Yang Wei, Chen Min Hua, Yin Shan Shan, Yan Kun, Gao Wen, Wang Yan Bin, Huo Ling, Zhang Xiao Peng, Xing Bao Cai
Department of Ultrasound, Peking University School of Oncology, 52 Fu-cheng Rd., Hai-dian District, Beijing 100036, People's Republic of China.
AJR Am J Roentgenol. 2006 May;186(5 Suppl):S275-83. doi: 10.2214/AJR.04.1573.
Our objective was to assess the efficacy and safety of radiofrequency ablation of recurrent hepatocellular carcinoma (HCC) after hepatectomy and to compare the effects on early- and late-phase recurrence.
We studied 41 patients with 76 recurrent HCC tumors (diameter range, 2.0-6.6 cm; mean, 3.8 +/- 1.3 [SD] cm) after hepatectomy who underwent sonography-guided percutaneous radiofrequency ablation in our hospital (recurrent-HCC group). The interval between surgery and recurrence ranged from 1 to 96 months (mean, 24.5 months). These patients were divided into an early-recurrence group (20 patients with 41 recurrent HCC tumors) and a late-recurrence group (21 patients with 35 recurrent HCC tumors). Early recurrence was defined as that occurring within 1 year after surgery, and late recurrence was defined as that occurring after 1 year. Another 116 patients with 172 primary HCC tumors (diameter range, 1.2-7.0 cm; mean, 3.9 +/- 1.1 cm) treated by radiofrequency ablation were regarded as a control group. No other therapies were given before radiofrequency ablation in any group. Regular follow-up with enhanced CT was performed to evaluate the treatment results. Ablation was considered successful if no contrast enhancement was detected in the treated area on 1-month CT scans. Indexes including ablation success rate, local recurrence rate, distant recurrence rate, and survival were obtained for analysis and comparison.
The ablation success rate, local recurrence rate, distant recurrence rate, and mean overall survival time of the recurrent-HCC group were 93.4% (71/76 tumors), 9.2% (7/76 tumors), 36.6% (15/41 patients), and 30.9 +/- 3.7 months, respectively. The incidence of distant recurrence in the early-recurrence group was significantly higher than that in the late-recurrence group (55.0% vs 19.0%, p = 0.017). The early-recurrence group had a shorter overall survival than did the late-recurrence group (mean overall survival, 16.4 +/- 2.4 vs 42.9 +/- 4.4 months, p < 0.001) or the control group (16.4 +/- 2.4 vs 45.9 +/- 2.5 months, p < 0.001). The survival time of the late-recurrence group was similar to that of the control group (42.9 +/- 4.4 vs 45.9 +/- 2.5 months, p > 0.05). Serious hemorrhage after radiofrequency ablation occurred in one patient in the late-recurrence group and was controlled with conservative treatment.
Radiofrequency ablation is generally effective and safe in treating recurrent HCC after hepatectomy and is more effective in late recurrence than in early recurrence.
我们的目的是评估肝切除术后复发性肝细胞癌（HCC）射频消融的疗效和安全性，并比较其对早期和晚期复发的影响。
我们研究了41例肝切除术后复发性HCC肿瘤患者（共76个复发性肿瘤，直径范围2.0 - 6.6 cm，平均3.8 ± 1.3 [标准差] cm），这些患者在我院接受了超声引导下经皮射频消融（复发性HCC组）。手术与复发的间隔时间为1至96个月（平均24.5个月）。这些患者被分为早期复发组（20例患者，41个复发性HCC肿瘤）和晚期复发组（21例患者，35个复发性HCC肿瘤）。早期复发定义为手术后1年内发生的复发，晚期复发定义为手术后1年后发生的复发。另外116例接受射频消融治疗的原发性HCC肿瘤患者（共172个肿瘤，直径范围1.2 - 7.0 cm，平均3.9 ± 1.1 cm）被视为对照组。任何组在射频消融前均未接受其他治疗。通过增强CT进行定期随访以评估治疗结果。如果在1个月的CT扫描中治疗区域未检测到对比增强，则认为消融成功。获取包括消融成功率、局部复发率、远处复发率和生存率等指标进行分析和比较。
复发性HCC组的消融成功率、局部复发率、远处复发率和平均总生存时间分别为93.4%（71/76个肿瘤）、9.2%（7/76个肿瘤）、36.6%（15/4例患者）和30.9 ± 3.7个月。早期复发组的远处复发发生率显著高于晚期复发组（55.0%对19.0%，p = 0.017）。早期复发组的总生存期短于晚期复发组（平均总生存期，16.4 ± 2.4对42.9 ± 4.4个月，p < 0.001）或对照组（16.4 ± 2.4对45.9 ± 2.5个月，p < 0.001）。晚期复发组的生存时间与对照组相似（42.9 ± 4.4对45.9 ± 2.5个月，p > 0.05）。晚期复发组有1例患者在射频消融后发生严重出血，经保守治疗得到控制。
射频消融治疗肝切除术后复发性HCC总体有效且安全，对晚期复发的效果优于早期复发。
