肝硬化中的小肝细胞癌：射频热消融与经皮乙醇注射的随机对照比较

Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection.

作者信息

Lencioni Riccardo A, Allgaier Hans-Peter, Cioni Dania, Olschewski Manfred, Deibert Peter, Crocetti Laura, Frings Holger, Laubenberger Joerg, Zuber Ina, Blum Hubert E, Bartolozzi Carlo

机构信息

Division of Diagnostic and Interventional Radiology, Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Via Roma 67, I-56125 Pisa, Italy.

出版信息

Radiology. 2003 Jul;228(1):235-40. doi: 10.1148/radiol.2281020718. Epub 2003 May 20.

DOI:10.1148/radiol.2281020718

PMID:12759473

Abstract

PURPOSE

To compare the effectiveness of radio-frequency (RF) thermal ablation with that of percutaneous ethanol injection (PEI) for the treatment of small hepatocellular carcinoma (HCC) in patients with cirrhosis.

MATERIALS AND METHODS

A series of 102 patients with hepatic cirrhosis and either single HCC 5 cm in diameter or smaller or as many as three HCCs each 3 cm or smaller (overall number of lesions, 142) randomly received either RF ablation (n = 52) or PEI (n = 50) as the sole first-line anticancer treatment. Mean follow-up was 22.9 months +/- 9.4 (SD) in the RF group and 22.4 months +/- 8.6 in the PEI group. Prognostic value of treatment techniques was assessed with univariate and multivariate Cox proportional hazards regression models.

RESULTS

One- and 2-year survival rates were 100% and 98% in the RF group and 96% and 88% in the PEI group, respectively (univariate relative risk [RR] = 0.20; 95% CI: 0.02, 1.69; P =.138). One- and 2-year local recurrence-free survival rates were 98% and 96% in the RF group and 83% and 62% in the PEI group, respectively (univariate RR = 0.17; 95% CI: 0.06, 0.51; P =.002). One- and 2-year event-free survival rates were 86% and 64% for the RF group and 77% and 43% for the PEI group, respectively (univariate RR = 0.48; 95% CI: 0.27, 0.85; P =.012). RF treatment was confirmed as an independent prognostic factor for local recurrence-free survival rates with multivariate analysis (adjusted RR = 0.20; 95% CI: 0.05, 0.73; P =.015).

CONCLUSION

RF ablation is superior to PEI with respect to local recurrence-free survival rates.

摘要

目的

比较射频（RF）热消融术与经皮乙醇注射（PEI）治疗肝硬化患者小肝细胞癌（HCC）的疗效。

材料与方法

102例肝硬化患者，其单个HCC直径为5 cm或更小，或多达3个HCC，每个直径为3 cm或更小（病灶总数142个），随机接受射频消融（n = 52）或PEI（n = 50）作为唯一的一线抗癌治疗。射频组平均随访时间为22.9个月±9.4（标准差），PEI组为22.4个月±8.6。采用单因素和多因素Cox比例风险回归模型评估治疗技术的预后价值。

结果

射频组1年和2年生存率分别为100%和98%，PEI组分别为96%和88%（单因素相对风险[RR]=0.20；95%可信区间：0.02，1.69；P = 0.138）。射频组1年和2年局部无复发生存率分别为98%和96%，PEI组分别为83%和62%（单因素RR = 0.17；95%可信区间：0.06，0.51；P = 0.002）。射频组1年和2年无事件生存率分别为86%和64%，PEI组分别为77%和43%（单因素RR = 0.48；95%可信区间：0.27，0.85；P = 0.012）。多因素分析证实射频治疗是局部无复发生存率的独立预后因素（校正RR = 0.20；95%可信区间：0.05，0.73；P = 0.015）。