Division of Endocrine Surgery, and Liver Tumor Ablation Program, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA.
Surgery. 2010 Dec;148(6):1288-93; discussion 1293. doi: 10.1016/j.surg.2010.09.014.
Since our first report 13 years ago, laparoscopic radiofrequency ablation has been incorporated into the treatment algorithm of patients with neuroendocrine liver metastases. The aim of this study is to report long-term oncologic results.
Eighty-nine patients with neuroendocrine hepatic metastases underwent 119 laparoscopic radiofrequency ablation sessions within 13 years. Data were obtained from a prospective, Institutional Review Board approved database. Univariate Kaplan Meier and multivariate Cox proportional hazards model were used for statistical analyses. Data are expressed as mean ± standard error of the mean.
Thirty-five women and 54 men with a mean age of 56 ± 1.4 years were included in this study. Tumor types included were carcinoid (n = 55), pancreatic islet cell (n = 23), and medullary thyroid cancer (n = 11). Mean tumor size was 3.6 ± 0.2 and the number of lesions was 6 ± 1. Perioperative morbidity was 6%, and 30-day mortality was 1%. Symptom relief was achieved in 97% of patients after radiofrequency ablation. Median follow-up was 30 ± 3 months. Twenty-two percent of patients developed local liver recurrence, 63% developed new liver lesions, and 59% developed extrahepatic disease in follow-up. Repeat radiofrequency ablation (27%) and chemoembolization (7%) were used to achieve additional local tumor control in follow up. Median disease-free survival was 1.3 years and the overall survival was 6 years after radiofrequency ablation. Liver tumor volume, symptoms, and extrahepatic disease were independent predictors of survival.
To our knowledge, this is the largest prospective experience with radiofrequency ablation of neuroendocrine liver metastases. Effective symptom palliation and long-term local tumor control are possible in these patients with minimal morbidity.
自 13 年前我们首次报告以来，腹腔镜射频消融术已被纳入神经内分泌肝转移患者的治疗方案。本研究旨在报告长期肿瘤学结果。
89 例神经内分泌肝转移患者在 13 年内接受了 119 次腹腔镜射频消融术。数据来自一个前瞻性的机构审查委员会批准的数据库。采用单变量 Kaplan-Meier 和多变量 Cox 比例风险模型进行统计分析。数据表示为平均值±平均值的标准误差。
本研究纳入了 35 名女性和 54 名男性，平均年龄为 56±1.4 岁。肿瘤类型包括类癌（n=55）、胰岛细胞瘤（n=23）和髓样甲状腺癌（n=11）。平均肿瘤大小为 3.6±0.2cm，病变数为 6±1 个。围手术期发病率为 6%，30 天死亡率为 1%。射频消融后，97%的患者症状缓解。中位随访时间为 30±3 个月。22%的患者在随访中出现局部肝复发，63%的患者出现新的肝病灶，59%的患者出现肝外疾病。在随访中，重复射频消融（27%）和化疗栓塞（7%）用于实现额外的局部肿瘤控制。射频消融后无疾病生存时间中位数为 1.3 年，总生存时间为 6 年。肝肿瘤体积、症状和肝外疾病是生存的独立预测因素。
据我们所知，这是最大的前瞻性射频消融治疗神经内分泌肝转移瘤的经验。这些患者的症状缓解有效，且长期局部肿瘤控制效果良好，且发病率低。
