Lu M-D, Yin X-Y, Xie X-Y, Xu H-X, Xu Z-F, Liu G-J, Kuang M, Zheng Y-L
Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.
Br J Surg. 2005 Nov;92(11):1393-8. doi: 10.1002/bjs.5102.
Tumour ablation using a thermal energy source has shown promising results, and is particularly suitable for recurrent hepatocellular carcinoma (HCC). The present study evaluated long-term outcomes after percutaneous thermal ablation for recurrent HCC following liver resection.
Radiofrequency ablation or microwave ablation was used to treat a total of 124 tumour nodules (0.9-7.0 cm in diameter) in 72 patients with recurrent HCC.
Complete ablation of 119 (96.0 per cent) of 124 tumour nodules was achieved. There was no treatment-related death and the major complication rate was 4 per cent. During a mean(s.d.) follow-up of 27.9(17.8) months, local recurrence developed in 16 (13.6 per cent) of 118 successfully treated tumour nodules. Distant recurrence developed in 60 (85 per cent) of 71 patients, of whom 26 had repeat metachronous distant recurrence. With repeated ablation for both local and distant recurrence, the 1-, 3- and 5-year overall survival rates after initial ablation were 75, 43 and 18 per cent respectively. Patients with a serum alpha-fetoprotein level greater than 200 ng/ml before treatment had significantly poorer survival than those with a lower level (P = 0.034) and multivariate analysis identified preablation AFP level as an independent prognostic factor (P = 0.054).
With their advantages of preservation of non-tumorous liver tissue and easy repetition, percutaneous thermal ablative therapies were particularly suitable for recurrent HCC and improved long-term survival.
使用热能源进行肿瘤消融已显示出有前景的结果，并且特别适用于复发性肝细胞癌（HCC）。本研究评估了肝切除术后复发性HCC经皮热消融后的长期结果。
采用射频消融或微波消融治疗72例复发性HCC患者的总共124个肿瘤结节（直径0.9 - 7.0厘米）。
124个肿瘤结节中有119个（96.0%）实现了完全消融。无治疗相关死亡，主要并发症发生率为4%。在平均（标准差）27.9（17.8）个月的随访期间，118个成功治疗的肿瘤结节中有16个（13.6%）发生局部复发。71例患者中有60例（85%）发生远处复发，其中26例有重复的异时性远处复发。对局部和远处复发均进行重复消融后，初次消融后的1年、3年和5年总生存率分别为75%、43%和18%。治疗前血清甲胎蛋白水平大于200 ng/ml的患者生存率明显低于水平较低者（P = 0.034），多变量分析确定消融前AFP水平为独立预后因素（P = 0.054）。
经皮热消融疗法具有保留非肿瘤肝组织和易于重复的优点，特别适用于复发性HCC并改善了长期生存率。
