Fontana Robert J, Hamidullah Halimi, Nghiem Hanh, Greenson Joel K, Hussain Hero, Marrero Jorge, Rudich Steve, McClure Leslie A, Arenas Juan
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA.
Liver Transpl. 2002 Dec;8(12):1165-74. doi: 10.1053/jlts.2002.36394.
The incidence of hepatocellular carcinoma (HCC) is increasing in the United States. Although liver transplantation is an effective means of treating selected patients, pretransplantation tumor progression may preclude some patients from undergoing transplantation. The aim of this study is to determine the safety and efficacy of percutaneous radiofrequency thermal ablation (RFA) in 33 consecutive patients with nonresectable HCC and advanced cirrhosis. Mean subject age was 57.2 +/- 10.6 years, mean Child-Turcotte-Pugh score was 7.0 +/- 1.4, and mean maximal tumor diameter was 3.6 +/- 1.1 cm. Using contrast-enhanced computed tomography and magnetic resonance imaging, 22 patients (66%) had a complete radiological response at 3 months post-RFA, whereas 11 patients (33%) had an incomplete radiological response. During follow-up, 18 patients (54%) experienced tumor progression and 9 subjects underwent repeated ablation for either residual disease or tumor progression. The overall actuarial patient survival rate of the 33 patients was 58% at 2 years, whereas the transplantation-free patient survival rate was 34% at 2 years. Fifteen of 23 transplant candidates were successfully bridged to liver transplantation after a mean post-RFA follow-up of 7.9 +/- 6.7 months. The extent of tumor necrosis in the explant varied, but no subjects had evidence of tumor seeding on post-RFA imaging, at liver transplantation, or in the explant. The 3-year actuarial posttransplantation patient survival rate was 85%. Two patients have developed posttransplantation recurrence, and both had microscopic vascular invasion in their explants. In summary, our data show that RFA is a safe and effective treatment modality for patients with advanced cirrhosis and nonresectable HCC. Although the ability of RFA to prevent or delay tumor progression requires further prospective study, its favorable safety profile and promising efficacy make it an attractive treatment option for liver transplant candidates with nonresectable HCC.
在美国，肝细胞癌（HCC）的发病率正在上升。尽管肝移植是治疗部分患者的有效手段，但移植前肿瘤进展可能使一些患者无法接受移植。本研究的目的是确定经皮射频热消融（RFA）在33例连续的不可切除HCC和晚期肝硬化患者中的安全性和有效性。受试者平均年龄为57.2±10.6岁，平均Child-Turcotte-Pugh评分为7.0±1.4，平均最大肿瘤直径为3.6±1.1cm。使用对比增强计算机断层扫描和磁共振成像，22例患者（66%）在RFA后3个月有完全的影像学反应，而11例患者（33%）有不完全的影像学反应。在随访期间，18例患者（54%）出现肿瘤进展，9例患者因残留疾病或肿瘤进展接受了重复消融。33例患者的2年总体精算生存率为58%，而无移植的患者2年生存率为34%。23例移植候选者中有15例在RFA后平均随访7.9±6.7个月后成功过渡到肝移植。移植肝中肿瘤坏死程度各不相同，但在RFA后成像、肝移植时或移植肝中，没有患者有肿瘤播散的证据。移植后患者的3年精算生存率为85%。2例患者发生了移植后复发，且两者的移植肝均有镜下血管侵犯。总之，我们的数据表明，RFA对于晚期肝硬化和不可切除HCC患者是一种安全有效的治疗方式。尽管RFA预防或延缓肿瘤进展的能力需要进一步的前瞻性研究，但其良好的安全性和有前景的疗效使其成为不可切除HCC肝移植候选者的一个有吸引力的治疗选择。
