Lin Ji-Wei, Lin Chen-Chun, Chen Wei-Ting, Lin Shi-Ming
Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taipei, Taiwan.
Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taipei, Taiwan.
Kaohsiung J Med Sci. 2014 Aug;30(8):396-401. doi: 10.1016/j.kjms.2014.04.006. Epub 2014 Jun 2.
Radiofrequency ablation (RFA) is more effective for hepatocellular carcinoma (HCC) < 3 cm. Combining percutaneous ethanol injection and RFA for HCC can increase ablation; however, the long-term outcome remains unknown. The aim of this study was to compare long-term outcomes between patients with HCC of 2-3 cm versus 3.1-4 cm and in high-risk versus non-high-risk locations after combination therapy. The primary endpoint was overall survival and the secondary endpoint was local tumor progression (LTP). Fifty-four consecutive patients with 72 tumors were enrolled. Twenty-two (30.6%) tumors and 60 (83.3%) tumors were of 3.1-4 cm and in high-risk locations, respectively. Primary technique effectiveness was comparable between HCC of 2-3 cm versus 3.1-4 cm (98% vs. 95.5%, p = 0.521), and HCC in non-high risk and high-risk locations (100% vs. 96.7%, p = 1.000). The cumulative survival rates at 1 year, 3 years, and 5 years were 90.3%, 78.9%, and 60.3%, respectively, in patients with HCC of 2-3 cm; 95.0%, 84.4%, and 69.3% in HCC of 3.1-4.0 cm (p = 0.397); 90.0%, 71.1%, and 71.1% in patients with HCC in non-high-risk locations; and 92.7%, 81.6%, and 65.4% in high-risk locations (p = 0.979). The cumulative LTP rates at 1 year, 3 years, and 5 years were 10.2%, 32.6%, and 32.6%, respectively, in all HCCs; 12.6%, 33.9%, and 33.9% in HCC of 2-3 cm; 4.8%, 29.5%, and 29.5% in HCC of 3.1-4 cm (p = 0.616); 16.7%, 50.0%, and 50.0% in patients with HCC in non-high-risk locations; and 8.8%, 29.9%, and 29.9% in patients with HCC in high-risk locations (p = 0.283). The cumulative survival and LTP rates were not significantly different among the various subgroups. Combining RFA and percutaneous ethanol injection achieved comparable long-term outcomes in HCCs of 2-3 cm versus 3.1-4.0 cm and in high-risk versus non-high-risk locations. A randomized controlled or cohort studies with larger sample size are warranted.
射频消融（RFA）对直径小于3 cm的肝细胞癌（HCC）更有效。经皮乙醇注射与RFA联合治疗HCC可增加消融范围；然而，长期疗效尚不清楚。本研究的目的是比较联合治疗后2 - 3 cm与3.1 - 4 cm HCC患者以及高风险与非高风险部位患者的长期疗效。主要终点是总生存期，次要终点是局部肿瘤进展（LTP）。连续纳入54例患者的72个肿瘤。分别有22个（30.6%）肿瘤和60个（83.3%）肿瘤直径为3.1 - 4 cm且位于高风险部位。2 - 3 cm HCC与3.1 - 4 cm HCC的主要技术有效性相当（98%对95.5%，p = 0.521），非高风险部位与高风险部位的HCC相当（100%对96.7%，p = 1.000）。2 - 3 cm HCC患者1年、3年和5年的累积生存率分别为90.3%、78.9%和60.3%；3.1 - 4.0 cm HCC患者分别为95.0%、84.4%和69.3%（p = 0.397）；非高风险部位HCC患者分别为90.0%、71.1%和71.1%；高风险部位患者分别为92.7%、81.6%和65.4%（p = 0.979）。所有HCC患者1年、3年和5年的累积LTP率分别为10.2%、32.6%和32.6%；2 - 3 cm HCC患者分别为12.6%、33.9%和33.9%；3.1 - 4 cm HCC患者分别为4.8%、29.5%和29.5%（p = 0.616）；非高风险部位HCC患者分别为16.7%、50.0%和50.0%；高风险部位HCC患者分别为8.8%、29.9%和29.9%（p = 0.283）。各亚组间的累积生存率和LTP率无显著差异。RFA与经皮乙醇注射联合治疗在2 - 3 cm与3.1 - 4.0 cm HCC以及高风险与非高风险部位的长期疗效相当。有必要开展更大样本量的随机对照或队列研究。
