Glazer Daniel I, Tatli Servet, Shyn Paul B, Vangel Mark G, Tuncali Kemal, Silverman Stuart G
1 Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
2 Department of Radiology, Medical Imaging of Lehigh Valley, Allentown, PA.
AJR Am J Roentgenol. 2017 Dec;209(6):1381-1389. doi: 10.2214/AJR.16.17582. Epub 2017 Sep 27.
The purpose of this article is to report our intermediate to long-term outcomes with image-guided percutaneous hepatic tumor cryoablation and to evaluate its technical success, technique efficacy, local tumor progression, and adverse event rate.
Between 1998 and 2014, 299 hepatic tumors (243 metastases and 56 primary tumors; mean diameter, 2.5 cm; median diameter, 2.2 cm; range, 0.3-7.8 cm) in 186 patients (95 women; mean age, 60.9 years; range, 29-88 years) underwent cryoablation during 236 procedures using CT (n = 126), MRI (n = 100), or PET/CT (n = 10) guidance. Technical success, technique efficacy at 3 months, local tumor progression (mean follow-up, 2.5 years; range, 2 months to 14.6 years), and adverse event rates were calculated.
The technical success rate was 94.6% (279/295). The technique efficacy rate was 89.5% (231/258) and was greater for tumors smaller than 4 cm (93.4%; 213/228) than for larger tumors (60.0%; 18/30) (p < 0.0001). Local tumor progression occurred in 23.3% (60/258) of tumors and was significantly more common after the treatment of tumors 4 cm or larger (63.3%; 19/30) compared with smaller tumors (18.0%; 41/228) (p < 0.0001). Adverse events followed 33.8% (80/236) of procedures and were grade 3-5 in 10.6% (25/236) of cases. Grade 3 or greater adverse events more commonly followed the treatment of larger tumors (19.5%; 8/41) compared with smaller tumors (8.7%; 17/195) (p = 0.04).
Image-guided percutaneous cryoablation of hepatic tumors is efficacious; however, tumors smaller than 4 cm are more likely to be treated successfully and without an adverse event.
本文旨在报告我们对影像引导下经皮肝肿瘤冷冻消融的中长期结果，并评估其技术成功率、技术疗效、局部肿瘤进展及不良事件发生率。
1998年至2014年间，186例患者（95名女性；平均年龄60.9岁；范围29 - 88岁）的299个肝肿瘤（243个转移瘤和56个原发性肿瘤；平均直径2.5 cm；中位直径2.2 cm；范围0.3 - 7.8 cm）在236次手术中接受了冷冻消融，使用CT引导（n = 126）、MRI引导（n = 100）或PET/CT引导（n = 10）。计算技术成功率、3个月时的技术疗效、局部肿瘤进展情况（平均随访2.5年；范围2个月至14.6年）以及不良事件发生率。
技术成功率为94.6%（279/295）。技术有效率为89.5%（231/258），直径小于4 cm的肿瘤的技术有效率（93.4%；213/228）高于直径较大的肿瘤（60.0%；18/30）（p < 0.0001）。23.3%（60/258）的肿瘤出现局部肿瘤进展，与较小肿瘤（18.0%；41/228）相比，直径4 cm或更大的肿瘤治疗后局部肿瘤进展明显更常见（63.3%；19/30）（p < 0.0001）。33.8%（80/236）的手术出现不良事件，10.6%（25/236）的病例为3 - 5级不良事件。与较小肿瘤（8.7%；17/195）相比，直径较大肿瘤治疗后3级或更高级别的不良事件更常见（19.5%；8/41）（p = 0.04）。
影像引导下经皮肝肿瘤冷冻消融是有效的；然而，直径小于4 cm的肿瘤更有可能成功治疗且无不良事件发生。
