Choe Won Hyeok, Kim Young Jun, Park Hee Sun, Park Sang Woo, Kim Jeong Han, Kwon So Young
Won Hyeok Choe, Jeong Han Kim, So Young Kwon, Department of Internal Medicine, Konkuk University School of Medicine, Seoul 143-729, South Korea.
World J Gastroenterol. 2014 Sep 21;20(35):12588-94. doi: 10.3748/wjg.v20.i35.12588.
To investigate hepatic function after combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) with a short-term interval (0-2 d).
A total of 115 patients with compensated liver cirrhosis underwent RFA combined with TACE at a time-interval of 0-2 d for the treatment of hepatocellular carcinoma (HCC) < 5.0 cm. There were 21 patients who received further hepatic directed treatment altering liver function within 12 mo after the combined therapy for HCC-recurrence, and were excluded. The remaining 94 patients who survived without HCC-recurrence were included in this retrospective study.
At 1 mo after treatment, Child-Pugh scores (CPs) remained unchanged in 89 of 94 patients (94.7%), and transiently increased by one-point in 5 patients (5.3%). However, the score returned to baseline score at 3 mo and was maintained until 6 mo in all patients. The baseline CPs of 8 or more was identified as a factor for transient rise of CPs after the treatment (CPs 8/9 vs 5/6/7; 21.4% vs 2.5%; P = 0.022). At 12 mo follow-up, CPs was unchanged in 90 patients (95.7%), and increased by one-point in 4 patients (4.3%). The rise of CPs at 12 mo was not statistically associated with the initial transient rise of CPs. There were procedure-related complications in 3 patients (3.2%), but the complications were resolved by medical and interventional treatments without hepatic functional sequelae.
The combined TACE and RFA with an interval of 0-2 d are safe for the management of HCC < 5 cm in cirrhotic patients.
研究短期间隔(0 - 2天)的经导管动脉化疗栓塞术(TACE)与射频消融术(RFA)联合治疗后的肝功能情况。
115例代偿期肝硬化患者接受了RFA联合TACE治疗,治疗间隔为0 - 2天,用于治疗直径<5.0 cm的肝细胞癌(HCC)。其中21例患者在联合治疗HCC复发后12个月内接受了进一步的肝脏定向治疗,导致肝功能改变,被排除。其余94例未出现HCC复发的存活患者纳入本回顾性研究。
治疗后1个月,94例患者中有89例(94.7%)的Child - Pugh评分(CPs)保持不变,5例(5.3%)患者的CPs短暂升高1分。然而,所有患者的评分在3个月时恢复至基线水平,并维持至6个月。基线CPs为8分或更高被确定为治疗后CPs短暂升高的一个因素(CPs 8/9与5/6/7;21.4%与2.5%;P = 0.022)。在12个月随访时,90例患者(95.7%)的CPs未改变,4例患者(4.3%)升高1分。12个月时CPs的升高与最初CPs的短暂升高无统计学关联。3例患者(3.2%)出现了与手术相关的并发症,但通过药物和介入治疗并发症得到解决,未留下肝功能后遗症。
间隔0 - 2天的TACE与RFA联合治疗对肝硬化患者中<5 cm的HCC治疗是安全的。