Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Value Health. 2019 Mar;22(3):284-292. doi: 10.1016/j.jval.2018.10.004. Epub 2018 Nov 27.
For patients with hepatocellular carcinoma (HCC) not eligible for surgical resection, radiofrequency ablation (RFA) is a promising technique that reduces the risk of disease progression.
To evaluate whether the trend of image guidance for RFA is moving toward the more expensive computed tomography (CT) technology and to determine the clinical benefits of CT guidance over the ultrasound (US) guidance.
A cohort of 463 patients was identified from the Surveillance, Epidemiology, and End Results and Medicare-linked database. The temporal trends in use of image guidance were assessed using the Cochrane-Armitage test. The associations between modality of image guidance and survival, complications, and costs were assessed using the Cox regression model, the logistic regression model, and the generalized linear model, respectively.
The use of CT-guided RFA increased sharply, from 20.7% in 2002 to 75.9% in 2011. Compared with CT-guided RFA, those who received US-guided RFA had comparable risk of periprocedural and delayed postprocedural complications. Stratified analyses by tumor size also showed no statistically significant difference. In adjusted survival analysis, no statistically significant difference was observed in overall and cancer-specific survival. Nevertheless, the cost of CT-guided RFA ($2847) was higher than that of US-guided RFA ($1862).
Despite its rapid adoption over time, CT-guided RFA incurred higher procedural costs than US-guided RFA but did not significantly improve postprocedural complications and survival. Echoing the American Board of Internal Medicine's Choosing Wisely campaign and the American Society of Clinical Oncology's Value of Cancer Care initiative, findings from our study call for critical evaluation of whether CT-guided RFA provides high-value care for patients with HCC.
对于不符合手术切除条件的肝细胞癌 (HCC) 患者，射频消融 (RFA) 是一种很有前途的技术，可以降低疾病进展的风险。
评估 RFA 的影像引导是否倾向于更昂贵的计算机断层扫描 (CT) 技术，并确定 CT 引导相对于超声 (US) 引导的临床优势。
从监测、流行病学和最终结果以及与医疗保险相关的数据库中确定了 463 名患者的队列。使用 Cochrane-Armitage 检验评估图像引导使用的时间趋势。使用 Cox 回归模型、逻辑回归模型和广义线性模型分别评估影像引导模式与生存、并发症和成本之间的关联。
CT 引导的 RFA 使用率急剧上升，从 2002 年的 20.7%上升到 2011 年的 75.9%。与 CT 引导的 RFA 相比，接受 US 引导的 RFA 的患者在围手术期和延迟术后并发症方面的风险相当。按肿瘤大小分层分析也没有统计学差异。在调整后的生存分析中，总生存率和癌症特异性生存率均无统计学差异。然而，CT 引导的 RFA（$2847）成本高于 US 引导的 RFA（$1862）。
尽管 CT 引导的 RFA 随着时间的推移迅速普及，但与 US 引导的 RFA 相比，其手术成本更高，但并未显著改善术后并发症和生存率。我们的研究结果呼应了美国内科医师学会的明智选择运动和美国临床肿瘤学会的癌症护理价值倡议，呼吁对 CT 引导的 RFA 是否为 HCC 患者提供高价值护理进行批判性评估。
