Feng Kai, Ma Kuan-Sheng
Kai Feng, Kuan-Sheng Ma, Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
World J Gastroenterol. 2014 May 28;20(20):5987-98. doi: 10.3748/wjg.v20.i20.5987.
Hepatocellular carcinoma (HCC) is a malignant disease that substantially affects public health worldwide. It is especially prevalent in east Asia and sub-Saharan Africa, where the main etiology is the endemic status of chronic hepatitis B. Effective treatments with curative intent for early HCC include liver transplantation, liver resection (LR), and radiofrequency ablation (RFA). RFA has become the most widely used local thermal ablation method in recent years because of its technical ease, safety, satisfactory local tumor control, and minimally invasive nature. This technique has also emerged as an important treatment strategy for HCC in recent years. RFA, liver transplantation, and hepatectomy can be complementary to one another in the treatment of HCC, and the outcome benefits have been demonstrated by numerous clinical studies. As a pretransplantation bridge therapy, RFA extends the average waiting time without increasing the risk of dropout or death. In contrast to LR, RFA causes almost no intra-abdominal adhesion, thus producing favorable conditions for subsequent liver transplantation. Many studies have demonstrated mutual interactions between RFA and hepatectomy, effectively expanding the operative indications for patients with HCC and enhancing the efficacy of these approaches. However, treated tumor tissue remains within the body after RFA, and residual tumors or satellite nodules can limit the effectiveness of this treatment. Therefore, future research should focus on this issue.
肝细胞癌(HCC)是一种严重影响全球公众健康的恶性疾病。它在东亚和撒哈拉以南非洲尤为普遍,其主要病因是慢性乙型肝炎的地方流行状况。早期HCC的有效根治性治疗方法包括肝移植、肝切除术(LR)和射频消融(RFA)。近年来,由于技术操作简便、安全性高、局部肿瘤控制效果良好且具有微创性,RFA已成为应用最广泛的局部热消融方法。近年来,该技术也已成为HCC的重要治疗策略。在HCC治疗中,RFA、肝移植和肝切除术可以相互补充,众多临床研究已证明其疗效益处。作为移植前的桥接治疗,RFA可延长平均等待时间,而不会增加退出或死亡风险。与LR不同,RFA几乎不会引起腹腔内粘连,从而为后续肝移植创造有利条件。许多研究已证明RFA与肝切除术之间存在相互作用,有效扩大了HCC患者的手术适应症并提高了这些治疗方法的疗效。然而,RFA治疗后肿瘤组织仍留在体内,残留肿瘤或卫星结节可能会限制该治疗的效果。因此,未来的研究应关注这一问题。