Department of Radiology, UT Southwestern Medical Center, United States of America.
Department of Radiology, UT Southwestern Medical Center, United States of America.
Clin Imaging. 2020 Nov;67:146-151. doi: 10.1016/j.clinimag.2020.06.014. Epub 2020 Jun 20.
To compare percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of Hepatocellular carcinoma (HCC) and to identify risk factors for treatment failure and local progression.
145 unique HCC [87 (60%) RFA, 58 (40%) MWA] were retrospectively reviewed from a single tertiary medical center. Adverse events were classified as severe, moderate, or mild according to the Society of Interventional Radiology Adverse Event Classification system. Primary and secondary efficacy, as well as local progression, were determined using mRECIST. Predictors of treatment failure and time to local progression were analyzed using generalized estimating equations and Cox regression, respectively.
Technical success was achieved in 143/145 (99%) HCC. There were 1 (0.7%) severe and 2 (1.4%) moderate adverse events. Of the 143 technically successful initial treatments, 136 (95%) completed at least one follow-up exam. Primary efficacy was achieved in 114/136 (84%). 9/22 (41%) primary failures underwent successful repeat ablation, so secondary efficacy was achieved in 128/136 (90%) HCC. Local progression occurred in 24 (19%) HCC at a median of 25 months (95% CI = 19-32 months). There was no difference in technical success, primary efficacy, or time to local progression between RFA and MWA. In HCC treated with MWA, same-day biopsy was associated with primary failure (RR = 9.0, 95% CI: 1.7-47, P = 0.015), and proximity to the diaphragm or gastrointestinal tract was associated with local progression (HR = 2.40, 95% CI:1.5-80, P = 0.017).
There was no significant difference in primary efficacy or time to local progression between percutaneous RFA and MWA.
比较经皮射频消融（RFA）和微波消融（MWA）治疗肝细胞癌（HCC）的效果，并确定治疗失败和局部进展的危险因素。
回顾性分析了单中心 145 例 HCC[87（60%）RFA，58（40%）MWA]患者的资料。根据介入放射学会不良事件分类系统，将不良事件分为严重、中度和轻度。采用 mRECIST 评估原发性和继发性疗效以及局部进展情况。采用广义估计方程和 Cox 回归分析治疗失败和局部进展时间的预测因素。
145 例 HCC 中，143 例（99%）技术上获得成功。1 例（0.7%）出现严重不良事件，2 例（1.4%）出现中度不良事件。在 143 例技术上成功的初始治疗中，有 136 例（95%）至少完成了一次随访检查。114 例（84%）达到原发性疗效。22 例（41%）原发性失败患者行再次消融治疗成功，因此，136 例 HCC 中（90%）达到继发性疗效。中位随访时间为 25 个月（95%CI=19-32 个月）时，24 例（19%）HCC 发生局部进展。RFA 和 MWA 之间在技术成功率、原发性疗效或局部进展时间方面均无差异。在接受 MWA 治疗的 HCC 中，当天活检与原发性失败相关（RR=9.0，95%CI：1.7-47，P=0.015），而距离膈肌或胃肠道较近与局部进展相关（HR=2.40，95%CI：1.5-80，P=0.017）。
经皮 RFA 和 MWA 在原发性疗效或局部进展时间方面无显著差异。
