Kato Keizo, Abe Hiroshi, Ika Makiko, Yonezawa Takeshi, Sato Yoshiyuki, Hanawa Noriko, Shimizu Shohei, Endo Shinji, Matsuo Ryota, Tsubota Akihito
Liver Disease Control Unit, The Jikei University School of Medicine, Tokyo, Japan.
Oncology. 2017;92(3):142-152. doi: 10.1159/000453665. Epub 2017 Jan 5.
To assess the usefulness of C-arm cone beam computed tomography (CBCT) combined with ultrasound for the treatment of hepatocellular carcinoma (HCC) by radiofrequency ablation (RFA).
Patients underwent RFA following transcatheter arterial chemoembolization (TACE) or RFA alone under ultrasound or CBCT guidance combined with ultrasound-based techniques. They were divided into 2 groups based on the use (C group) and nonuse (NC group) of CBCT guidance. The technical success of RFA and local tumor progression after the first RFA session were evaluated by dynamic contrast-enhanced imaging methods. Between-group differences were assessed retrospectively.
We enrolled 198 patients with 260 HCC nodules. The complete ablation rates were 63.0 and 89.4% in the NC and C groups, respectively. In log-rank testing, local tumor progression occurred significantly more often in the NC group when RFA was used without TACE, in males when des-gamma-carboxy prothrombin was ≥29 mAU/mL, and when the diameter of a nodule was ≥18 mm. On Cox proportional-hazards regression analysis, the NC group, RFA alone without TACE, and male gender were significant independent variables.
TACE followed by RFA under CBCT and ultrasound guidance improves the reliability of ablation of target HCC nodules, reduces the need for additional treatment sessions, and prevents local tumor progression.
评估C形臂锥形束计算机断层扫描（CBCT）联合超声在经射频消融（RFA）治疗肝细胞癌（HCC）中的应用价值。
患者在经动脉化疗栓塞术（TACE）后接受RFA，或在超声或CBCT引导联合基于超声的技术下单独接受RFA。根据是否使用CBCT引导将患者分为2组（C组和未使用CBCT引导的NC组）。通过动态对比增强成像方法评估首次RFA治疗后RFA的技术成功率和局部肿瘤进展情况。对组间差异进行回顾性评估。
我们纳入了198例患有260个HCC结节的患者。NC组和C组的完全消融率分别为63.0%和89.4%。在对数秩检验中，当不进行TACE而使用RFA时，NC组局部肿瘤进展的发生率显著更高；当去γ-羧基凝血酶原≥29 mAU/mL时，男性患者局部肿瘤进展的发生率显著更高；当结节直径≥18 mm时，局部肿瘤进展的发生率也显著更高。在Cox比例风险回归分析中，NC组、不进行TACE单独使用RFA以及男性性别是显著的独立变量。
在CBCT和超声引导下先进行TACE再进行RFA可提高目标HCC结节消融的可靠性，减少额外治疗次数的需求，并预防局部肿瘤进展。
