Brillet Pierre-Yves, Paradis Valérie, Brancatelli Giuseppe, Rangheard Anne-Sophie, Consigny Yann, Plessier Aurélie, Durand François, Belghiti Jacques, Sommacale Daniele, Vilgrain Valérie
Department of Radiology, APHP-Hôpital Beaujon, 100 Boulevard du General Leclerc, Clichy 92118, France.
AJR Am J Roentgenol. 2006 May;186(5 Suppl):S296-305. doi: 10.2214/AJR.04.1927.
The aims of this study were to determine the feasibility and efficacy of percutaneous radiofrequency ablation in patients with hepatocellular carcinoma waiting for liver transplantation and to compare the radiologic and pathologic findings.
Twenty-six patients with 35 hepatocellular carcinomas were addressed for transplantation. Complications of the procedures were recorded. Primary and secondary technique effectiveness and causes of exclusion from the waiting list were assessed. After transplantation, tumor recurrence was evaluated for at least 1 year in all patients. Radiologic-pathologic comparison of the explant was performed.
Percutaneous radiofrequency ablation was performed in 21 (81%) patients for 28 tumors. Both minor and major complications occurred in three patients (10% each per session). The rates of primary technique effectiveness, secondary technique effectiveness for percutaneous radiofrequency ablation alone (seven tumors), and combined percutaneous radiofrequency ablation and transcatheter arterial chemoembolization (three tumors) were 56%, 76%, and 86%, respectively. After a mean follow-up of 11.9 months, 16 patients (76%) received transplants, whereas five patients were excluded from the waiting list because of distant tumor progression (n =3, 14%) or other causes (n = 2, 10%). After transplantation, tumor recurred in one (6%) of 16 patients. Histopathologic examinations were performed for 13 (81%) of 16 patients and showed complete necrosis and satellite nodules in, respectively, 12 (75%) and seven (44%) of 16 tumors.
Percutaneous radiofrequency ablation can be performed on hepatocellular carcinoma patients waiting for transplantation, allows most patients to undergo transplantation, and does not impair posttransplantation outcomes. The procedure produces complete necrosis of the treated tumor in most cases but is associated with a high rate of satellite nodules.
本研究旨在确定经皮射频消融术在等待肝移植的肝细胞癌患者中的可行性和疗效，并比较影像学和病理学结果。
26例患有35个肝细胞癌的患者接受移植评估。记录手术并发症。评估主要和次要技术有效性以及被排除在等待名单之外的原因。移植后，对所有患者进行至少1年的肿瘤复发评估。对切除的标本进行影像学-病理学比较。
21例（81%）患者的28个肿瘤接受了经皮射频消融术。3例患者（每次手术各占10%）出现了轻微和严重并发症。单纯经皮射频消融术（7个肿瘤）、经皮射频消融术联合经动脉化疗栓塞术（3个肿瘤）的主要技术有效率、次要技术有效率分别为56%、76%和86%。平均随访11.9个月后，16例患者（76%）接受了移植，而5例患者因远处肿瘤进展（n = 3，14%）或其他原因（n = 2，10%）被排除在等待名单之外。移植后，16例患者中有1例（6%）出现肿瘤复发。16例患者中的13例（81%）进行了组织病理学检查，结果显示16个肿瘤中分别有12个（75%）和7个（44%）出现完全坏死和卫星结节。
经皮射频消融术可应用于等待移植的肝细胞癌患者，能使大多数患者接受移植，且不影响移植后的预后。该手术在大多数情况下能使治疗的肿瘤完全坏死，但卫星结节发生率较高。
