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肝恶性肿瘤的微波消融:呼吁标准化报告与结果

Microwave ablation for hepatic malignancies: a call for standard reporting and outcomes.

作者信息

North Durham A, Groeschl Ryan T, Sindram David, Martinie John B, Iannitti David A, Bloomston Mark, Schmidt Carl, Rilling William S, Gamblin Thomas Clark, Martin Robert C G

机构信息

Department of Surgery, University of Louisville, Louisville, KY, USA.

Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.

出版信息

Am J Surg. 2014 Aug;208(2):284-94. doi: 10.1016/j.amjsurg.2014.02.002. Epub 2014 Apr 12.

Abstract

BACKGROUND

Clinical standards of reporting microwave ablation outcomes have not been defined with regard to ablation success, 90-day morbidity, local recurrence after ablation, and nonablation hepatic recurrence. We propose recommendations for microwave ablation reporting and quality standards.

METHODS

Literature review of clinical studies focusing on microwave ablation of primary and metastatic hepatic tumors was reported.

RESULTS

Ablation success remains the highest quality reporting standard with variations in nomenclature, but with a universal agreement of complete destruction of the target lesion within 1 month after initial microwave ablation. Local recurrence after ablation remains highly variable, with reports as low as 2.2% to as high as 22%; standards lack a common, clearly defined distance from the initial target ablated lesion and the requirement that the target lesion be defined as an ablation success before it can be called a recurrence. Nonablation hepatic recurrence, nonhepatic recurrence, and 90-day morbidity and mortality remain limited in the current literature.

CONCLUSIONS

Standardization of hepatic microwave ablation reporting standards are proposed. Current reporting standards in microwave ablation of hepatic malignancies are suboptimal and lack standardization for comparison across institutions.

摘要

背景

关于微波消融治疗的成功、90天发病率、消融后局部复发以及非消融性肝内复发,尚未确定临床报告标准。我们提出微波消融报告及质量标准的建议。

方法

报告了聚焦于原发性和转移性肝肿瘤微波消融的临床研究的文献综述。

结果

消融成功仍然是最高质量的报告标准,命名存在差异,但普遍认同在初次微波消融后1个月内目标病灶完全被破坏。消融后局部复发率差异仍然很大,报告低至2.2%,高至22%;标准缺乏一个统一、明确界定的与初始消融目标病灶的距离,以及在将目标病灶称为复发之前需将其定义为消融成功的要求。目前文献中关于非消融性肝内复发、非肝内复发以及90天发病率和死亡率的报道仍然有限。

结论

提出了肝微波消融报告标准的规范化。目前肝恶性肿瘤微波消融的报告标准并不理想,缺乏跨机构比较的标准化。

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