Cammà Calogero, Di Marco Vito, Orlando Ambrogio, Sandonato Luigi, Casaril Andrea, Parisi Piero, Alizzi Silvia, Sciarrino Elio, Virdone Roberto, Pardo Salvatore, Di Bona Danilo, Licata Anna, Latteri Federica, Cabibbo Giuseppe, Montalto Giuseppe, Latteri Mario Adelfio, Nicoli Nicola, Craxì Antonio
Cattedra e Unità Operativa di Gastroenterologia, University of Palermo, Palermo, Italy.
J Hepatol. 2005 Apr;42(4):535-40. doi: 10.1016/j.jhep.2004.11.042.
BACKGROUND/AIMS: To assess the effectiveness and the safety of radio-frequency thermal ablation (RFTA) in patients with hepatocellular carcinoma (HCC) < or = 5 cm in compensated cirrhosis.
A cohort of 202 consecutive patients (165 Child-Pugh class A and 37 class B) was prospectively assessed. A single lesion was observed in 160/202 (79.2%), two lesions in 29/202 (14.3%), and three lesions in 13/202 (6.4%) of patients.
Sixty-seven patients died. Survival rates were 80% at 12 months, 67% at 24 months and 57% at 30 months (Child-Pugh A 59% and Child-Pugh B 48%). By Cox regression analysis, survival was independently predicted by serum albumin levels > or = 35 g/L, platelet count > or = 100.000/mmc, tumor size < or = 3 cm, complete response at 1 month and Barcelona Clinic Liver Cancer (BCLC) staging classification. Overall recurrence rates were 22, 38, and 44% at 12, 24, and 30 months, respectively. One procedure-related death occurred. The proportion of major complications after treatment was 3.9%.
A complete response after RFTA significantly increases survival. The longest survival is obtained in the presence of HCC < or = 3 cm and of higher baseline albumin levels and platelet counts. BCLC staging classification is able to discriminate patients with good or poor prognosis.
背景/目的：评估射频热消融（RFTA）治疗代偿期肝硬化且肝细胞癌（HCC）直径≤5 cm患者的有效性和安全性。
前瞻性评估连续202例患者（165例Child-Pugh A级和37例B级）。160/202例（79.2%）患者观察到单个病灶，29/202例（14.3%）患者观察到两个病灶，13/202例（6.4%）患者观察到三个病灶。
67例患者死亡。12个月生存率为80%，24个月生存率为67%，30个月生存率为57%（Child-Pugh A级为59%，Child-Pugh B级为48%）。通过Cox回归分析，血清白蛋白水平≥35 g/L、血小板计数≥100,000/mmc、肿瘤大小≤3 cm、1个月时完全缓解以及巴塞罗那临床肝癌（BCLC）分期分类可独立预测生存情况。12、24和30个月时的总体复发率分别为22%、38%和44%。发生1例与手术相关的死亡。治疗后严重并发症的比例为3.9%。
RFTA后完全缓解显著提高生存率。HCC直径≤3 cm、基线白蛋白水平和血小板计数较高时生存率最长。BCLC分期分类能够区分预后良好或不良的患者。
