经导管动脉化疗栓塞联合锥形束计算机断层扫描引导下微波消融治疗小肝细胞癌 50 例临床经验

Transcatheter Arterial Chemoembolization Combined with Simultaneous Cone-beam Computed Tomography-guided Microwave Ablation in the Treatment of Small Hepatocellular Carcinoma: Clinical Experiences From 50 Procedures.

机构信息

Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 450000, China.

Geriatric respiratory Ward, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

出版信息

Acad Radiol. 2021 Nov;28 Suppl 1:S64-S70. doi: 10.1016/j.acra.2020.08.036. Epub 2020 Oct 13.

DOI:10.1016/j.acra.2020.08.036

PMID:33060007

Abstract

RATIONALE AND OBJECTIVES

To investigate the technical success, safety and outcomes of transcatheter arterial chemoembolization (TACE) combined with simultaneous cone-beam computed tomography (CBCT)-guided microwave ablation (MWA) in small hepatocellular carcinoma (SHCC).

MATERIALS AND METHODS

Retrospective analysis of 66 lesions in 50 patients (38 men, 12 women) who underwent TACE combined with simultaneous CBCT-guided MWA for SHCC. After 1 month of treatment, the tumor responses were assessed using the mRECIST criteria, along with interventional-related complications and changes in hepatic and renal function. Moreover, progression-free survival (PFS) and overall survival (OS) were calculated.

RESULTS

All patients achieved technical success. The mean target tumor size was 3.4 ± 0.7 (range, 2.2-4.9) cm. The mean energy, ablation duration per tumor, and the mean safety margin were 51.3 ± 8.4 kJ, 6.7 ± 0.8 minutes and 1.4 ± 0.6 cm, respectively. The 1-, 3-, and 5-year PFS rates were 90.0%, 65.4%, and 35.7%, respectively, with a mean PFS of 43.46 months; and the 1-, 3-, and 5-year OS rates were 98.0%, 89.8%, and 74.3%, respectively, with a mean OS of 54.90 months. Multivariate Cox regression analysis further illustrated that TACE combined with MWA in the treatment of a single tumor with a diameter of less than 3 cm was an independent protective factor for PFS and OS (p < 0.001). The patients had no major complications. Among the exceptions, one patient (2%) had an asymptomatic perihepatic effusion that resolved spontaneously, two patients (4%) developed massive right pleural effusion, requiring thoracic drainage, and another patient (2%) developed a hepatic subcapsular hemorrhage required interventional embolization.

CONCLUSION

CBCT-guided TACE combined with simultaneous MWA was a safe and successful treatment of SHCC with a high technical efficacy.

摘要

背景与目的

探讨经导管肝动脉化疗栓塞（TACE）联合同步锥形束 CT（CBCT）引导下微波消融（MWA）治疗小肝细胞癌（SHCC）的技术成功率、安全性和临床疗效。

材料与方法

回顾性分析 50 例（男 38 例，女 12 例）共 66 个病灶接受 TACE 联合同步 CBCT 引导下 MWA 治疗 SHCC 的患者资料。治疗后 1 个月，采用 mRECIST 标准评估肿瘤反应，同时记录介入相关并发症及肝肾功能变化。计算无进展生存期（PFS）和总生存期（OS）。

结果

所有患者均达到技术成功。靶肿瘤平均直径为 3.4±0.7（2.2-4.9）cm。平均能量、每个肿瘤的消融时间和平均安全边缘分别为 51.3±8.4 kJ、6.7±0.8 分钟和 1.4±0.6 cm。1、3、5 年 PFS 率分别为 90.0%、65.4%和 35.7%，平均 PFS 为 43.46 个月；1、3、5 年 OS 率分别为 98.0%、89.8%和 74.3%，平均 OS 为 54.90 个月。多因素 Cox 回归分析进一步表明，TACE 联合 MWA 治疗单个肿瘤直径＜3 cm 是 PFS 和 OS 的独立保护因素（p＜0.001）。患者均未发生严重并发症。其中，1 例（2%）出现无症状性肝周积液，自行缓解；2 例（4%）发生大量右侧胸腔积液，需行胸腔引流；另 1 例（2%）发生肝包膜下血肿，行介入栓塞治疗。