From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.).
Radiology. 2016 Aug;280(2):611-21. doi: 10.1148/radiol.2016150743. Epub 2016 Mar 24.
Purpose To assess the long-term outcome in 108 consecutive patients treated with no-touch multibipolar radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) that met the Milan criteria. Materials and Methods This retrospective study was approved by the ethical review board, and the need to obtain informed consent was waived. Between November 1, 2006, and December 31, 2011, 132 HCC tumors (diameter, 10-45 mm; 39 tumors ≥ 30 mm) in 108 consecutive patients (106 with cirrhosis) that met Milan criteria were treated with no-touch multibipolar RFA, which consisted of activating, in bipolar mode, three or four electrodes inserted just beyond the tumor margins. Follow-up was performed every 3 months for 2 years and every 6 months thereafter with computed tomographic or magnetic resonance imaging. Survival probabilities were computed by using the Kaplan-Meier method. Predictive factors of tumor progression and overall survival were assessed by using the Cox proportional hazard model. Results No technical failure occurred, and complete ablation was achieved for all the nodules. After a median of 40.5 months (range, 2-84 months) of follow-up, 3- and 5-year local and overall tumor progression-free survival were 96%, 94%, 52%, and 32%, respectively. Neither tumor diameter greater than 30 mm nor location abutting a large vessel were associated with local tumor progression. Tumor diameter greater than 30 mm was the only parameter predictive of overall tumor progression (P = .0036). Independent factors associated with shorter overall survival were Child-Pugh class B disease, age greater than 65 years, and platelet count of less than 150 g/L (P < .003). Three major complications occurred (2.7%): hemothorax in one patient and liver failure in two, with major portal-systemic shunts. One patient (0.9%) died, and one underwent transplantation. Conclusion No-touch multibipolar RFA for HCC tumors that meet Milan criteria provides a high local tumor progression-free survival rate. An ongoing randomized trial might help to clarify the role of this new approach for the treatment of early HCC. (©) RSNA, 2016 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on March 30, 2016.
评估符合米兰标准的 108 例连续患者接受无接触多点射频消融（RFA）治疗肝细胞癌（HCC）的长期疗效。
本回顾性研究获得了伦理审查委员会的批准，并豁免了获得知情同意的要求。在 2006 年 11 月 1 日至 2011 年 12 月 31 日期间，对符合米兰标准的 108 例连续患者（106 例伴有肝硬化）的 132 个 HCC 肿瘤（直径 10-45mm；39 个肿瘤≥30mm）进行了无接触多点 RFA 治疗。RFA 采用双极模式激活插入肿瘤边缘外的三个或四个电极。采用 CT 或 MRI 每 3 个月随访 2 年，此后每 6 个月随访一次。采用 Kaplan-Meier 法计算生存率。采用 Cox 比例风险模型评估肿瘤进展和总生存的预测因素。
无技术失败发生，所有结节均达到完全消融。中位随访时间为 40.5 个月（范围 2-84 个月）后，3 年和 5 年局部和总肿瘤无进展生存率分别为 96%、94%、52%和 32%。肿瘤直径大于 30mm 和毗邻大血管的位置均与局部肿瘤进展无关。肿瘤直径大于 30mm 是唯一与总肿瘤进展相关的参数（P =.0036）。与总生存时间较短相关的独立因素包括 Child-Pugh 分级 B 级疾病、年龄大于 65 岁和血小板计数小于 150g/L（P<.003）。发生 3 种主要并发症（2.7%）：1 例患者出现血胸，2 例患者出现肝功能衰竭和主要门体分流。1 例患者（0.9%）死亡，1 例患者接受了移植。
符合米兰标准的 HCC 肿瘤的无接触多点 RFA 提供了较高的局部肿瘤无进展生存率。正在进行的随机试验可能有助于阐明这种新方法治疗早期 HCC 的作用。
