Kapoor Harit, Nisiewicz Michael J, Jayavarapu Ravi, Gedaly Roberto, Raissi Driss
Departments of Radiology, University of Kentucky, Lexington, Kentucky.
Departments of Surgery, University of Kentucky, Lexington, Kentucky.
J Clin Imaging Sci. 2020 Mar 31;10:10. doi: 10.25259/JCIS_173_2019. eCollection 2020.
Microwave ablation (MWA) of liver malignancies has gained much traction over the past 5 years. However, MWA carries relatively higher rates of residual disease compared to resection. Likelihood of MWA success is multifactorial and newer devices with more reliable ablation zones are being developed to overcome these drawbacks. This manuscript is a review of our first 100 liver ablations with the newer single antenna high powered MWA system.
Retrospective chart review of patients that underwent MWA for either primary or secondary hepatic malignancies between March 2015 and July 2016 was conducted. The complete ablation rates, rate of new lesions, complications, and short-term survival were analyzed. Multiple statistical tests, including multivariate regression, were used to assess risk factors for local residual and recurrent disease.
Fifty-three patients (median age 61 ± 9 years, 39 males) underwent 100 MWAs. Of the 100 lesions ablated, 76 were hepatocellular cancers (HCCs) and 24 were metastases. Median lesion size was 16 ± 9 mm. Seventy- five of these patients had multifocal disease targeted in the same session. Seventy patients had cirrhosis (median model for end-stage liver disease score 9 ± 3; Child-Pugh B and C in 42%). An 83% complete lesion ablation rate was seen on follow-up imaging with liver protocol magnetic resonance imaging/computed tomography (median follow-up of 1 year). The minor complication rate was 9.4% with no major complications or 30-day mortality. Despite this, evidence of new foci of hepatic disease was found in 47% of patients, the majority (80%) of which were in HCC patients ( < 0.01) and most of these new lesions were in a different hepatic segment (64%). Degree of cirrhosis ( < 0.01), presence of non-alcoholic steatohepatitis (NASH) ( = 0.01) and lesion's subcapsular location ( = 0.03) was significant predictors of residual disease. With the subset analysis of only HCC lesions larger than 1 cm, only the presence of NASH remained significant.
The single probe high power MWA of malignant hepatic lesions is safe and effective with minimal morbidity. Degree of cirrhosis, NASH, and subcapsular location was associated with an increased rate of residual disease on short-term follow-up.
在过去5年中，肝脏恶性肿瘤的微波消融（MWA）技术已获得广泛应用。然而，与手术切除相比，MWA术后疾病残留率相对较高。MWA成功的可能性受多种因素影响，目前正在研发具有更可靠消融区域的新型设备以克服这些缺点。本文是对我们使用新型单天线高功率MWA系统进行的前100例肝脏消融手术的回顾。
对2015年3月至2016年7月期间因原发性或继发性肝脏恶性肿瘤接受MWA治疗的患者进行回顾性病历审查。分析完全消融率、新发病变率、并发症及短期生存率。采用包括多因素回归在内的多种统计学检验评估局部残留和复发疾病的危险因素。
53例患者（中位年龄61±9岁，男性39例）接受了100次MWA治疗。在消融的100个病灶中，76个为肝细胞癌（HCC），24个为转移瘤。病灶中位大小为16±9mm。其中75例患者在同一次治疗中针对多灶性病变进行了治疗。70例患者有肝硬化（终末期肝病模型评分中位值9±3；Child-Pugh B级和C级占42%）。采用肝脏磁共振成像/计算机断层扫描方案进行随访成像（中位随访时间1年）时，完全病灶消融率为83%。轻微并发症发生率为9.4%，无严重并发症或30天死亡率。尽管如此，47%的患者发现有肝脏疾病新病灶的证据，其中大多数（80%）为HCC患者（P<0.01），且这些新病灶大多位于不同肝段（64%）。肝硬化程度（P<0.01）、非酒精性脂肪性肝炎（NASH）的存在（P=0.01）和病灶的包膜下位置（P=0.03）是残留疾病的重要预测因素。仅对大于1cm的HCC病灶进行亚组分析时，仅NASH的存在仍具有统计学意义。
单探头高功率MWA治疗肝脏恶性病变安全有效，发病率极低。肝硬化程度、NASH和包膜下位置与短期随访时残留疾病发生率增加相关。
