| Objective: To study the clinical characteristics of small hepatocellular carcinoma and the prognosis evaluation after receiving surgery resection /radio frequency ablation therapy.Background: The primary hepatic carcinoma is one of the most malignancy carcinoma in the world , it has distributed all over the world .the mortality is very high ,which ranks seven in men / eight in female.It mainly distributed in the Pacific coast of Asia and southeastern of Africa. Each year, there is about 100 million new cases. the mortality ranks three in China ,after the mortality of the malignant tumors of stomach and esophagus. About 11 million people has dead each year, accounting for 45% of the world ,who has dead for the hepatocellular carcinoma. For its high mortality, there is no single method can be used for cured., if following certification of medical consultation, to take a comprehensive range of treatment measures and individual application is the main measures for the treatment of liver cancer. For the small hepatocellular carcinoma (diameter≦5cm), surgery resection and radio frequency ablation therapy are the major measures.In particular, radiofrequency ablation has a rapid development in recent years, some researchs showed that its therapeutic effect to tumor (diameter≦3cm) was perfect, but with the modified electrode, the tumor volume significantly increased which could be damaged, the ablation used for the tumors of 3-5cm also have a better effect.Method:I had collected 97cases from Jan 2001 to Dec 2008 in the first hospital attached to Jilin university, which was diagnosed to small hepatocellular carcinoma, and receiving surgery resection or radiofrequency ablation therapy as initial treatment. To do the research about the clinical characterics of small hepatocellular carcinoma,then had followed up through phonecall to the patients after the expiry of the initial treatment with 2-years. I had followed up 63 cases, 34 cases received hepatic operation and the other 29 cases received radio frequency ablation therapy,then applicated of SAS 9.0 statistical software for analysis of experimental data. To compare the Surgery group and RF group'intrahepatic recurrence rate in 3-months, 1-year, 2-years using four table X2 test, Through logistic regression analysis compared the impact of risk factors for recurrence, and the application of Log-rank analysis to compare whether the disease free survival rates of the two groups has statistically significance. P<0.05 is considered has statistically significance.Results: The case features: 1.The ratio of the prevalence of the small hepatocellular carcinoma in male and female is 5: 1, males were significantly more than females. 2.The minimum age at onset was 24, the maximum age was 74, the average age was 54.7±10.9. Mainly concentrates in the 40-70 years old, the highest peak was the 50-60 years old group. 3.The symptoms mainly were symptomless (49%), liver pain (41%); Many patients were sensitive to percussion on the liver(30%). 4.The majority of the patients had chronic hepatitis with hepatic virus infection:There was 73 cases (74%) only had HBV infection, 22 cases (22%) only had HCV infection, one case (1%) had both HBV,HCV infection; 61% patients'AFP were higher than normal comparing to 39% were normal; 5.The complication incidences : the incidence of pain and fever in the surgical resection group were obviously higher than radio frequency ablation therapy group,but the different of the the incident of fever had no statistically significance,incidence of lung infection,urinary infection,hepatic failure and pleural effusion in the surgical resection group were higher than radio frequency ablation therapy group , but there was no statistically significance through Fisher calibration. The days of stay in hospital was significantly shorter in radio frequency ablation therapy group than the the surgical resection group (P <0.05).Prognostic analysis: 1.The intrahepatic recurrence rates in 3 months, 1 year, 2 years were 15%, 38%,64% in surgical resection group,and 21%, 45%, 65% in radiofrequency ablation therapy group of small hepatocellular carcinoma, using four table X2 test, the results shows there was no statistically significance between the two group. 2. The treatment methods,sex,Child-Pugh grade, tumor size,number of nodules,whether combine with cirrhosis,the level of alpha-fetoprotein all were not the associated with the recurrence through the Cox.3.The application of Log-rank to compare the two groups of patients's overall disease free survival rate, no significant difference between had manifestated (P=0.7948), tumor size of below 3cm and 3-5cm of the two groups of patients were tested,results suggested that the disease free survival rate had no statistically differences remained (P=0.7981, 0.2913), but the tumor size of 3-5cm comparison, the disease free survival rate in surgery group had the tendency higher than the RF group.Conclusion:1. The majority of small hepatocellular carcinoma patients were lack of clinical symptoms,the patients with chronic hepatitis should be regularly monitored.2. The incidents of postoperative compliances radiofrequency ablation therapy group is less than Surgery resection group,but there was no statistically differents and days of stay in hospital was significantly shorter in radio frequency ablation therapy group than the the surgical resection group (P <0.05).3. The intrahepatic recurrences after initial theatment of small primary hepatic carcinoma had no statistically significance between the Surgery resection and radiofrequency ablation therapy groups in 3 months, 1 year, 2 years. 4. The intrahepatic recurrences of small primary hepatic carcinoma were not associated with the treatment methods,sex,age,Child-Pugh grade,tumor size,number of nodules,whether combine with cirrhosis,the level of alpha fetoprotein.5. The disease free survival rate had no significant differences between the surgery resection group and the radiofrequency ablation therapy group.
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