Raut Chandrajit P, Izzo Francesco, Marra Paolo, Ellis Lee M, Vauthey Jean-Nicolas, Cremona Francesco, Vallone Paolo, Mastro Angelo, Fornage Bruno D, Curley Steven A
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, Texas, 77030-4009, USA.
Ann Surg Oncol. 2005 Aug;12(8):616-28. doi: 10.1245/ASO.2005.06.011. Epub 2005 Jun 20.
Radiofrequency ablation (RFA) offers an alternative treatment in some unresectable hepatocellular carcinoma (HCC) patients with disease confined to the liver. We prospectively evaluated survival rates in patients with early-stage, unresectable HCC treated with RFA.
All patients with HCC treated with RFA between September 1, 1997, and July 31, 2002, were prospectively evaluated. Patients were treated with RFA by using a percutaneous or open intraoperative approach with ultrasound guidance and were evaluated at regular intervals to determine disease recurrence and survival.
A total of 194 patients (153 men [79%] and 41 women [21%]) with a median age of 66 years (range, 39-86 years) underwent RFA of 289 sonographically detectable HCC tumors. All patients were followed up for at least 12 months (median follow-up, 34.8 months). Percutaneous and open intraoperative RFA was performed in 140 (72%) and 54 (28%) patients, respectively. The median diameter of tumors treated with RFA was 3.3 cm. Disease recurred in 103 (53%) of 194 patients, including 69 (49%) of 140 patients treated percutaneously and 34 (63%) of 54 treated with open RFA (not significant). Local recurrence developed in nine patients (4.6%). Most recurrence was intrahepatic. The overall complication rate was 12%. Overall survival rates at 1, 3, and 5 years for all 194 patients were 84.5%, 68.1%, and 55.4%, respectively.
Treatment with RFA can produce significant long-term survival rates for cirrhotic patients with early-stage, unresectable HCC. RFA can be performed in these patients with relatively low complication rates. Confirmation of these results in randomized trials should be considered.
对于一些疾病局限于肝脏的无法切除的肝细胞癌（HCC）患者，射频消融（RFA）提供了一种替代治疗方法。我们前瞻性评估了接受RFA治疗的早期、无法切除的HCC患者的生存率。
对1997年9月1日至2002年7月31日期间接受RFA治疗的所有HCC患者进行前瞻性评估。患者在超声引导下采用经皮或开放手术入路接受RFA治疗，并定期进行评估以确定疾病复发和生存情况。
共有194例患者（153例男性[79%]和41例女性[21%]），中位年龄66岁（范围39 - 86岁），对289个超声可检测到的HCC肿瘤进行了RFA治疗。所有患者均随访至少12个月（中位随访时间34.8个月）。分别有140例（72%）和54例（28%）患者接受了经皮和开放手术RFA。接受RFA治疗的肿瘤中位直径为3.3 cm。194例患者中有103例（53%）疾病复发，包括经皮治疗的140例患者中的69例（49%）和开放手术RFA治疗的54例患者中的34例（63%）（无显著差异）。9例患者（4.6%）发生局部复发。大多数复发为肝内复发。总体并发症发生率为12%。194例患者1年、3年和5年的总体生存率分别为84.5%、68.1%和55.4%。
RFA治疗可为早期、无法切除的HCC肝硬化患者带来显著的长期生存率。RFA可在这些患者中以相对较低的并发症发生率进行。应考虑在随机试验中证实这些结果。
