Ng Kelvin K, Poon Ronnie T, Lo Chung-Mau, Yuen Jimmy, Tso Wai Kuen, Fan Sheung-Tat
Department of Surgery, The University of Hong Kong Medical Center, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
J Gastrointest Surg. 2008 Jan;12(1):183-91. doi: 10.1007/s11605-007-0276-y. Epub 2007 Sep 15.
Radiofrequency ablation (RFA) is an effective local ablation therapy for hepatocellular carcinoma (HCC) with favorable long-term outcome. There is no data on the analysis of recurrence pattern and its influence on long-term survival outcome after RFA in HCC patients.
To evaluate the tumor recurrence pattern and its influence on long-term survival in patients with HCC treated with RFA.
From April 2001 to January 2005, 209 patients received RFA using internally cooled electrode as the sole treatment modality for HCC. Among them, 117 patients (56%) had unresectable HCC because of bilobar disease, poor liver function, and/or high medical risk for resection; whereas 92 patients (44%) underwent RFA as the primary treatment for small resectable HCC. The ablation procedure was performed through percutaneous (n=101), laparoscopic (n=17), or open approaches (n=91). The tumor recurrence pattern and long-term survival were analyzed. Multivariate analysis was carried out to identify independent prognostic factors affecting the overall survival of patients.
The mortality and morbidity rates were 0.9 and 15.7%, respectively. Complete tumor ablation was achieved in 192 patients (92.7%). With a median follow-up period of 26 months, local recurrence occurred in 28 patients (14.5%). Same segment and different segment intrahepatic recurrence occurred in 30 patients (15.6%) and 78 patients (40.6%), respectively. Twenty patients (10.4%) developed distant extrahepatic metastases. The overall 1-, 3-, and 5-year survival rates were 87.2, 66.6, and 42%, respectively. Different segment intrahepatic recurrence and distant recurrence after RFA carried significant poor prognostic influence on overall survival outcome. Using multivariate analysis, Child-Pugh grade (risk ratio [RR]=2.918, 95% confident interval [CI] 1.704-4.998, p=0.000), tumor size (RR=1.231, 95% CI 1.031-1.469, p=0.021), and pattern of recurrence (risk ratio [RR]=1.464, 95% CI 1.156-1.987, P=0.020) were identified as independent prognostic factors for overall survival.
The tumor recurrence pattern after RFA carries significant prognostic value in relation to overall survival. Long-term regular surveillance and aggressive treatment strategy are required for patients with different segment intrahepatic recurrence to optimize the benefits of RFA.
射频消融（RFA）是一种治疗肝细胞癌（HCC）的有效局部消融疗法，长期疗效良好。目前尚无关于HCC患者RFA术后复发模式及其对长期生存结果影响的分析数据。
评估接受RFA治疗的HCC患者的肿瘤复发模式及其对长期生存的影响。
2001年4月至2005年1月，209例患者接受了以内部冷却电极进行的RFA治疗，作为HCC的唯一治疗方式。其中，117例患者（56%）因双侧病变、肝功能差和/或手术切除医疗风险高而无法进行手术切除；而92例患者（44%）接受RFA作为小的可切除HCC的主要治疗方法。消融操作通过经皮（n = 101）、腹腔镜（n = 17）或开放途径（n = 91）进行。分析肿瘤复发模式和长期生存情况。进行多变量分析以确定影响患者总生存的独立预后因素。
死亡率和发病率分别为0.9%和15.7%。192例患者（92.7%）实现了肿瘤完全消融。中位随访期为26个月，28例患者（14.5%）发生局部复发。同一肝段和不同肝段肝内复发分别发生在30例患者（15.6%）和78例患者（40.6%）中。20例患者（10.4%）发生远处肝外转移。1年、3年和5年总生存率分别为87.2%、66.6%和42%。RFA术后不同肝段肝内复发和远处复发对总生存结果具有显著不良预后影响。通过多变量分析，Child-Pugh分级（风险比[RR]=2.918，95%置信区间[CI]1.704 - 4.998，p = 0.000）、肿瘤大小（RR = 1.231，95% CI 1.031 - 1.469，p = 0.021）和复发模式（风险比[RR]=1.464，95% CI 1.156 - 1.987，P = 0.020）被确定为总生存的独立预后因素。
RFA术后的肿瘤复发模式对总生存具有显著的预后价值。对于不同肝段肝内复发患者，需要长期定期监测和积极的治疗策略，以优化RFA的获益。
