Zhong-Yi Zhang, Wei Yang, Kun Yan, Ying Dai, Wei Wu, Jung-Chieh Lee, Min-Hua Chen
a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of ultrasound , Peking University Cancer Hospital and Institute , Beijing , China.
Int J Hyperthermia. 2017 Jun;33(4):454-458. doi: 10.1080/02656736.2017.1278630. Epub 2017 Jan 23.
To determine the incidence, risk factors and prognosis associated with needle track seeding after percutaneous radiofrequency ablations (RFA) for hepatocellular carcinoma (HCC) with a long-term follow-up.
A total of 741 HCC patients undergoing percutaneous RFA were retrospectively analysed. Mean follow-up interval was 34.3 ± 26.8 months. All seeding neoplasms were diagnosed by imaging modalities with or without pathological evaluation. Risk factors, including Child-Pugh grading, tumour size, number, location, serum alpha-fetoprotein (AFP) level, track number, biopsy before RFA and electrode type were performed by univariate analysis. Further therapy and survival of seeding after RFA were assessed. Survival analysis was analysed by Kaplan-Meier method.
Twelve patients (12 tumours) were diagnosed as seeding. It corresponds to an incidence of 1.6% (12/741) per patient and 0.9% (12/1341) per tumour. Seeding developed an average of 14.0 ± 8.1 months (6-33 months). Significant risk factors included tumour >3 cm (p = 0.031), subcapsular tumour (p = 0.031), biopsy before RFA (p = 0.001) and non-cool-tip electrode (p = 0.034). Eight patients received local therapy and four cases only received systematic therapy for uncontrolled advanced hepatic tumour or distal metastasis. Of eight patients receiving local therapy, one patient had local recurrence 16 months later and other seven patients did not have local recurrence for 3-73 months. The cumulative survival rates after seeding were 55.6%, 27.8%, 9.3% at 1, 3 and 5 years, respectively.
Needle track seeding is a rare delayed complication after percutaneous RFA. Tumour >3 cm, subcapsular tumour, biopsy before RFA and non-cool-tip electrode are potential risk factors for seeding. Local therapies are effective methods for seeding patients.
通过长期随访确定经皮射频消融术（RFA）治疗肝细胞癌（HCC）后针道种植转移的发生率、危险因素及预后。
回顾性分析741例行经皮RFA的HCC患者。平均随访时间为34.3±26.8个月。所有种植转移瘤均通过影像学检查确诊，部分进行了病理评估。对包括Child-Pugh分级、肿瘤大小、数量、位置、血清甲胎蛋白（AFP）水平、针道数量、RFA前活检及电极类型等危险因素进行单因素分析。评估RFA后种植转移的进一步治疗及生存情况。采用Kaplan-Meier法进行生存分析。
12例患者（12个肿瘤）被诊断为种植转移。患者发生率为1.6%（12/741），肿瘤发生率为0.9%（12/1341）。种植转移平均发生时间为14.0±8.1个月（6 - 33个月）。显著危险因素包括肿瘤>3 cm（p = 0.031）、包膜下肿瘤（p = 0.031）、RFA前活检（p = 0.001）及非冷循环电极（p = 0.034）。8例患者接受了局部治疗，4例因晚期肝肿瘤无法控制或远处转移仅接受了系统治疗。接受局部治疗的8例患者中，1例16个月后出现局部复发，其他7例3 - 73个月未出现局部复发。种植转移后1、3、5年的累积生存率分别为55.6%、27.8%、9.3%。
针道种植转移是经皮RFA术后罕见的延迟并发症。肿瘤>3 cm、包膜下肿瘤、RFA前活检及非冷循环电极是种植转移的潜在危险因素。局部治疗是种植转移患者的有效治疗方法。
