*Department of Surgery, Medical College of Wisconsin; Milwaukee, WI †Department of General Surgery, Carolinas Medical Center; Charlotte, NC ‡Division of Surgical Oncology, Ohio State University Wexner Medical Center; Columbus, OH §Department of Radiology, Ohio State University Wexner Medical Center; Columbus, OH ¶Department of Surgery, University of Louisville; Louisville, KY ∥Department of Radiology, Medical College of Wisconsin; Milwaukee, WI.
Ann Surg. 2014 Jun;259(6):1195-200. doi: 10.1097/SLA.0000000000000234.
This study hypothesized that tumor size, number of tumors, surgical approach, and tumor histology significantly affected microwave ablation (MWA) success and recurrence-free survival.
Although many hepatobiliary centers have adopted MWA, the factors that influence local control are not well described.
Consecutive patients with hepatic malignancy treated by MWA were included from 4 high-volume institutions (2003-2011) and grouped by histology: hepatocellular carcinoma (HCC), colorectal liver metastases, neuroendocrine liver metastases, and other cancers. Independent significance of outcome variables was established with logistic regression and Cox proportional hazards models.
Four hundred fifty patients were treated with 473 procedures (139 HCC, 198 colorectal liver metastases, 61 neuroendocrine liver metastases, and 75 other) for a total of 875 tumors. Median follow-up was 18 months. Concurrent hepatectomy was performed in 178 patients (38%), and when performed was associated with greater morbidity. Complete ablation was confirmed for 839 of 865 tumors (97.0%) on follow-up cross-sectional imaging (10 were unevaluable). A surgical approach (open, laparoscopic, or percutaneous) had no significant impact on complication rates, recurrence, or survival. The local recurrence rate was 6.0% overall and was highest for HCC (10.1%, P = 0.045) and percutaneously treated lesions (14.1%, P = 0.014). In adjusted models, tumor size 3 cm or more predicted poorer recurrence-free survival (hazard ratio: 1.60, 95% CI: 1.02-2.50, P = 0.039).
In this large data set, patients with 3 cm or more tumors showed a propensity for early recurrence, regardless of histology. Higher rates of local recurrence were noted in HCC patients, which may reflect underlying liver disease. There were no significant differences in morbidity or survival based on the surgical approach; however, local recurrence rates were highest for percutaneously ablated tumors.
本研究假设肿瘤大小、肿瘤数量、手术方式和肿瘤组织学显著影响微波消融（MWA）的成功率和无复发生存率。
尽管许多肝胆中心已采用 MWA，但影响局部控制的因素尚未得到很好的描述。
从 4 个高容量机构（2003-2011 年）中连续纳入接受 MWA 治疗的肝恶性肿瘤患者，并按组织学分组：肝细胞癌（HCC）、结直肠癌肝转移、神经内分泌肝转移和其他癌症。使用逻辑回归和 Cox 比例风险模型确定结果变量的独立意义。
450 例患者接受了 473 次治疗（139 例 HCC、198 例结直肠癌肝转移、61 例神经内分泌肝转移和 75 例其他），共 875 个肿瘤。中位随访时间为 18 个月。178 例患者（38%）同时行肝切除术，当行肝切除术时，并发症发生率更高。在随访的横断面影像学上，865 个肿瘤中有 839 个（97.0%）确认完全消融（10 个无法评估）。手术方式（开腹、腹腔镜或经皮）对并发症发生率、复发或生存无显著影响。总的局部复发率为 6.0%，HCC（10.1%，P=0.045）和经皮治疗的病变（14.1%，P=0.014）的局部复发率最高。在调整模型中，肿瘤大小为 3cm 或更大预测复发无进展生存较差（风险比：1.60，95%CI：1.02-2.50，P=0.039）。
在这个大数据集中，无论组织学如何，肿瘤大小为 3cm 或更大的患者复发倾向更高。HCC 患者局部复发率较高，这可能反映了潜在的肝脏疾病。手术方式对发病率或生存率无显著差异；然而，经皮消融的肿瘤局部复发率最高。
