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孤立性结直肠癌肝转移患者肝切除与射频消融的临床疗效

Clinical outcomes of hepatic resection and radiofrequency ablation in patients with solitary colorectal liver metastasis.

作者信息

Lee Won-Suk, Yun Seong Hyeon, Chun Ho-Kyung, Lee Woo Yong, Kim Sung-Joo, Choi Seong-Ho, Heo Jin-Seok, Joh Jae Won, Choi Dongil, Kim Seung-Hoon, Rhim Hyunchul, Lim Hyo-Keun

机构信息

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

J Clin Gastroenterol. 2008 Sep;42(8):945-9. doi: 10.1097/MCG.0b013e318064e752.

Abstract

BACKGROUND

The role of the radiofrequency ablation (RFA) in treatment of solitary liver metastasis has not been established yet. Both hepatic resection (HR) and RFA have been used increasingly in the treatment of colorectal liver metastases.

STUDY

A systemic review was performed to determine the impact of treatment modality of solitary liver metastasis on recurrence patterns, disease-free survival, and overall survival (OS) rates.

RESULTS

Solitary liver metastases were treated by HR in 116 patients (75.8%) and 37 patients (24.2%) were treated with RFA. Prognostic factors, recurrence rate, recurrence patterns, and survival rates were analyzed. The cumulative 3-year and 5-year local recurrence free survival rates were markedly higher in the HR group (88.0% and 84.6%) as compared with those in the RFA group [53.3% and 42.6%, respectively (P</=0.001)]. The 5-year OS rate was lower in the RFA group as compared with the HR group without statistical significance (5-year OS, 65.7% in the HR, 48.5% in the RFA group, P=0.227).

CONCLUSIONS

Despite of higher local recurrence rate, RFA may be considered as a therapeutic option for patients who are considered unsuitable for conventional surgical treatment. Randomized prospective controlled trials comparing the therapeutic outcome of RFA and HR are definitely warranted.

摘要

背景

射频消融术(RFA)在治疗孤立性肝转移瘤中的作用尚未明确。肝切除术(HR)和RFA在结直肠癌肝转移的治疗中应用越来越广泛。

研究

进行了一项系统评价,以确定孤立性肝转移瘤的治疗方式对复发模式、无病生存期和总生存率(OS)的影响。

结果

116例患者(75.8%)采用HR治疗孤立性肝转移瘤,37例患者(24.2%)采用RFA治疗。分析了预后因素、复发率、复发模式和生存率。HR组的3年和5年累积局部无复发生存率显著高于RFA组[分别为88.0%和84.6%,而RFA组分别为53.3%和42.6%(P≤0.001)]。RFA组的5年OS率低于HR组,但无统计学意义(5年OS,HR组为65.7%,RFA组为48.5%,P = 0.227)。

结论

尽管局部复发率较高,但对于不适合传统手术治疗的患者,RFA可被视为一种治疗选择。比较RFA和HR治疗效果的随机前瞻性对照试验绝对有必要进行。

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