Wang Y M, Qian G J, Xu Y, Wang N, Sheng Y H
Department of Minimally Invasive Therapy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University of Chinese PLA, Shanghai 200438, China.
Zhonghua Gan Zang Bing Za Zhi. 2017 May 20;25(5):344-348. doi: 10.3760/cma.j.issn.1007-3418.2017.05.007.
To investigate the efficacy of microwave ablation in the treatment of hepatocellular carcinoma (HCC) within the Milan criteria and to investigate the differences in clinical efficacy of microwave ablation in tumors with different sizes. A retrospective analysis was performed on the clinical data of the patients with HCC within the Milan criteria who received microwave ablation in our hospital from January 2011 to January 2013. The complete ablation rate, incidence rate of major complications, recurrence rate, and overall survival rate were analyzed and the treatment outcomes were compared between two groups with different tumors sizes. The patients were followed up for 3.4-61.8 months. The Kaplan-Meier method was used to calculate overall survival rate, local recurrence rate, and distant recurrence rate. Comparison of rates between groups was made by the chi-square test and comparison of survival rates between groups was made by the log-rank test. A total of 696 patients with HCC within the Milan criteria involving 801 tumors were included in this study. The complete ablation rate was 93.8% (653/696) and the incidence rate of major complications was 1.7% (12/696). The median survival time was 59.6 months and the 1-, 2-, and 3-year overall survival rates were 94.8%, 82.2%, and 71.7%, respectively. The local recurrence rate was 13.4% (93/696) and the rate of intrahepatic distant metastasis was 40.1% (279/696). The overall intrahepatic recurrence rate was 48.1% (335/696), and the 1-, 2-, and 3-year recurrence rates were 22.9%, 38.4%, and 46.8%, respectively. There were no significant differences in complete ablation rate, incidence rate of major complications, and overall survival rate between the two groups with different tumor sizes (diameters≤3 cm and 3-5 cm) ( = 0.12; = 0.61; = 0.61). Microwave ablation is a safe and effective treatment modality for HCC within the Milan criteria. And there are no significant differences in safety, effectiveness, and long-term efficacy of microwave ablation between the two groups with different tumor sizes (diameters ≤3 cm and 3-5 cm). However, if the operator's experience is not rich and cannot accurately use conformal ablation and make an individualized treatment, the tumors with a diameter of 3-5 cm should be carefully treated using microwave ablation to avoid residual tumor after treatment.
探讨微波消融治疗米兰标准内肝细胞癌（HCC）的疗效，并研究微波消融在不同大小肿瘤中的临床疗效差异。对2011年1月至2013年1月在我院接受微波消融治疗的米兰标准内HCC患者的临床资料进行回顾性分析。分析完全消融率、主要并发症发生率、复发率和总生存率，并比较不同肿瘤大小两组的治疗效果。对患者进行3.4 - 61.8个月的随访。采用Kaplan - Meier法计算总生存率、局部复发率和远处复发率。组间率的比较采用卡方检验，组间生存率的比较采用对数秩检验。本研究共纳入696例米兰标准内的HCC患者，涉及801个肿瘤。完全消融率为93.8%（653/696），主要并发症发生率为1.7%（12/696）。中位生存时间为59.6个月，1年、2年和3年总生存率分别为94.8%、82.2%和71.7%。局部复发率为13.4%（93/696），肝内远处转移率为40.1%（279/696）。肝内总复发率为48.1%（335/696），1年、2年和3年复发率分别为22.9%、38.4%和46.8%。不同肿瘤大小（直径≤3 cm和3 - 5 cm）两组间的完全消融率、主要并发症发生率和总生存率无显著差异（=0.12；=0.61；=0.61）。微波消融是治疗米兰标准内HCC的一种安全有效的治疗方式。不同肿瘤大小（直径≤3 cm和3 - 5 cm）两组间微波消融的安全性、有效性和长期疗效无显著差异。然而，如果操作者经验不丰富，不能准确使用适形消融并进行个体化治疗，对于直径3 - 5 cm的肿瘤，应谨慎使用微波消融治疗，以避免治疗后肿瘤残留。
