Chinnaratha Mohamed A, Sathananthan Dharshan, Pateria Puraskar, Tse Edmund, MacQuillan Gerry, Mosel Leigh, Pathi Ramon, Madigan Dan, Wigg Alan J
aHepatology and Liver Transplant Medicine Unit bDepartment of Medical Imaging, Flinders Medical Centre, Bedford Park cDepartment of Gastroenterology/Hepatology dDepartment of Radiology, Royal Adelaide Hospital eSchool of Medicine, Flinders University of South Australia, Adelaide, South Australia fDepartment of Gastroenterology/Hepatology, Sir Charles Gairdner Hospital, Nedlands gSchool of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
Eur J Gastroenterol Hepatol. 2015 Mar;27(3):349-54. doi: 10.1097/MEG.0000000000000270.
The risk of local tumour progression (LTP) and factors predicting LTP following percutaneous thermal ablation (PTA) of early-stage hepatocellular carcinoma (HCC) have not been well studied in non-trial settings and may be underestimated. We aimed to assess these outcomes in a multicentre study.
This was a retrospective review of consecutive patients with early-stage HCC treated with a curative intent across three tertiary Australian centres between 2006 and 2012 with either radiofrequency ablation or microwave ablation. The primary endpoint was LTP and multivariate analysis was carried out to identify the independent predictors of LTP.
In total 145 HCC nodules were treated in 126 patients (78% men, mean±SD age 62±10 years) with a mean±SD follow-up of 13.5±13 months. Local recurrence was observed in 23.4% (34/145). Mean±SD LTP-free survival was 46.9±3.6 months. For HCC nodules 2 cm or less, local recurrence rates were lower (15.9%), with a mean±SD LTP-free survival of 48.8±4.2 months. Poorly differentiated HCC [hazard ratio (95% confidence interval)=4.8 (1.1-20.4), P=0.032] and pretreatment α-fetoprotein more than 50 kIU/l [8.2 (1.7-39.0), P=0.008] were independent predictors of LTP. LTP rates were not significantly different between the radiofrequency ablation and the microwave ablation groups (22.8 vs. 25.8%, P=0.7). There were six (4.8%) procedure-related adverse events, but no deaths.
Local recurrence after PTA for early-stage HCC is high in routine clinical practice. Poorly differentiated HCC and pretreatment α-fetoprotein are important, independent predictors of LTP. Further well-designed randomized controlled trials with larger sample sizes using adjuvant therapies in combination with PTA to decrease LTP rates are warranted.
在非试验环境中，早期肝细胞癌（HCC）经皮热消融（PTA）后局部肿瘤进展（LTP）的风险及预测LTP的因素尚未得到充分研究，且可能被低估。我们旨在通过一项多中心研究评估这些结果。
这是一项对2006年至2012年间澳大利亚三个三级医疗中心连续收治的有治愈意向的早期HCC患者进行的回顾性研究，这些患者接受了射频消融或微波消融治疗。主要终点是LTP，并进行多变量分析以确定LTP的独立预测因素。
共126例患者（78%为男性，平均±标准差年龄62±10岁）的145个HCC结节接受了治疗，平均±标准差随访时间为13.5±13个月。23.4%（34/145）观察到局部复发。平均±标准差无LTP生存期为46.9±3.6个月。对于直径2 cm及以下的HCC结节，局部复发率较低（15.9%），平均±标准差无LTP生存期为48.8±4.2个月。低分化HCC [风险比（95%置信区间）=4.8（1.1 - 20.4），P = 0.032]和治疗前甲胎蛋白超过50 kIU/l [8.2（1.7 - 39.0），P = 0.008]是LTP的独立预测因素。射频消融组和微波消融组的LTP发生率无显著差异（22.8%对25.8%，P = 0.7）。有6例（4.8%）与手术相关的不良事件，但无死亡病例。
在常规临床实践中，早期HCC经PTA后的局部复发率较高。低分化HCC和治疗前甲胎蛋白是LTP重要的独立预测因素。有必要开展进一步设计良好、样本量更大的随机对照试验，采用辅助治疗联合PTA以降低LTP发生率。
