经皮氩氦刀冷冻消融治疗紧邻膈肌的肝细胞癌的疗效与安全性
Efficacy and Safety of Percutaneous Argon-Helium Cryoablation for Hepatocellular Carcinoma Abutting the Diaphragm.
作者信息
Yang Yumei, Zhang Yanfang, Wu Yumin, Chen Jibing, Liang Bing, Chen Quanhong, Wang Qiuyu, Lyu Jialing, Li Yong, Mu Feng, Du Duanming
机构信息
Department of Ultrasound, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.
Department of Interventional Therapy, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, China.
出版信息
J Vasc Interv Radiol. 2020 Mar;31(3):393-400.e1. doi: 10.1016/j.jvir.2019.11.003. Epub 2020 Jan 24.
PURPOSE
To evaluate the efficacy and safety of percutaneous argon-helium cryoablation (CA) for hepatocellular carcinoma (HCC) abutting the diaphragm (<5 mm).
MATERIALS AND METHODS
A total of 61 consecutive patients (50 men, 11 women; mean age, 56.3 ± 12.1 years old; range, 32-83 years) with 74 HCC tumors (mean size, 3.3 ± 1.7 cm; range, 0.8-7 cm) who were treated with percutaneous argon-helium CA were enrolled in this retrospective study. Adverse events were evaluated according to Common Terminology Criteria for Adverse Events, version 5.0. Local tumor progression (LTP) and overall survival (OS) were analyzed using the Kaplan-Meier method and the log-rank test. The risk factors associated with OS and LTP were evaluated using univariate and multivariate Cox regression analysis.
RESULTS
No periprocedural (30-day) deaths occurred. A total of 29 intrathoracic adverse events occurred in 24 of the 61 patients. Major adverse events were reported in 5 patients (pleural effusion requiring catheter drainage in 4 patients and pneumothorax requiring catheter placement in 1 patient). Median follow-up was 18.7 months (range, 2.3-60.0 months). Median time to LTP after CA was 20.9 months (interquartile range [IQR], 14.1-30.6 months). Median times of OS after CA and diagnosis were 27.3 months (IQR, 15.1-45.1 months) and 40.9 months (interquartile range, 24.8-68.6 months), respectively. Independent prognostic factors for OS included tumor location (left lobe vs right lobe; hazard ratio [HR], 2.031; 95% confidence interval [CI], 1.062-3.885; P = .032) and number of intrahepatic tumors (solitary vs multifocal; HR, 2.684; 95% CI, 1.322-5.447; P = .006). Independent prognostic factors for LTP included age (HR, 0.931; 95% CI, 0.900-0.963; P < .001), guidance modality (ultrasound vs computed tomography and US; HR, 6.156 95% CI, 1.862-20.348; P = .003) and origin of liver disease.
CONCLUSIONS
Percutaneous argon-helium CA is safe for the treatment of HCC abutting the diaphragm, with acceptable LTP and OS.
目的
评估经皮氩氦冷冻消融术（CA）治疗紧贴膈肌（<5mm）的肝细胞癌（HCC）的疗效和安全性。
材料与方法
本回顾性研究纳入了61例连续接受经皮氩氦CA治疗的患者（50例男性，11例女性；平均年龄56.3±12.1岁；范围32 - 83岁），共74个HCC肿瘤（平均大小3.3±1.7cm；范围0.8 - 7cm）。根据不良事件通用术语标准第5.0版评估不良事件。采用Kaplan-Meier法和对数秩检验分析局部肿瘤进展（LTP）和总生存期（OS）。使用单因素和多因素Cox回归分析评估与OS和LTP相关的危险因素。
结果
围手术期（30天）无死亡发生。61例患者中有24例共发生29例胸腔内不良事件。5例患者报告了严重不良事件（4例患者胸腔积液需置管引流，1例患者气胸需置管）。中位随访时间为18.7个月（范围2.3 - 60.0个月）。CA后至LTP的中位时间为20.9个月（四分位间距[IQR]，14.1 - 30.6个月）。CA后和诊断后的OS中位时间分别为27.3个月（IQR，15.1 - 45.1个月）和40.9个月（四分位间距，24.8 - 68.6个月）。OS的独立预后因素包括肿瘤位置（左叶与右叶；风险比[HR]，2.031；95%置信区间[CI]，1.062 - 3.885；P = 0.032）和肝内肿瘤数量（单发与多发；HR，2.684；95% CI，1.322 - 5.447；P = 0.006）。LTP的独立预后因素包括年龄（HR，0.931；95% CI，0.900 - 0.963；P < 0.001）、引导方式（超声与计算机断层扫描和超声；HR，6.156 95% CI，1.862 - 20.348；P = 0.003）和肝病起源。
结论
经皮氩氦CA治疗紧贴膈肌的HCC是安全的，LTP和OS均可接受。
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