Giovannini Marc, Moutardier Vincent, Danisi Carcline, Bories Erwan, Pesenti Christian, Delpéro Jean-Robert
Department of Digestive Oncology, Paoli-Calmettes Institute, Marseilles, France.
J Gastrointest Surg. 2003 Sep-Oct;7(6):791-6. doi: 10.1016/s1091-255x(03)00112-4.
The aim of this study was to evaluate the efficacy of and tolerance for radiofrequency thermoablation (RFTA) in patients with hepatocellular carcinoma (HCC). From March 1999 to September 2001, a total of 56 patients (46 men and 10 women) whose mean age was 67.8 years (range 51 to 76 years) underwent RFTA for 71 HCCs at our institution. RFTA was carried out in 45 patients with one lesion less than 6 cm in diameter, in seven patients with two lesions less than 4 cm in diameter each, and in four patients with three lesions less than 3 cm in diameter each. The mean diameter of the lesions was 4.1 cm (range 0.8 to 6.0 cm). The etiology of the cirrhosis was alcoholism in 31 patients, post-hepatitis C in 19 patients, post-hepatitis B in four patients, and hemochromatosis in two patients. Forty-five patients were classified as Child stage A and 11 were Child stage B. No ascites, prothrombin time >60%, and platelet count <60,000/mm(3) were needed. Two types of cooled needles were used depending on the size of the lesion (a needle 15 cm in length was used for 2 or 3 cm tumors, and a cluster of needles was used for tumors larger than 4 cm). Helical computed tomography was performed 8 weeks after treatment. The main criterion for a complete response was the presence of a hypodense lesion without contrast enhancement. Mean follow-up was 14 months. Complete tumor destruction was achieved in 50 (89.2%) of 56 patients after one session and in 52 (92.8%) of 56 after two sessions. Twelve months later, a complete response was confirmed in 45 patients (80.3%), four patients had a local recurrence and new liver nodules, and three patients had died (one of bone metastasis, one of acute alcoholic hepatitis, and one of bronchial carcinoma). Thirty-nine patients (69.6%) were still in complete remission 36 months later, and a new HCC had developed in six patients. At 36 months 49 of 56 patients were alive and 39 of 56 were free of disease. Patients with HCCs that developed following viral cirrhosis had a worse prognosis than those with HCCs that occurred after alcoholic cirrhosis (2-year survival, 57.7% vs. 77.7%; P=0.0241). It was concluded that radiofrequency ablation is an effective treatment for HCC, although the prognosis is better in patients who develop HCC after alcoholic cirrhosis compared to those in whom HCC occurs after viral cirrhosis.
本研究旨在评估射频热消融（RFTA）治疗肝细胞癌（HCC）患者的疗效及耐受性。1999年3月至2001年9月，我院共有56例患者（46例男性，10例女性）接受了RFTA治疗71个HCC病灶，患者平均年龄67.8岁（范围51至76岁）。45例患者有1个直径小于6 cm的病灶，7例患者有2个直径均小于4 cm的病灶，4例患者有3个直径均小于3 cm的病灶。病灶平均直径为4.1 cm（范围0.8至6.0 cm）。肝硬化病因：酒精性31例，丙型肝炎后19例，乙型肝炎后4例，血色素沉着症2例。45例患者为Child A期，11例为Child B期。无需出现腹水、凝血酶原时间>60%及血小板计数<60,000/mm³。根据病灶大小使用两种类型的冷却针（长度15 cm的针用于2或3 cm的肿瘤，针簇用于大于4 cm的肿瘤）。治疗8周后进行螺旋CT检查。完全缓解的主要标准是存在无强化的低密度病灶。平均随访14个月。56例患者中，一次治疗后50例（89.2%）实现肿瘤完全破坏，两次治疗后52例（92.8%）实现肿瘤完全破坏。12个月后，45例患者（80.3%）确认完全缓解，4例患者出现局部复发及新的肝结节，3例患者死亡（1例死于骨转移，1例死于急性酒精性肝炎，1例死于支气管癌）。此后36个月，39例患者（69.6%）仍处于完全缓解状态，6例患者出现新的HCC。36个月时，56例患者中有49例存活，56例中有39例无疾病。病毒性肝硬化后发生HCC的患者预后比酒精性肝硬化后发生HCC的患者差（2年生存率分别为57.7%和77.7%；P = 0.0241）。结论是，射频消融是治疗HCC的有效方法，尽管酒精性肝硬化后发生HCC的患者预后比病毒性肝硬化后发生HCC的患者好。
