From the Department of Radiology, Section of Interventional Radiology (R.J.L., A.G., N.A., R.A., A.A., R.A.M., K.D., B.T., S.M., R.H., A.R., R.S.), Department of Medicine, Division of Hepatology (L.K., D.G.), Department of Surgery, Division of Transplantation (J.C.C., M.A., R.S.), and Department of Medicine, Division of Hematology and Oncology (R.S.), Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N St. Clair St, Suite 800, Chicago IL 60611.
Radiology. 2018 Jun;287(3):1050-1058. doi: 10.1148/radiol.2018171768. Epub 2018 Apr 24.
Purpose To report long-term outcomes of radiation segmentectomy (RS) for early hepatocellular carcinoma (HCC). The authors hypothesized that outcomes are comparable to curative treatments for patients with solitary HCC less than or equal to 5 cm and preserved liver function. Materials and Methods This retrospective study included 70 patients (median age, 71 years; range, 22-96 years) with solitary HCC less than or equal to 5 cm not amenable to percutaneous ablation who underwent RS (dose of >190 Gy) between 2003 and 2016. Patients who underwent subsequent curative liver transplantation were excluded to eliminate this confounding variable affecting survival. Radiologic response of time to progression and median overall survival were estimated by using the Kaplan-Meier method per the guidelines of the European Association for the Study of the Liver (EASL) and the World Health Organization (WHO). Results Seventy patients were treated with RS over 14 years. Sixty-three patients (90%) showed response by using EASL criteria, of which 41 (59%) showed complete response. Fifty patients (71%) achieved response by using WHO criteria, of which 11 (16%) achieved complete response. Response rates at 6 months were 86% and 49% by using EASL and WHO criteria, respectively. Median time to progression was 2.4 years (95% confidence interval: 2.1, 5.7), with 72% of patients having no target lesion progression at 5 years. Median overall survival was 6.7 years (95% confidence interval: 3.1, 6.7); survival probability at 1, 3, and 5 years was 98%, 66%, and 57%, respectively. Overall survival probability at 1, 3, and 5 years was 100%, 82%, and 75%, respectively, in patients with baseline tumor size less than or equal to 3 cm (n = 45) and was significantly longer than in patients with tumors greater than 3 cm (P = .026). Conclusion RS provides response rates, tumor control, and survival outcomes comparable to curative-intent treatments for selected patients with early-stage HCC who have preserved liver function. RSNA, 2018 Online supplemental material is available for this article.
报告放射段切除术（RS）治疗早期肝细胞癌（HCC）的长期结果。作者假设，对于肝功能正常、单个 HCC 直径小于或等于 5cm 的患者，RS 的治疗结果可与根治性治疗相媲美。
本回顾性研究纳入了 2003 年至 2016 年间接受 RS（剂量>190Gy）治疗的 70 例单个 HCC 直径小于或等于 5cm 且不适于行经皮消融治疗的患者。排除随后接受根治性肝移植的患者，以消除影响生存的混杂因素。根据欧洲肝脏研究协会（EASL）和世界卫生组织（WHO）的指南，采用 Kaplan-Meier 法估计无进展时间和中位总生存期的放射学反应。
14 年间，70 例患者接受 RS 治疗。63 例（90%）患者符合 EASL 标准，其中 41 例（59%）患者为完全缓解。50 例（71%）患者符合 WHO 标准，其中 11 例（16%）为完全缓解。EASL 和 WHO 标准下的 6 个月时的缓解率分别为 86%和 49%。中位无进展时间为 2.4 年（95%可信区间：2.1，5.7），5 年内 72%的患者无靶病灶进展。中位总生存期为 6.7 年（95%可信区间：3.1，6.7）；1、3 和 5 年的生存率分别为 98%、66%和 57%。在基线肿瘤直径小于或等于 3cm（n=45）的患者中，1、3 和 5 年的总生存率分别为 100%、82%和 75%，明显长于肿瘤直径大于 3cm 的患者（P=.026）。
RS 为肝功能正常的早期 HCC 患者提供了与根治性治疗相当的缓解率、肿瘤控制率和生存率。RSNA，2018 在线补充材料可供本文参考。
