a Department of Diagnostic and Interventional Radiology , Hopital Saint-André, Centre Hospitalier Universitaire de Bordeaux , Bordeaux , France.
b Department of Radiodiagnostic and Interventional Radiology , Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne , Lausanne , Switzerland.
Int J Hyperthermia. 2018 Dec;34(8):1171-1178. doi: 10.1080/02656736.2018.1440017. Epub 2018 Apr 18.
To compare overall local tumour progression (OLTP), defined as the failure of primary ablation or local tumour progression, with single applicator monopolar radiofrequency ablation (RFA), microwave ablation (MWA), cluster-RFA and multi-bipolar radiofrequency (mbpRFA) in the treatment of hepatocellular carcinoma (HCC) ≤ 5 cm abutting large vessels (≥3 mm).
This multicenter, retrospective, per-nodule study was performed from 2007 to 2015. The study was approved by the ethics review board, and informed consent was waived. A total of 160/914 HCC nodules treated by thermal ablation and abutting large vessels (40 per treatment group) treated by monopolar RFA, MWA, cluster-RFA or mbpRFA were matched for tumour size, alpha-feto-protein level and vessel size. OLTP rates were compared by the log-rank test and the multivariate Cox model after matching.
No differences were observed in tumour size, vessel size or alpha-feto-protein levels among the three groups (p = 1). The cumulative 4-year OLTP rates following monopolar RFA, cluster-RFA, multi-bipolar RFA and MWA were 50.5%, 16.3%, 16.3% and 44.2%, respectively (p = 0.036). On multivariate Cox regression, vessel size ≥10 mm, monopolar RFA and MWA were independent risk factors of OLTP compared to cluster-RFA or mbpRFA.
Multi-applicator RFA provides better local tumour control in HCC abutting large vessels than single-applicator techniques (monopolar RFA or MWA).
比较伴大血管（≥3mm）≤5cm 的肝细胞癌（HCC）的整体肿瘤局部进展（OLTP），定义为原发性消融失败或局部肿瘤进展，与单极射频消融（RFA）、微波消融（MWA）、多极 RFA（mbpRFA）治疗的单个消融器消融治疗。
这是一项多中心、回顾性、逐结节研究，于 2007 年至 2015 年进行。该研究得到了伦理审查委员会的批准，并放弃了知情同意。共 160/914 个 HCC 结节伴大血管（40 个/治疗组）接受了热消融治疗，包括单极 RFA、MWA、多极 RFA 或 mbpRFA 治疗，其肿瘤大小、甲胎蛋白水平和血管大小均匹配。OLTP 率通过对数秩检验和匹配后的多变量 Cox 模型进行比较。
三组间肿瘤大小、血管大小或甲胎蛋白水平无差异（p=1）。单极 RFA、多极 RFA、多极 RFA 和 MWA 治疗后 4 年累积 OLTP 率分别为 50.5%、16.3%、16.3%和 44.2%（p=0.036）。多变量 Cox 回归分析显示，血管大小≥10mm、单极 RFA 和 MWA 是与多极 RFA 或 mbpRFA 相比 OLTP 的独立危险因素。
多极 RFA 为伴大血管的 HCC 提供了比单极 RFA 或 MWA 更好的局部肿瘤控制。
