Zhang N N, Lu W, Cheng X J, Liu J Y, Zhou Y H, Li F
Tianjin Second People's Hospital, 7 Sudi Road, Tianjin 300192, China; Tianjin Institute of Hepatology, 7 Sudi Road, Tianjin 300192, China.
Tianjin Second People's Hospital, 7 Sudi Road, Tianjin 300192, China; Tianjin Institute of Hepatology, 7 Sudi Road, Tianjin 300192, China.
Clin Radiol. 2015 Nov;70(11):1237-43. doi: 10.1016/j.crad.2015.06.092. Epub 2015 Jul 26.
To evaluate the safety and efficacy of high-powered (80-100 W) percutaneous microwave ablation (MWA) at a frequency of 2450±10 MHz for treating larger hepatocellular carcinoma (HCC) and to predict the risk factors of local recurrence after high-powered MWA.
The study was approved by the Institutional Review Board, and informed consent was waived because of the retrospective study design. Forty-five patients with a total of 60 lesions received high-power (80-100 W) MWA at a frequency of 2450±10 MHz through a percutaneous approach that was guided by ultrasound. Of the 60 lesions with a maximum tumour measuring 3-8 cm, 46 lesions were 3-5 cm and 14 were 5-8 cm. The complete ablation rates, local recurrence rates, complications, and short-term survival were analysed. Ten possible risk factors for local recurrence were analysed.
The complete ablation rates were 82.61% for the first ablation and 100% for the second ablation for 3-5 cm lesions. The complete ablation rates were 64.29% (82.61% versus 64.29%, p=0.037) for the first ablation and 85.71% (100% versus 85.71%, p=0.055) for the second ablation for 5-8 cm lesions. Local recurrence was observed in 11 out of the 45 (24.44%) successfully treated patients. The 1-year and 2-year survival rates were 95.56% (43/45) and 86.67% (39/45), respectively. No procedure-related mortality was observed and no major bleeding, liver rupture, or liver abscesses occurred. Univariate analysis showed that a positive correlation existed between the number of lesions (p=0.022), proximity to the risk area (p=0.001), pre-ablation alpha-fetoprotein (AFP) levels (p=0.025), hepatitis B virus (HBV)-DNA replication (p=0.027) and local recurrence. Multivariate analysis identified HBV-DNA (p=0.031) and proximity to the risk area (p=0.039) as the independent prognosis factors causing postoperative HCC local recurrence.
High-powered MWA of larger hepatocellular carcinomas appears to be a safe and effective treatment. HBV-DNA and proximity to the risk area appear to be independent predictors of local tumour recurrence.
评估频率为2450±10MHz、功率为80 - 100W的经皮微波消融（MWA）治疗较大肝细胞癌（HCC）的安全性和有效性，并预测高功率MWA后局部复发的危险因素。
本研究经机构审查委员会批准，由于采用回顾性研究设计，故无需获得知情同意。45例患者共60个病灶，通过超声引导下的经皮途径接受了频率为2450±10MHz、功率为80 - 100W的MWA治疗。在这60个最大肿瘤直径为3 - 8cm的病灶中，46个病灶直径为3 - 5cm，14个病灶直径为5 - 8cm。分析了完全消融率、局部复发率、并发症及短期生存率。分析了10个可能的局部复发危险因素。
对于3 - 5cm的病灶，首次消融的完全消融率为82.61%，第二次消融的完全消融率为100%。对于5 - 8cm的病灶，首次消融的完全消融率为64.29%（82.61%对64.29%，p = 0.037），第二次消融的完全消融率为85.71%（100%对85.71%，p = 0.055）。45例成功治疗的患者中有11例（24.44%）出现局部复发。1年和2年生存率分别为95.56%（43/45）和86.67%（39/45）。未观察到与手术相关的死亡，也未发生大出血、肝破裂或肝脓肿。单因素分析显示，病灶数量（p = 0.022）、与危险区域的接近程度（p = 0.001）、消融前甲胎蛋白（AFP）水平（p = 0.025）、乙型肝炎病毒（HBV）-DNA复制（p = 0.027）与局部复发之间存在正相关。多因素分析确定HBV-DNA（p = 0.031）和与危险区域的接近程度（p = 0.039）是导致术后HCC局部复发的独立预后因素。
高功率MWA治疗较大肝细胞癌似乎是一种安全有效的治疗方法。HBV-DNA和与危险区域的接近程度似乎是局部肿瘤复发的独立预测因素。
