Langan Russell C, Goldman Debra A, D'Angelica Michael I, DeMatteo Ronald P, Allen Peter J, Balachandran Vinod P, Jarnagin William R, Kingham T Peter
Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Biostatistics Service, Memorial Sloan Kettering Cancer Center, New York, New York.
J Surg Oncol. 2017 May;115(6):704-710. doi: 10.1002/jso.24570. Epub 2017 May 11.
Irreversible electroporation (IRE) has emerged as a novel, safe ablative therapy for peri-vascular lesions. However, there remains a paucity of data on long-term outcomes.
We identified patients who underwent open IRE (1/2011-6/2015) for primary and secondary hepatic malignancies. Local ablation-zone recurrence (LR) was determined by cross-sectional imaging. Cumulative incidence (CumI) of LR was calculated and a competing risks regression assessed factors associated with LR.
Forty patients had 77 lesions treated. The majority of lesions were of colorectal origin (74%). Median tumor size was 1.3 cm (range 0.5-6). Most patients (86%) had prior systemic therapy and 29% received systemic therapy following IRE. With a median follow-up of 25.7 months (range 4.5-58.8 months), 10 lesions in 9 patients recurred locally (CumI: 13.4%, 95%CI: 7.8-22.2%). Median estimated time to LR was not reached and no LR occurred after 19 months. Factors significantly associated with LR included ablation zone size (HR 1.58; 95%CI 1.12-2.23; P = 0.0093) and body mass index (HR 1.21 95%CI 1.10-1.34; P = 0.0001).
IRE LR rates were low after the treatment of well selected, small tumors. This technique is useful for lesions in anatomic locations precluding resection or thermal ablation.
不可逆电穿孔（IRE）已成为一种用于血管周围病变的新型安全消融疗法。然而，关于长期疗效的数据仍然匮乏。
我们确定了因原发性和继发性肝恶性肿瘤接受开放性IRE治疗（2011年1月至2015年6月）的患者。通过横断面成像确定局部消融区复发（LR）情况。计算LR的累积发病率（CumI），并采用竞争风险回归分析与LR相关的因素。
40例患者共77个病灶接受了治疗。大多数病灶起源于结肠直肠（74%）。肿瘤中位大小为1.3厘米（范围0.5 - 6厘米）。大多数患者（86%）曾接受过全身治疗，29%在IRE后接受了全身治疗。中位随访时间为25.7个月（范围4.5 - 58.8个月），9例患者的10个病灶出现局部复发（CumI：13.4%，95%CI：7.8 - 22.2%）。未达到LR的中位估计时间，19个月后未发生LR。与LR显著相关的因素包括消融区大小（HR 1.58；95%CI 1.12 - 2.23；P = 0.0093）和体重指数（HR 1.21，95%CI 1.10 - 1.34；P = 0.0001）。
对于精心挑选的小肿瘤，IRE治疗后的LR率较低。该技术适用于因解剖位置而无法进行切除或热消融的病灶。
