肝硬化合并孤立性大肝细胞癌患者行肝切除与射频消融联合经动脉化疗栓塞术的比较
Liver Resection versus Radiofrequency Ablation plus Transcatheter Arterial Chemoembolization in Cirrhotic Patients with Solitary Large Hepatocellular Carcinoma.
作者信息
Saviano Antonio, Iezzi Roberto, Giuliante Felice, Salvatore Lucia, Mele Caterina, Posa Alessandro, Ardito Francesco, De Gaetano Anna Maria, Pompili Maurizio
机构信息
Department of Internal Medicine and Gastroenterology, "A. Gemelli" Hospital, Catholic University of Rome, Largo F. Vito 1, Rome 00168, Italy.
Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University of Rome, Largo F. Vito 1, Rome 00168, Italy.
出版信息
J Vasc Interv Radiol. 2017 Nov;28(11):1512-1519. doi: 10.1016/j.jvir.2017.06.016. Epub 2017 Jul 19.
PURPOSE
To compare liver resection (LR) with single-step, balloon-occluded radiofrequency (RF) ablation plus drug-eluting embolics transarterial chemoembolization in cirrhotic patients with single hepatocellular carcinoma (HCC) ≥ 3 cm.
MATERIALS AND METHODS
From 2010 to 2014, 25 patients with compensated cirrhosis and single HCC ≥ 3 cm (median size 4.5 cm; range, 3.0-6.8 cm) not suitable for LR or liver transplantation were treated with RF ablation plus transarterial chemoembolization in a prospective observational single-center pilot study; all patients had complete tumor necrosis after treatment. A retrospective control group included 29 patients (median HCC size 4.0 cm; range, 3.0-7.4 cm) who underwent LR. RF ablation plus transarterial chemoembolization group included more patients with severe portal hypertension (65.5% vs 35.0%, P = .017). Primary endpoints were overall survival (OS) and tumor recurrence (TR) rates.
RESULTS
One death and 1 major complication (4%) were observed in LR group. No major complications were reported in RF ablation plus transarterial chemoembolization group (P = .463). OS rates at 1 and 3 years were 91.8% and 79.3% in LR group and 89.4% and 48.2% in RF ablation plus transarterial chemoembolization group (P = 0.117). TR rates at 1 and 3 years were 29.5% and 45.0% in LR group and 42.4% and 76.0% in RF ablation plus transarterial chemoembolization group (P = .034). Local tumor progression (LTP) rates at 3 years were significantly lower in LR group (21.8% vs 58.1%, P = .005). Similar results were found in patients with HCC ≤ 5 cm (TR rates 35.4% vs 75.1%, P = .016; LTP 16.0% vs 55.7%, P = .013).
CONCLUSIONS
LR achieved lower TR and LTP rates than RF ablation plus transarterial chemoembolization, but 3-years OS rates were not statistically different between the 2 groups. RF ablation plus transarterial chemoembolization is an effective treatment option in patients with compensated cirrhosis and solitary HCC ≥ 3 cm unsuitable for LR.
目的
比较肝切除术（LR）与单步球囊闭塞射频（RF）消融联合药物洗脱栓塞经动脉化疗栓塞术在单发性肝细胞癌（HCC）≥3 cm的肝硬化患者中的疗效。
材料与方法
2010年至2014年，在一项前瞻性观察性单中心试点研究中，对25例代偿期肝硬化且单发性HCC≥3 cm（中位大小4.5 cm；范围3.0 - 6.8 cm）、不适合行LR或肝移植的患者进行了RF消融联合经动脉化疗栓塞术治疗；所有患者治疗后均实现了肿瘤完全坏死。一个回顾性对照组包括29例行LR的患者（中位HCC大小4.0 cm；范围3.0 - 7.4 cm）。RF消融联合经动脉化疗栓塞术组中重度门静脉高压患者更多（65.5%对35.0%，P = 0.017）。主要终点为总生存期（OS）和肿瘤复发（TR）率。
结果
LR组观察到1例死亡和1例严重并发症（4%）。RF消融联合经动脉化疗栓塞术组未报告严重并发症（P = 0.463）。LR组1年和3年的OS率分别为91.8%和79.3%，RF消融联合经动脉化疗栓塞术组为89.4%和48.2%（P = 0.117）。LR组1年和3年的TR率分别为29.5%和45.0%，RF消融联合经动脉化疗栓塞术组为42.4%和76.0%（P = 0.034）。LR组3年的局部肿瘤进展（LTP）率显著更低（21.8%对58.1%，P = 0.005）。在HCC≤5 cm的患者中也发现了类似结果（TR率35.4%对75.1%，P = 0.016；LTP 16.0%对55.7%，P = 0.013）。
结论
与RF消融联合经动脉化疗栓塞术相比，LR的TR和LTP率更低，但两组的3年OS率无统计学差异。RF消融联合经动脉化疗栓塞术是不适合行LR的代偿期肝硬化和孤立性HCC≥3 cm患者的一种有效治疗选择。
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