Kim Young-sun, Rhim Hyunchul, Cho On Koo, Koh Byung Hee, Kim Yongsoo
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea.
Eur J Radiol. 2006 Sep;59(3):432-41. doi: 10.1016/j.ejrad.2006.03.007. Epub 2006 May 9.
To evaluate the pattern and risks for intrahepatic recurrence after percutaneous radiofrequency (RF) ablation for hepatocellular carcinoma (HCC).
We studied 62 patients with 72 HCCs (< or =4 cm) who were treated with percutaneous RF ablation. The mean follow-up period was 19.1 months (6.0-49.1). We assessed the incidence and cumulative disease-free survival of local tumor progression (LTP) and intrahepatic distant recurrence (IDR). To analyze the risk factors, we examined the following, for the LTP: (1) tumor diameter, (2) contact with vessels, (3) degree of approximation to hepatic hilum, (4) contact with hepatic capsule, (5) presence of ablative safety margin, (6) degree of benign periablational enhancement and (7) serum alpha-fetoprotein; for the IDR: (1) severity of hepatic disease, (2) presence of HBsAg, (3) serum alpha-fetoprotein, (4) whether RF ablation was the initial treatment and (5) multiplicity of tumor for IDR.
The incidence of overall recurrence, LTP and IDR was 62.9%, 26.4% and 53.2%, respectively. The cumulative disease-free survival rates were 52%, 82% and 56% at 1 year, 26%, 63% and 30% at 2 years, respectively. Univariate analysis showed that the significant risk factors for LTP were: a tumor with a diameter >3 cm, contact of HCC with a vessel and an insufficient safety margin (p<0.05). A multivariate stepwise Cox hazard model showed that the measurement of a tumor diameter >3 cm and insufficient safety margin were independent factors. Only the increased serum alpha-fetoprotein was a significant risk factor for IDR (p<0.05).
Intrahepatic recurrence after percutaneous RF ablation is common. Large HCC (>3 cm) with high serum alpha-fetoprotein should be treated more aggressively because of higher risk for recurrence.
评估经皮射频（RF）消融治疗肝细胞癌（HCC）后肝内复发的模式及风险。
我们研究了62例患有72个HCC（直径≤4 cm）且接受经皮RF消融治疗的患者。平均随访期为19.1个月（6.0 - 49.1个月）。我们评估了局部肿瘤进展（LTP）和肝内远处复发（IDR）的发生率及累积无病生存率。为分析危险因素，我们针对LTP检查了以下各项：（1）肿瘤直径，（2）与血管的接触情况，（3）与肝门的接近程度，（4）与肝包膜的接触情况，（5）消融安全 margins的存在情况，（6）消融周围良性强化程度以及（7）血清甲胎蛋白；针对IDR检查了以下各项：（1）肝脏疾病的严重程度，（2）HBsAg的存在情况，（3）血清甲胎蛋白，（4）RF消融是否为初始治疗以及（5）IDR的肿瘤 multiplicity。
总体复发、LTP和IDR的发生率分别为62.9%、26.4%和53.2%。1年时累积无病生存率分别为52%、82%和56%，2年时分别为26%、63%和30%。单因素分析显示，LTP的显著危险因素为：直径>3 cm的肿瘤、HCC与血管的接触以及安全 margins不足（p<0.05）。多因素逐步Cox风险模型显示，肿瘤直径>3 cm的测量值和安全 margins不足是独立因素。仅血清甲胎蛋白升高是IDR的显著危险因素（p<0.05）。
经皮RF消融后肝内复发很常见。血清甲胎蛋白水平高的大HCC（>3 cm）因复发风险较高，应更积极地进行治疗。
