经肝动脉化疗栓塞（TACE）后碘油残留的局部复发性肝细胞癌的全肿瘤消融可改善无进展生存期。
Whole tumor ablation of locally recurred hepatocellular carcinoma including retained iodized oil after transarterial chemoembolization improves progression-free survival.
机构信息
Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, South Korea.
Institute of Radiation Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
出版信息
Eur Radiol. 2019 Sep;29(9):5052-5062. doi: 10.1007/s00330-018-5993-y. Epub 2019 Feb 15.
OBJECTIVES
To evaluate and compare clinical outcomes of two different radiofrequency ablation (RFA) methods for locally recurred hepatocellular carcinoma (LrHCC) after locoregional treatment.
METHODS
Our institutional review board approved this study with a waiver of informed consent. A total of 313 patients previously treated with transarterial chemoembolization (TACE) (n = 167) and RFA (n = 146) with a single LrHCC ≤ 3 cm was included from five tertiary referral hospitals. RFA was done for LrHCCs using either viable tumor alone ablation (VTA) method (VTA: n = 61 in the TACE group and n = 127 in the RFA group) or whole tumor ablation (WTA) method which includes both viable tumor and retained iodized oil or previously ablated zone (WTA: n = 106 in the TACE group and n = 19 in the RFA group). Local tumor progression (LTP)-free survival as well as progression-free survival (PFS) were estimated using the Kaplan-Meier method, and prognostic factors were evaluated using the Cox proportional hazards regression model.
RESULTS
In 167 patients with LrHCC who underwent TACE, the 5-year LTP-free survival after RFA was significantly higher with the VTA method than with the WTA method (26.9% vs. 87.8%; p < 0.001; hazard ratio (HR) = 8.53 [4.16-17.5]). The estimated 5-year PFS after RFA for LrHCC after TACE using the VTA method was 5.7%, which was significantly lower than that with the WTA method (26.4%) (p = 0.014; HR = 1.62 [1.10-2.38]). However, in 146 patients with LrHCC after initial RFA, there were no significant differences in cumulative incidence of LTP (p = 0.514) or PFS (p = 0.905) after RFA between the two ablation methods.
CONCLUSIONS
For RFA of LrHCC after TACE, the WTA method including both viable tumor and retained iodized oil could significantly lower LTP and improve PFS than VTA.
KEY POINTS
• Whole tumor ablation (WTA) could provide significantly better local tumor control for locally recurred HCC (LrHCC) after TACE than viable tumor alone ablation (VTA). • WTA for LrHCC after TACE could also provide significantly better progression-free survival than VTA. • Regarding LrHCC after RFA, VTA would provide a comparable clinical outcome to WTA.
目的
评估和比较两种不同射频消融（RFA）方法治疗局部复发性肝细胞癌（LrHCC）的临床疗效。
方法
本研究经机构审查委员会批准，豁免知情同意。共纳入来自 5 家三级转诊医院的 313 例既往接受过经动脉化疗栓塞术（TACE）（n=167）和 RFA（n=146）治疗且单个 LrHCC≤3cm 的患者。对于 LrHCC，RFA 分别采用单纯活性肿瘤消融（VTA）方法（VTA：TACE 组 61 例，RFA 组 127 例）或包括活性肿瘤和保留碘化油或先前消融区域的全肿瘤消融（WTA）方法（WTA：TACE 组 106 例，RFA 组 19 例）。采用 Kaplan-Meier 法估计无局部肿瘤进展（LTP）生存率和无进展生存率（PFS），采用 Cox 比例风险回归模型评估预后因素。
结果
在 167 例接受 TACE 治疗的 LrHCC 患者中，与 WTA 方法相比，VTA 方法行 RFA 后 5 年 LTP 无进展生存率显著更高（26.9% vs. 87.8%；p<0.001；风险比（HR）=8.53[4.16-17.5]）。在 VTA 方法下，TACE 后 LrHCC 行 RFA 的 5 年 PFS 估计值为 5.7%，明显低于 WTA 方法（26.4%）（p=0.014；HR=1.62[1.10-2.38]）。然而，在 146 例接受初始 RFA 治疗的 LrHCC 患者中，两种消融方法后 LTP 的累积发生率（p=0.514）或 PFS（p=0.905）无显著差异。
结论
对于 TACE 后 RFA 治疗的 LrHCC，包括活性肿瘤和保留碘化油的 WTA 方法可显著降低 LTP 并改善 PFS，优于 VTA。
关键点
对于 TACE 后 LrHCC，WTA 可显著提高局部肿瘤控制率，优于 VTA。
对于 TACE 后 LrHCC，WTA 可显著提高无进展生存率，优于 VTA。
对于 RFA 后 LrHCC，VTA 与 WTA 的临床结果相当。
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