Martin Adrian P, Goldstein Robert M, Dempster Jane, Netto George J, Katabi Nora, Derrick Howard C, Altrabulsi Basel, Jennings Linda W, Ueno Takehisa, Chinnakotla Srinath, Dawson Sherfield, Randall Henry B, Levy Marlon F, Onaca Nicholas, Sanchez Edmund Q, Orr Douglas, Klintmalm Goran B
Baylor Regional Transplant Institute, Dallas, TX, USA.
Clin Transplant. 2006 Nov-Dec;20(6):695-705. doi: 10.1111/j.1399-0012.2006.00538.x.
Radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) is an optional treatment for patients awaiting liver transplantation (LTX). The study evaluates the efficacy of RFA in the explanted liver and its effect on patient outcome.
Forty-seven patients underwent RFA and were listed for transplant between January 1998 and May 2003. The patients were divided into two groups: transplanted and non-transplanted. Both groups were evaluated in terms of tumor characteristics, recurrence, mortality rate, and time on the waiting list. The ablation sites in the explanted livers were examined for percentage of necrosis by Hematoxylin & Eosin (H&E) stain and by TUNEL stain.
Transplantation was carried out in 35 patients (74.5%). Ten patients (21.3%) died before transplant or were removed from the wait list, while two patients (4.2%) are still listed. Mortality and tumor-related mortality were significantly higher in the non-transplanted group. The time spent on the waiting list was longer in the non-transplanted patients (350 vs. 186 d average, p = 0.0345). Thirty-eight ablation sites were examined in the explanted livers. The percentage of tumor necrosis by TUNEL staining was 19.6% higher than that reported by H&E staining. After TUNEL staining, 28 sites (73.7%) had more than 90% necrosis, eight sites (21.0%) had 50-90%, and two sites (5.3%) had less than 50% necrosis.
RFA and LTX can be used successfully in HCC patients, and in most cases, tumor necrosis can be achieved with ultrasound-guided RFA. H&E stain tends to under-represent the amount of tumor necrosis on the ablation sites. Survival of RFA patients after LTX is excellent.
肝细胞癌（HCC）的射频消融（RFA）是等待肝移植（LTX）患者的一种可选治疗方法。本研究评估了RFA在移植肝中的疗效及其对患者预后的影响。
1998年1月至2003年5月期间，47例患者接受了RFA并被列入移植名单。患者分为两组：移植组和未移植组。对两组患者的肿瘤特征、复发情况、死亡率以及等待名单上的时间进行了评估。对移植肝中的消融部位进行苏木精和伊红（H&E）染色及TUNEL染色，以检查坏死百分比。
35例患者（74.5%）接受了移植。10例患者（21.3%）在移植前死亡或被从等待名单中移除，2例患者（4.2%）仍在等待名单上。未移植组的死亡率和肿瘤相关死亡率显著更高。未移植患者在等待名单上花费的时间更长（平均350天对186天，p = 0.0345）。对移植肝中的38个消融部位进行了检查。TUNEL染色显示的肿瘤坏死百分比比H&E染色报告的高19.6%。TUNEL染色后，28个部位（73.7%）坏死超过90%，8个部位（21.0%）坏死为50 - 90%，2个部位（5.3%）坏死少于50%。
RFA和LTX可成功用于HCC患者，在大多数情况下，超声引导下的RFA可实现肿瘤坏死。H&E染色往往低估了消融部位的肿瘤坏死量。LTX后RFA患者的生存率良好。
