a State Key Laboratory of Oncology in South China , Collaborative Innovation Center for Cancer Medicine , Guangzhou , PR China.
b Minimally Invasive Interventional Division , Sun Yat-sen University Cancer Center , Guangzhou , PR China.
Int J Hyperthermia. 2018 Feb;34(1):59-67. doi: 10.1080/02656736.2017.1318332. Epub 2017 May 2.
The aim of this study was to evaluate the therapeutic outcome of percutaneous computed tomography (CT)-guided radiofrequency ablation (RFA) for extrahepatic oligometastases of hepatocellular carcinoma (HCC).
Institutional review board approval was obtained for this retrospective study, and all patients provided written informed consent. Between April 2004 and December 2015, 116 oligometastases (diameter, 5-50 mm; 20.3 ± 10.4) in 79 consecutive HCC patients (73 men and 6 women; average age, 50.3 years ±13.0) were treated with RFA. We focussed on patients with 1-3 extrahepatic metastases (EHM) confined to 1-2 organs (including the lung, adrenal gland, bone, lymph node and pleura/peritoneum) who were treated naïve with curative intent. Survival, technical success and safety were evaluated. The log-rank test and Cox proportional hazards regression models were used to analyse the survival data.
No immediate technical failure occurred, and at 1 month, the technique effectiveness rate was determined to be 95.8%. After a median follow-up time of 28.0 months (range, 6-108 months), the 1-, 2- and 3-year overall survival (OS) rates were 91, 70 and 48%, respectively, with a median survival time of 33.5 months. Time to unoligometastatic progression (TTUP) of less than 6 months (p < 0.001) and a Child-Pugh score of more than 5 (p = 0.001) were significant indicators of shorter OS. The 1-, 2- and 3-year disease free survival (DFS) rates were 34, 21 and 8%, respectively, with a median DFS time of 6.8 months. DFS was better for those with lung metastases (p = 0.006). Major complication occurred in nine (9.5%, 9/95) RFA sessions without treatment-related mortality.
CT-guided RFA for oligometastatic HCC may provide favourable efficacy and technical success with a minimally invasive approach.
本研究旨在评估经皮 CT 引导下射频消融（RFA）治疗肝细胞癌（HCC）肝外寡转移灶的疗效。
本回顾性研究获得了机构审查委员会的批准，所有患者均签署了书面知情同意书。2004 年 4 月至 2015 年 12 月，对 79 例 HCC 患者（73 例男性，6 例女性；平均年龄 50.3 ±13.0 岁）的 116 个寡转移灶（直径 5-50mm；20.3±10.4）进行了 RFA 治疗。我们重点关注的是 1-3 个局限于 1-2 个器官（包括肺、肾上腺、骨、淋巴结和胸膜/腹膜）的肝外转移灶（EHM）且以治愈为目的进行治疗的患者。评估了生存、技术成功率和安全性。采用对数秩检验和 Cox 比例风险回归模型分析生存数据。
无即刻技术失败，1 个月时技术有效率为 95.8%。中位随访时间为 28.0 个月（范围 6-108 个月）后，1、2、3 年总生存率（OS）分别为 91%、70%和 48%，中位 OS 时间为 33.5 个月。无寡转移进展时间（TTUP）小于 6 个月（p<0.001）和 Child-Pugh 评分大于 5 分（p=0.001）是 OS 较短的显著指标。1、2、3 年无病生存率（DFS）分别为 34%、21%和 8%，中位 DFS 时间为 6.8 个月。肺转移患者的 DFS 更好（p=0.006）。95 次 RFA 中有 9 次（9.5%，9/95）出现主要并发症，但无治疗相关死亡。
CT 引导下 RFA 治疗 HCC 肝外寡转移灶可提供良好的疗效和技术成功率，且为微创方法。
