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老年患者肝脏肿瘤的立体定向射频消融术

Stereotactic Radiofrequency Ablation of Liver Tumors in Octogenarians.

作者信息

Schullian Peter, Putzer Daniel, Silva Michael A, Laimer Gregor, Kolbitsch Christian, Bale Reto

机构信息

Section of Interventional Oncology - Microinvasive Therapy, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.

Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.

出版信息

Front Oncol. 2019 Sep 19;9:929. doi: 10.3389/fonc.2019.00929. eCollection 2019.

Abstract

This study aimed to evaluate the efficacy and overall clinical outcome of patients over the age of 80 undergoing stereotactic radiofrequency ablation (SRFA) and to compare the results to a younger population with propensity score matching. Between 2006 and 2018 36 patients aged between 80 and 90 years underwent 46 SRFA sessions of 70 primary and secondary liver tumors. For comparison of treatment safety and efficacy 36 younger patients were selected with propensity score matching by the R package "MatchIt" in this retrospective, single-center study. 68/70 tumors were successfully ablated at first ablation session (97% primary technical efficacy rate). Local tumor recurrence developed in 5 of 70 nodules (7.1%). The complication rate above Clavien-Dindo Grade III was 6.5% (3 of 46). The overall survival (OS) rates at 1-, 3-, and 5- years from the date of the first SRFA were 84.6, 50.5, and 37.9% for HCC patients and 87.5%, 52.5% at 1-, and 3-years for CRC patients. The disease-free survival (DFS) for HCC patients after SRFA was 79.1, 35.6, and 23.7%, at 1-, 3-, and 5- years, and 75%, 22.5% at 1-, and 3-years for CRC patients. There were no significant differences in terms of technical efficacy, local recurrences, major complications, OS and DFS compared to the control group. SRFA in octogenarians is a safe, feasible and useful option in the management of primary or metastatic liver tumors with no significant difference in outcomes compared to a younger control group.

摘要

本研究旨在评估80岁以上患者接受立体定向射频消融术(SRFA)的疗效和总体临床结局,并通过倾向评分匹配将结果与年轻人群进行比较。2006年至2018年期间,36例年龄在80至90岁之间的患者接受了46次SRFA治疗,共治疗70个原发性和继发性肝肿瘤。在这项回顾性单中心研究中,为比较治疗安全性和疗效,通过R软件包“MatchIt”对36例年轻患者进行倾向评分匹配。70个肿瘤中有68个在首次消融治疗时成功消融(初次技术有效率为97%)。70个结节中有5个发生局部肿瘤复发(7.1%)。Clavien-DindoⅢ级以上并发症发生率为6.5%(46例中有3例)。肝癌患者自首次SRFA之日起1年、3年和5年的总生存率(OS)分别为84.6%、50.5%和37.9%,结直肠癌患者1年和3年的总生存率分别为87.5%和52.5%。SRFA术后肝癌患者的无病生存率(DFS)在1年、3年和5年分别为79.1%、35.6%和23.7%,结直肠癌患者1年和3年的无病生存率分别为75%和22.5%。与对照组相比,在技术疗效、局部复发、主要并发症、OS和DFS方面无显著差异。对于原发性或转移性肝肿瘤的治疗,八旬老人接受SRFA是一种安全、可行且有用的选择,与年轻对照组相比,结局无显著差异。

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