From the Department of Radiology and Center for Imaging Science (T.W.K., H.K.L., M.W.L., Y.S.K., H.R., W.J.L.) and Division of Hepatology, Department of Medicine (Y.H.P.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul 135-710, Republic of Korea; Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (H.K.L., W.J.L., Y.H.P.); and Biostatistics Team, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea (M.J.K., J.H.A.).
Radiology. 2016 Jul;280(1):300-12. doi: 10.1148/radiol.2016151243. Epub 2016 Jan 29.
Purpose To compare the long-term therapeutic outcomes of radiofrequency (RF) ablation for hepatocellular carcinoma (HCC) in subcapsular versus nonsubcapsular locations by using propensity score matching. Materials and Methods RF ablation for subcapsular HCC is controversial because of a high risk of incomplete ablation or major complications. This retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. Between April 2006 and December 2011, 508 consecutive patients (396 men, 112 women; age range, 30-80 years) with a single HCC (Barcelona Clinic Liver Cancer stage 0 or A) underwent ultrasonography-guided percutaneous RF ablation as a first-line treatment. The patients were divided into two groups according to tumor location: subcapsular (n = 227) and nonsubcapsular (n = 281). Subcapsular HCC was defined as an index tumor located within 0.1 cm of the liver capsule. The association of subcapsular location and therapeutic outcomes of RF ablation was evaluated, including (a) local tumor progression (LTP) by using a competing risk regression model and (b) overall survival (OS) by using a Cox proportional hazards model according to propensity score matched data. The major complication rates from both overall data and matched data were assessed. Results Matching yielded 163 matched pairs of patients. In the two matched groups, cumulative LTP rates were 18.8% and 20.9% at 3 and 5 years, respectively, in the subcapsular group and 13.2% and 16.0% in the nonsubcapsular group. Corresponding OS rates were 90.7% for 3 years and 83.2% for 5 years in the subcapsular group and 91.4% and 79.1%, respectively, in the nonsubcapsular group. Hazard ratios (HRs) for LTP (HR = 1.37, P = .244) and OS (HR = 0.86, P = .604) were not significantly different between the two matched groups. Additionally, differences in major complication rates were not significant between groups for the two sets of data (P > .05). Conclusion The differences in LTP, OS, and major complication rates of RF ablation for HCC were not significant between subcapsular and nonsubcapsular groups. (©) RSNA, 2016.
目的 通过倾向评分匹配比较射频消融治疗肝包膜下与非肝包膜下肝细胞癌的长期疗效。
材料与方法 由于存在不完全消融或严重并发症的高风险，肝包膜下肝细胞癌的射频消融治疗存在争议。本回顾性研究经机构审查委员会批准，且豁免了知情同意书的要求。2006 年 4 月至 2011 年 12 月，508 例（男 396 例，女 112 例；年龄 30-80 岁）单发肝细胞癌（巴塞罗那临床肝癌分期 0 或 A 期）患者接受超声引导经皮射频消融作为一线治疗。根据肿瘤位置将患者分为两组：肝包膜下组（227 例）和非肝包膜下组（281 例）。肝包膜下肝癌定义为位于肝包膜下 0.1cm 以内的指数肿瘤。采用竞争风险回归模型评估肝包膜下位置与射频消融治疗效果的关系，包括（a）使用倾向评分匹配数据根据累积局部肿瘤进展（LTP）评估（b）使用 Cox 比例风险模型评估总生存率（OS）。评估两组患者的总体数据和匹配数据的主要并发症发生率。
结果 匹配后获得 163 对匹配患者。在两组匹配患者中，肝包膜下组 3 年和 5 年的累积 LTP 率分别为 18.8%和 20.9%，非肝包膜下组分别为 13.2%和 16.0%。肝包膜下组 3 年和 5 年的 OS 率分别为 90.7%和 83.2%，非肝包膜下组分别为 91.4%和 79.1%。LTP（HR=1.37，P=.244）和 OS（HR=0.86，P=.604）的风险比（HR）在两组之间无显著差异。此外，两组患者的主要并发症发生率差异无统计学意义（P＞.05）。
结论 肝包膜下与非肝包膜下射频消融治疗肝细胞癌的 LTP、OS 和主要并发症发生率无显著差异。
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