Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Okayama City, Okayama 700-8558, Japan.
J Vasc Interv Radiol. 2011 Jun;22(6):741-8. doi: 10.1016/j.jvir.2011.02.030. Epub 2011 Apr 30.
To retrospectively evaluate technical success, effectiveness, complications, patient survival, and prognostic factors with percutaneous radiofrequency (RF) ablation for pulmonary metastases resulting from hepatocellular carcinoma (HCC).
Thirty-two patients from six institutions were included, with a total of 83 pulmonary metastases treated in 65 sessions. RF ablation was always performed percutaneously with computed tomography (CT) guidance. Primary endpoints were technical success and technique effectiveness. Technique effectiveness was evaluated based on sequential follow-up CT images. Secondary study endpoints were complications, patient survival, and determination of prognostic factors. Complications were classified as major or minor. Prognostic factors were determined by analyzing multiple variables with the log-rank test.
Technical success rate was 100%. Primary technique effectiveness rates were 92% each at 1, 2, and 3 years. Major and minor complications occurred after 16 (25%) and 23 (35%) of the 65 sessions, respectively. The median follow-up period was 20.5 months. Overall survival rates were 87% at 1 year and 57% each at 2 and 3 years (median and mean survival times, 37.7 mo and 43.2 mo, respectively). Significantly better survival rates were obtained in cases of (i) no viable intrahepatic recurrence (P < .001), (ii) Child-Pugh class A disease (P < .001), (iii) absence of liver cirrhosis (P < .001), (iv) absence of hepatitis C virus infection (P = .006), and (v) α-fetoprotein level of 10 ng/mL or lower (P = .007) at the time of RF ablation.
RF ablation appears effective, with an acceptable safety profile, in selected patients with pulmonary metastases resulting from HCC.
回顾性评估经皮射频（RF）消融治疗肝细胞癌（HCC）肺转移的技术成功率、疗效、并发症、患者生存率和预后因素。
本研究纳入了来自 6 家机构的 32 名患者，共对 83 个肺部转移灶进行了 65 次 RF 消融治疗。RF 消融始终在 CT 引导下经皮进行。主要终点是技术成功率和技术有效性。技术有效性基于连续的随访 CT 图像进行评估。次要研究终点是并发症、患者生存率和确定预后因素。并发症分为主要和次要并发症。采用对数秩检验分析多个变量来确定预后因素。
技术成功率为 100%。1、2、3 年的主要技术有效率分别为 92%。65 次治疗中有 16 次（25%）和 23 次（35%）分别发生了主要和次要并发症。中位随访时间为 20.5 个月。1 年、2 年和 3 年的总生存率分别为 87%、57%和 57%（中位和平均生存时间分别为 37.7 个月和 43.2 个月）。在以下情况下，患者的生存率显著提高：（i）无肝内存活肿瘤复发（P <.001），（ii）Child-Pugh 分级为 A 级（P <.001），（iii）无肝硬化（P <.001），（iv）无丙型肝炎病毒感染（P =.006），和（v）RF 消融时 AFP 水平为 10ng/ml 或更低（P =.007）。
在选择的 HCC 肺转移患者中，RF 消融具有良好的疗效和可接受的安全性。
