Zanus G, Boetto R, Gringeri E, Vitale A, D'Amico F, Carraro A, Bassi D, Bonsignore P, Noaro G, Mescoli C, Rugge M, Angeli P, Senzolo M, Burra P, Feltracco P, Cillo U
General Surgery and Organ Transplantation, Hepatobiliary Surgery and Liver Transplant Unit, Azienda Università di Padova, Padova, Italy.
Transplant Proc. 2011 May;43(4):1091-4. doi: 10.1016/j.transproceed.2011.02.044.
Surgical resection for malignant hepatic tumors, especially hepatocarcinoma (HCC), has been demonstrated to increase overall survival; however, the majority of patients are not suitable for resection. Radiofrequency ablation (RFA) is the most widely used modality for radical treatment of small HCC (<3 cm). It improves 5-year survival compared with standard chemotherapy and chemical ablation, allowing down-staging of unresectable hepatic masses. Microwave ablation (MWA) has been extensively applied in Asia and was recently introduced in the United States of America and Europe with excellent results, especially with regard to large unresectable HCC. Our single-center experience between May 2009 and October 2010 included application of MWA to 154 patients of median age ± standard deviation of 63.5 ± 8.5 years, 6 males, and 1 female, of mean Model for End-Stage Liver Disease (MELD) score (10.1 ± 3.8). The HCC included, hepatitis C virus (HCV)-related (n=70; 45.5%); alcool (ETOH)-related (n=42; 27%), hepatitis B virus (HBV)-related (n=16; 10.5%); and cryptogenic cases (n=26; 17%). The cases were performed for radical treatment down-staging for multifocal pathology or bridging liver transplantation to orthotopic (OLT) in selected patients with single nodules. A computed tomography (CT) scan was performed at 1 month after the surgical procedure to evalue responses to treatment. Among 6 selected patients who underwent OLT; 5 (83.3%) showed disease-free survival at one-year follow-up. The radical treatment achieved no intraoperative evidence of tumor spread or of pathological signs of active HCC among the explanted liver specimens. In conclusion, a MWA seemed to be a safe novel approach to treat HCC and could serve as a "bridge" to OLT and down-staging for patients with HCC.
手术切除恶性肝肿瘤，尤其是肝癌（HCC），已被证明可提高总生存率；然而，大多数患者不适合进行手术切除。射频消融（RFA）是治疗小肝癌（<3 cm）最广泛使用的根治性治疗方式。与标准化疗和化学消融相比，它可提高5年生存率，使不可切除的肝肿块降期。微波消融（MWA）已在亚洲广泛应用，最近在美利坚合众国和欧洲也开始应用，效果良好，尤其是对于不可切除的大肝癌。我们在2009年5月至2010年10月的单中心经验包括对154例患者应用MWA，患者年龄中位数±标准差为63.5±8.5岁，男性6例，女性1例，终末期肝病模型（MELD）平均评分为（10.1±3.8）。肝癌包括丙型肝炎病毒（HCV）相关（n = 70；45.5%）；酒精（ETOH）相关（n = 42；27%），乙型肝炎病毒（HBV）相关（n = 16；10.5%）；以及隐源性病例（n = 26；17%）。这些病例用于对多灶性病变进行根治性降期治疗，或在选定的单结节患者中作为肝移植到原位肝移植（OLT）的桥梁。术后1个月进行计算机断层扫描（CT）以评估治疗反应。在6例接受OLT的选定患者中，5例（83.3%）在1年随访时无病生存。根治性治疗在切除的肝脏标本中未发现肿瘤扩散的术中证据或活动性肝癌的病理迹象。总之，MWA似乎是一种治疗肝癌的安全新方法，可作为肝癌患者OLT和降期的“桥梁”。
