多种影像学引导下射频消融联合经动脉化疗栓塞治疗特殊部位肝细胞癌。
Multiple imaging modality-guided radiofrequency ablation combined with transarterial chemoembolization for hepatocellular carcinoma in special locations.
机构信息
Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China;Shanghai Institute of Medical Imaging, Shanghai, China.
出版信息
Diagn Interv Radiol. 2020 Mar;26(2):131-139. doi: 10.5152/dir.2019.18540.
PURPOSE
We aimed to evaluate the safety and effectiveness of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) guided by multiple imaging modalities for hepatocellular carcinomas (HCCs) in special (i.e., high-risk or unfavorable) locations compared with those in conventional locations.
METHODS
A total of 122 HCC patients were enrolled, including 85 patients (69.7%) with HCC in conventional locations and 37 (30.3%) with HCC in special locations. The clinical data, overall survival (OS), progression-free survival (PFS), and procedure-related adverse events were analyzed.
RESULTS
RFA combined with TACE was successfully performed in all patients. Three complications (2.5%) occurred, with no significant difference between the conventional (n=1, 1.2%) and special (n=2, 5.4%) locations (P = 0.218). Complete tumor necrosis rate was not significantly different between the conventional (n=73, 85.9%) and special (n=34, 91.9%) locations at one-month imaging (P = 0.353). After a follow-up of 3-48 months, the PFS was 17 months for patients with HCC in conventional locations and 14 months for patients with HCC in special locations; one-year PFS rate was 68.1% in the conventional location group, not significantly (P = 0.741) different from 59.1% in the special location group. The OS was 28 months in the conventional location group while 32 months in the special location group. The cumulative one- and two-year OS rates were 89.9% and 63.3%, respectively, in the conventional location group, not significantly different from 96.3% and 65% in the special location group (P = 0.273). Age (P = 0.043) and tumor size (P < 0.001) were significant prognostic factors for OS, and tumor size (P < 0.001) was the only significant prognostic factor for PFS.
CONCLUSION
RFA guided by multiple imaging modalities combined with TACE may be safe and effective for treating HCCs in special locations.
目的
我们旨在评估射频消融（RFA）联合多模态影像学引导的经动脉化疗栓塞（TACE）治疗特殊（即高危或不利）部位肝细胞癌（HCC）与常规部位 HCC 的安全性和有效性。
方法
共纳入 122 例 HCC 患者，其中 85 例（69.7%）HCC 位于常规部位，37 例（30.3%）HCC 位于特殊部位。分析了患者的临床资料、总生存期（OS）、无进展生存期（PFS）和与操作相关的不良事件。
结果
所有患者均成功完成 RFA 联合 TACE 治疗。3 例（2.5%）发生并发症，常规部位（n=1，1.2%）与特殊部位（n=2，5.4%）之间无显著差异（P=0.218）。1 个月影像学检查时，常规部位（n=73，85.9%）与特殊部位（n=34，91.9%）完全肿瘤坏死率无显著差异（P=0.353）。随访 3-48 个月后，常规部位 HCC 患者的 PFS 为 17 个月，特殊部位 HCC 患者为 14 个月；常规部位组 1 年 PFS 率为 68.1%，与特殊部位组（59.1%）无显著差异（P=0.741）。常规部位组 OS 为 28 个月，特殊部位组为 32 个月。常规部位组累积 1 年和 2 年 OS 率分别为 89.9%和 63.3%，与特殊部位组（96.3%和 65%）无显著差异（P=0.273）。年龄（P=0.043）和肿瘤大小（P<0.001）是 OS 的显著预后因素，而肿瘤大小（P<0.001）是 PFS 的唯一显著预后因素。
结论
多模态影像学引导的 RFA 联合 TACE 治疗特殊部位 HCC 可能是安全有效的。
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