Nishiwada Satoshi, Ko Saiho, Mukogawa Tomohide, Ishikawa Hirofumi, Matsusaka Masanori, Nakatani Toshiya, Kikuchi Eiryo, Watanabe Akihiko
Hepatogastroenterology. 2014 Mar-Apr;61(130):436-41.
BACKGROUND/AIMS: Therapeutic efficacy of radiofrequency ablation (RFA) for colorectal liver metastases (CRLM) was compared with hepatic resection (HR), focusing on local disease control rate as well as risk factors of recurrence and patients survival.
From April 2002 to March 2012, 32 patients underwent RFA and 60 patients underwent HR for CRLM. The rate of local recurrence along the ablated or resected margin was evaluated in these patients.
The local recurrence was seen in 8 patients (13.3%) after HR, and 15 (46.9%) after RFA. Multivariate analysis of all patients revealed that RFA as an initial therapy (P < 0.001), venous invasion liver metastases (P = 0.049) were independent risk factors for local recurrence. Subgroup analysis showed that local recurrence rate after RFA was significantly higher than that after HR in patients with tumors 20 mm or larger (P < 0.001), while there was no significant difference in local recurrence rate between RFA and HR in patients with tumors less than 20 mm (P = 0.676).
RFA showed a high risk of local recurrence in comparison to HR especially in patients with tumors larger than 20 mm. Indication of RFA should be restricted drastically considering the limitation of efficacy.
背景/目的：比较射频消融（RFA）与肝切除术（HR）治疗结直肠癌肝转移（CRLM）的疗效，重点关注局部疾病控制率、复发风险因素及患者生存率。
2002年4月至2012年3月，32例患者接受RFA治疗，60例患者接受HR治疗CRLM。评估这些患者消融或切除边缘的局部复发率。
HR术后8例患者（13.3%）出现局部复发，RFA术后15例（46.9%）出现局部复发。对所有患者进行多因素分析显示，RFA作为初始治疗（P < 0.001）、肝转移静脉侵犯（P = 0.049）是局部复发的独立危险因素。亚组分析显示，肿瘤直径20 mm或更大的患者中，RFA术后局部复发率显著高于HR术后（P < 0.001），而肿瘤直径小于20 mm的患者中，RFA与HR术后局部复发率无显著差异（P = 0.676）。
与HR相比，RFA显示出较高的局部复发风险，尤其是在肿瘤大于20 mm的患者中。考虑到疗效的局限性，RFA的适应证应大幅受限。
