Kikuchi Luciana, Menezes Marcos, Chagas Aline L, Tani Claudia M, Alencar Regiane Ssm, Diniz Marcio A, Alves Venâncio Af, D'Albuquerque Luiz Augusto Carneiro, Carrilho Flair José
Luciana Kikuchi, Aline L Chagas, Claudia M Tani, Regiane SSM Alencar, Marcio A Diniz, Luiz Augusto Carneiro D'Albuquerque, Flair J Carrilho, São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 01246000, Brazil.
World J Gastroenterol. 2014 Feb 14;20(6):1585-93. doi: 10.3748/wjg.v20.i6.1585.
To evaluate outcomes of radiofrequency ablation (RFA) therapy for early hepatocellular carcinoma (HCC) and identify survival- and recurrence-related factors.
Consecutive patients diagnosed with early HCC by computed tomography (CT) or magnetic resonance imaging (MRI) (single nodule of ≤ 5 cm, or multi- (up to 3) nodules of ≤ 3 cm each) and who underwent RFA treatment with curative intent between January 2010 and August 2011 at the Instituto do Câncer do Estado de São Paulo, Brazil were enrolled in the study. RFA of the liver tumors (with 1.0 cm ablative margin) was carried out under CT-fluoro scan and ultrasonic image guidance of the percutaneous ablation probes. Procedure-related complications were recorded. At 1-mo post-RFA and 3-mo intervals thereafter, CT and MRI were performed to assess outcomes of complete response (absence of enhancing tissue at the tumor site) or incomplete response (enhancing tissue remaining at the tumor site). Overall survival and disease-free survival rates were estimated by the Kaplan-Meier method and compared by the log rank test or simple Cox regression. The effect of risk factors on survival was assessed by the Cox proportional hazard model.
A total of 38 RFA sessions were performed during the study period on 34 patients (age in years: mean, 63 and range, 49-84). The mean follow-up time was 22 mo (range, 1-33). The study population showed predominance of male sex (76%), less severe liver disease (Child-Pugh A, n = 26; Child-Pugh B, n = 8), and single tumor (65%). The maximum tumor diameters ranged from 10 to 50 mm (median, 26 mm). The initial (immediately post-procedure) rate of RFA-induced complete tumor necrosis was 90%. The probability of achieving complete response was significantly greater in patients with a single nodule (vs patients with multi-nodules, P = 0.04). Two patients experienced major complications, including acute pulmonary edema (resolved with intervention) and intestinal perforation (led to death). The 1- and 2-year overall survival rates were 82% and 71%, respectively. Sex, tumor size, initial response, and recurrence status influenced survival, but did not reach the threshold of statistical significance. Child-Pugh class and the model for end-stage liver disease score were identified as predictors of survival by simple Cox regression, but only Child-Pugh class showed a statistically significant association to survival in multiple Cox regression analysis (HR = 15; 95%CI: 3-76 mo; P = 0.001). The 1- and 2-year cumulative disease-free survival rates were 65% and 36%, respectively.
RFA is an effective therapy for local tumor control of early HCC, and patients with preserved liver function are the best candidates.
评估射频消融（RFA）治疗早期肝细胞癌（HCC）的疗效，并确定与生存和复发相关的因素。
连续纳入2010年1月至2011年8月在巴西圣保罗州癌症研究所被计算机断层扫描（CT）或磁共振成像（MRI）诊断为早期HCC（单个结节≤5 cm，或多个（最多3个）结节，每个结节≤3 cm）且接受了根治性RFA治疗的患者。在CT荧光扫描和经皮消融探头的超声图像引导下对肝肿瘤进行RFA（消融边缘为1.0 cm）。记录与手术相关的并发症。在RFA后1个月及此后每3个月进行CT和MRI检查，以评估完全缓解（肿瘤部位无强化组织）或不完全缓解（肿瘤部位仍有强化组织）的情况。采用Kaplan-Meier法估计总生存率和无病生存率，并通过对数秩检验或简单Cox回归进行比较。通过Cox比例风险模型评估危险因素对生存的影响。
在研究期间，对34例患者（年龄：平均63岁，范围49 - 84岁）共进行了38次RFA治疗。平均随访时间为22个月（范围1 - 33个月）。研究人群中男性占优势（76%），肝病较轻（Child-Pugh A级，n = 26；Child-Pugh B级，n = 8），且为单个肿瘤（65%）。肿瘤最大直径范围为10至50 mm（中位数26 mm）。RFA诱导的初始（术后即刻）肿瘤完全坏死率为90%。单个结节患者实现完全缓解的概率显著高于多结节患者（P = 0.04）。2例患者出现严重并发症，包括急性肺水肿（经干预后缓解）和肠穿孔（导致死亡）。1年和2年总生存率分别为82%和71%。性别、肿瘤大小、初始反应和复发状态影响生存，但未达到统计学意义阈值。通过简单Cox回归确定Child-Pugh分级和终末期肝病模型评分是生存的预测因素，但在多因素Cox回归分析中只有Child-Pugh分级显示与生存有统计学显著关联（HR = 15；95%CI：3 - 76个月；P = 0.001）。1年和2年累积无病生存率分别为65%和36%。
RFA是早期HCC局部肿瘤控制的有效治疗方法，肝功能良好的患者是最佳候选者。
