射频消融治疗直径 > 3cm 且 ≤ 5cm 的肝细胞癌：消融边界大于 1cm 是否合理？
Radiofrequency ablation of hepatocellular carcinoma sized > 3 and ≤ 5 cm: is ablative margin of more than 1 cm justified?
机构信息
Shan Ke, Xue-Mei Ding, Wen-Bing Sun, Department of Hepatobiliary Surgery, Chao-yang Hospital Affiliated to Capital Medical University, Beijing 100043, China.
出版信息
World J Gastroenterol. 2013 Nov 14;19(42):7389-98. doi: 10.3748/wjg.v19.i42.7389.
AIM
To investigate whether an ablative margin (AM) > 1.0 cm might reduce chance of recurrence for patients with hepatocellular carcinoma (HCC) tumors 3.1 to 5.0 cm in size, compared with an AM of 0.5-1.0 cm.
METHODS
From October 2005 to December 2012, 936 consecutive patients with HCC who received radiofrequency ablation were screened. Of these, 281 patients, each with a single primary HCC tumor of 3.1 to 5.0 cm in size on its greatest diameter, were included in the study. Based on the AM width, we categorized patients into the 0.5-1.0 cm group and the > 1.0 cm group. Local tumor progression (LTP)-free survival, intrahepatic distant recurrence (IDR)-free survival and overall survival (OS) rates were obtained using the Kaplan-Meier method.
RESULTS
The 1-, 2-, 3-, 4-, and 5-year LTP-free survival rates and IDR-free survival rates were significantly higher in the > 1.0 cm group compared with the 0.5-1.0 cm group (97.5%, 86.3%, 73.6%, 49.5% and 26.4% vs 91.3%, 78.4%, 49.5%, 27.8%, and 12.8%; 95.1%, 90.3%, 77.0%, 61.0% and 48.3% vs 95.2%, 85.9%, 62.6%, 47.2% and 28.5%; P < 0.05). The 1-, 2-, 3-, 4-, and 5-year OS rates were 98.6%, 91.5%, 69.2%, 56.0% and 42.2%, respectively, in the 0.5-1.0 cm group and 100%, 98.9%, 90.1%, 68.7% and 57.4%, respectively, in the > 1.0 cm group (P = 0.010). There were no significant differences in complication rates between the two groups. Both univariate and multivariate analyses identified AM as an independent prognostic factor linked to LTP, IDR, and OS.
CONCLUSION
For HCC tumors > 3.0 cm and ≤ 5.0 cm, AM > 1.0 cm could reduce chances of recurrence compared with AM of 0.5-1.0 cm, emphasizing the need for a more defensive strategy using AMs > 1.0 cm for ablating HCC tumors of 3.1 to 5.0 cm.
目的
研究对于最大径为 3.1 至 5.0cm 的 HCC 肿瘤，与 0.5-1.0cm 的消融边缘（AM）相比，AM＞1.0cm 是否会降低复发的机会。
方法
从 2005 年 10 月至 2012 年 12 月，对 936 例接受射频消融治疗的 HCC 连续患者进行了筛查。其中，281 例患者，每个患者的单个原发性 HCC 肿瘤的最大直径为 3.1 至 5.0cm，纳入本研究。根据 AM 宽度，我们将患者分为 0.5-1.0cm 组和＞1.0cm 组。采用 Kaplan-Meier 法获得局部肿瘤进展（LTP）无进展生存率、肝内远处复发（IDR）无进展生存率和总生存率（OS）。
结果
与 0.5-1.0cm 组相比，＞1.0cm 组的 1、2、3、4 和 5 年 LTP 无进展生存率和 IDR 无进展生存率显著更高（97.5%、86.3%、73.6%、49.5%和 26.4%比 91.3%、78.4%、49.5%、27.8%和 12.8%；95.1%、90.3%、77.0%、61.0%和 48.3%比 95.2%、85.9%、62.6%、47.2%和 28.5%；P＜0.05）。0.5-1.0cm 组的 1、2、3、4 和 5 年 OS 率分别为 98.6%、91.5%、69.2%、56.0%和 42.2%，而＞1.0cm 组的 1、2、3、4 和 5 年 OS 率分别为 100%、98.9%、90.1%、68.7%和 57.4%（P=0.010）。两组间并发症发生率无显著差异。单因素和多因素分析均将 AM 确定为与 LTP、IDR 和 OS 相关的独立预后因素。
结论
对于最大径为 3.0cm 且≤5.0cm 的 HCC 肿瘤，与 AM 为 0.5-1.0cm 相比，AM＞1.0cm 可降低复发的机会，这强调了对于 3.1 至 5.0cm 的 HCC 肿瘤，使用 AM＞1.0cm 进行消融治疗时，需要采用更具防御性的策略。
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