Department of Gastroenterology, Interventional Ultrasound, S. Maria della Pietà Camilliani Hospital, Via S. Rocco 9, Casoria, NA 80026, Italy.
AJR Am J Roentgenol. 2012 Dec;199(6):1393-401. doi: 10.2214/AJR.11.7850.
A high-risk location--defined as the tumor margin being less than 5 mm from large vessels or vital structures--represents a well-known limitation and contraindication for radiofrequency ablation of hepatocellular carcinoma (HCC) nodules. The aim of this study was to verify whether HCC nodule location negatively affected the outcome of percutaneous laser ablation in terms of its primary effectiveness, safety, and ability to prevent local tumor progression.
The medical records and radiologic examinations of 164 cirrhotic patients (90 men, 74 women; mean age ± SD, 68.6 ± 8.3 years) with 182 HCC nodules 4 cm or smaller (mean diameter ± SD, 2.7 ± 0.78 cm) that had been treated by laser ablation between 1996 and 2008 were retrospectively analyzed. One hundred six patients had 116 nodules in high-risk sites (high-risk group), whereas 58 patients had 66 tumors located elsewhere (standard-risk group).
The overall median follow-up was 81 months (range, 6-144 months). The initial complete ablation rate per nodule did not significantly differ between the high-risk group and the standard-risk group (92.2% vs 95.5%, respectively; p = 0.2711). Rates of major complications (high-risk group vs standard-risk group, 1.9% [including one death] vs 0%) and minor complications (5.6% vs 1.0%) were not statistically different between the two groups. Only side effects were recorded significantly more often in high-risk patients than in standard-risk patients (31.5% vs 19.8%; p = 0.049). There was no significant difference in either cumulative incidence of local tumor progression (p = 0.499) or local tumor progression-free survival (p = 0.499, log rank test) between the high-risk group and the standard-risk group.
When laser ablation is used to treat small HCC nodules, tumor location does not have a significant negative impact on the technique's primary effectiveness or safety or on its ability to achieve local control of disease.
高危部位——定义为肿瘤边缘距大血管或重要结构小于 5 毫米——是射频消融治疗肝细胞癌（HCC）结节的一个众所周知的限制和禁忌。本研究旨在验证 HCC 结节位置是否会对经皮激光消融的主要疗效、安全性和预防局部肿瘤进展的能力产生负面影响。
回顾性分析了 1996 年至 2008 年间采用激光消融治疗的 164 例肝硬化患者（90 例男性，74 例女性；平均年龄±标准差，68.6±8.3 岁）的病历和影像学检查资料，这些患者共有 182 个 4cm 或更小的 HCC 结节（平均直径±标准差，2.7±0.78cm）。106 例患者的 116 个结节位于高危部位（高危组），58 例患者的 66 个肿瘤位于其他部位（标准风险组）。
所有患者的中位随访时间为 81 个月（范围为 6-144 个月）。每个结节的初始完全消融率在高危组和标准风险组之间无显著差异（分别为 92.2%和 95.5%；p=0.2711）。两组主要并发症（高危组 vs 标准风险组，1.9%[包括 1 例死亡] vs 0%；p=0.2711）和次要并发症（5.6% vs 1.0%）发生率无统计学差异。仅副作用在高危患者中比在标准风险患者中记录得更频繁（31.5% vs 19.8%；p=0.049）。高危组和标准风险组局部肿瘤进展的累积发生率（p=0.499）或局部肿瘤无进展生存率（p=0.499，对数秩检验）均无显著差异。
当使用激光消融治疗小 HCC 结节时，肿瘤位置不会对该技术的主要疗效、安全性或局部疾病控制能力产生显著的负面影响。
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