中男86例，女10例；年龄27~78岁，中位年龄55岁。患者均签署知情同意书，符合医学伦理学规定。根据治疗方式不同分为RH组（43例）和RFA组（53例）。采用1∶1倾向性评分匹配（PSM）对两组进行匹配，对比复发性肝癌患者行RH和RFA疗效及安全性。患者总生存期（OS）和无进展生存期（PFS）分期采用Kaplan-Meier法和Log-rank检验。通过Cox多因素回归分析患者生存预后的影响因素。

结果

PSM后RH组1、3、5年总生存率分别为93.1%，81.8%，71.9%，RFA组相应为83.7%，58.9%，45.4%，差异无统计学意义（χ2=3.133，P=0.077）。RH组1、3、5年无进展生存率分别为70.8%，45.4%，34.4%，RFA组分别为45.1%，7.6%，4.0%，差异有统计学意义（χ2=12.308，P<0.001）。PFS亚组分析显示，在小肿瘤、单发和多发病灶亚组中RH比RFA更优（Z=9.811，6.699，5.998；P<0.05）。Cox回归分析显示，治疗方案、肝硬化及卫星灶是肝癌复发患者PFS独立影响因素（RR=0.005，0.015，0.013；P<0.05）。PSM后RFA组术后住院时间2（1，2）d，亦明显短于RH组的7（6，9）d（Z=-6.612，P<O.001）；RFA组并发症发生率为10%（3/31），亦明显低于RH组的42%（13/31）（χ2=6.823，P=0.009）。

结论

对于复发性肝癌患者，RH治疗PFS获益优于RFA，尤其在小肿瘤、单发和多发患者中获益明显，而两者OS相似。

关键词: 癌，肝细胞, 复发, 再次肝切除术, 射频消融, 预后
Objective

To compare the safety and efficacy between repeated hepatectomy (RH) and radiofrequency ablation (RFA) in the treatment of recurrent hepatocellular carcinoma (HCC), and to explore the influencing factors of postoperative survival.

Methods

Clinical data of 96 patients with recurrent HCC admitted to the First People's Hospital of Foshan from January 2017 to December 2023 were retrospectively analyzed. Among them, 86 patients were male and 10 female, aged from 27 to 78 years, with a median age of 55 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different treatment methods, all patients were divided into the RH (n=43) and RFA groups (n=53). Patients between two groups were matched by 1∶1 propensity score matching (PSM). Clinical efficacy and safety between RH and RFA in patients with recurrent HCC were also compared. Overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier method and Log-rank test. Prognostic factors were determined by using multivariate Cox's regression analysis.

Results

After PSM, the 1-, 3- and 5-year OS rates in the RH group were 93.1%, 81.8% and 71.9%, and 83.7%, 58.9% and 45.4% in the RFA group, respectively, with no statistical significance between two groups (χ2=3.133, P=0.077). The 1-, 3- and 5-year PFS rates in the RH group were 70.8%, 45.4% and 34.4%, and 45.1%, 7.6% and 4.0% in the RFA group, respectively, with statistical significance between two groups (χ2=12.308, P<0.001). PFS subgroup analysis revealed that RH was superior to RFA in small tumors, single and multiple lesion subgroups (Z=9.811, 6.699, 5.998; all P<0.05). Cox's regression analysis revealed that treatment regimen, liver cirrhosis and satellite lesion were the independent influencing factors of PFS in patients with recurrent HCC (RR=0.005, 0.015, 0.013; all P<0.05). After PSM, the length of postoperative hospital stay was 2 (1,2) d in the RFA group, also significantly shorter than 7 (6,9) d in the RH group (Z=-6.612, P<0.001). The incidence of complications was 10%(3/31) in the RFA group, significantly lower than 42% (13/31) in the RH group (χ2=6.823, P=0.009).

Conclusions

For patients with recurrent HCC, RH achieves better PFS benefits compared with RFA, especially in patients with small tumors, single and multiple lesions. Patients between two groups obtain similar OS.

Key words: Carcinoma,hepatocellular, Recurrence, Rehepatectomy, Radiofrequency ablation(RFA), Prognosis
表1 PSM前后两组复发性肝癌患者基线数据比较
变量 PSM前 PSM后
RH组 RFA组 统计值 P值 RH组 RFA组 统计值 P值
年龄(岁,
±s)		 54±13 55±12 t=0.575 0.567 53±12 57±13 t=1.391 0.169
男性(例) 38 48 χ2=0.000 0.989 26 31 χ2=3.481 0.062
AFP≥400 μg/L(例) 3 8 χ2=0.846 0.358 2 5 χ2=0.644 0.422
肝硬化(例) 19 26 χ2=0.073 0.787 14 18 χ2=0.581 0.446
HBV感染(例) 42 52 χ2=0.000 >0.999 30 31 χ2=0.000 >0.999
Child-Pugh分级A级(例) 43 53 - - 35 35 - -
复发间隔[月, M(Q1, Q3)] 18(11, 32) 8(5, 16) Z=4.233 >0.999 15(10, 25) 13(6,21) Z=1.042 0.297
肿瘤最大直径[cm, M(Q1, Q3)] 2.3(1.5, 2.8) 1.6(1.2, 1.9) Z=3.284 0.001 2.0(1.5, 2.5) 1.70(1.3, 2.5) Z=0.494 0.621
肿瘤单发(例) 35 33 χ2=4.218 0.121 24 22 χ2=0.378 0.828
TB[μmol/L, M(Q1, Q3)] 12.7(9.5, 17.4) 15.2(11.7, 18.3) Z=1.592 0.111 12.7(10.3, 17.7) 17.3(12.2, 20.7) Z=1.795 0.073
ALB(g/L)a 39±4 40±4 t=1.295 0.198 39(38, 42) 41(38, 42) Z=0.810 0.418
ALT[U/L, M(Q1, Q3)] 22(15, 34) 24(19, 29) Z=0.446 0.656 23(17, 3) 27(23, 29) Z=0.634 0.526
AST[U/L, M(Q1, Q3)] 27(23, 32) 30(23, 33) Z=0.937 0.349 27(23, 35) 28(22, 33) Z=0.212 0.832
MVI(例)b 8 25 χ2=7.367 0.007 6 10 χ2=0.758 0.384
卫星灶(例)b 11 20 χ2=1.096 0.295 11 11 - -
低分化(例)b 29 37 χ2=2.527 0.283 20 23 χ2=1.432 0.489
图1 PSM后两组复发性肝癌患者生存分析Kaplan-Meier曲线 注：PSM为倾向性评分匹配，RH为再次肝切除术，RFA为射频消融
表2 PSM后亚组分析不同治疗方式对于复发性肝癌患者生存预后的影响（月）
亚组 OS(95%CI) Z值 P值 PFS(95%CI) Z值 P值
RH组 RFA组 RH组 RFA组
肿瘤最大直径≤3 cm 77(64, 89) 54(40, 68) 3.410 0.065 39(28, 49) 18(10, 25) 9.811 0.002
肿瘤最大直径>3 cm 44(20, 67) 42(23, 61) <0.001 0.984 36(3, 70) 10(5, 15) 0.961 0.327
肿瘤单发 76(63, 90) 61(46, 76) 1.179 0.277 35(26, 44) 20(11, 29) 6.699 0.010
肿瘤多发 58(36, 80) 39(35, 62) 1.452 0.228 39(17, 61) 9(5, 14) 5.998 0.014
表3 复发性肝癌患者OS和PFS影响因素Cox回归分析
变量 OS PFS
单因素分析 多因素分析 单因素分析 多因素分析
RR 95%CI P值 RR 95%CI P值 RR 95%CI P值 RR 95%CI P值
年龄≥50岁 0.62 0.32~1.21 0.162 0.48 0.22~1.02 0.056 1.65 1.00~2.70 0.049 1.33 0.78~2.25 0.298
RFA(对比RH) 1.97 0.94~4.12 0.073 1.49 0.65~3.42 0.348 2.78 1.69~4.58 <0.001 2.26 1.29~3.97 0.005
肝硬化 1.08 0.55~2.11 0.829 1.26 0.57~2.76 0.568 1.42 0.89~2.26 0.141a 1.97 1.14~3.41 0.015
复发时间间隔≥24个月 0.50 0.18~1.43 0.198 0.72 0.22~2.40 0.591 0.37 0.19~0.72 0.003 0.63 0.30~1.36 0.239
肿瘤多发 1.99 1.00~3.91 0.047 1.23 0.52~2.93 0.640 1.61 0.99~2.63 0.057 1.55 0.85~2.82 0.151
AST 1.01 0.99~1.03 0.002 1.04 1.01~1.06 0.003 1.02 1.00~1.05 0.061 1.02 0.99~1.04 0.179
MVI 1.83 0.93~3.59 0.079 1.31 0.51~3.33 0.575 1.69 1.05~2.71 0.030 1.14 0.61~2.13 0.678
卫星灶 1.64 0.83~3.25 0.155 1.57 0.75~3.29 0.235 2.01 1.25~3.24 0.004 2.06 1.16~3.65 0.013
表4 PSM后两组复发性肝癌患者术后并发症（例）
变量 RH组 RFA组 χ2值 P值
术后并发症 13 3 6.823 0.009
疼痛 6 3
高热 1 0
胸腔积液 4 0
腹腔积液 3 0
消化道出血 1 0
伤口脂肪液化 1 0
Clavien-Dindo分级
Ⅰ 7 3
Ⅱ 2 0
Ⅲ 4 0
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