Shimizu Ryo, Tamai Hideyuki, Ida Yoshiyuki, Maeshima Shuya, Shingaki Naoki, Maekita Takao, Iguchi Mikitaka, Kitano Masayuki
Second Department of Internal Medicine Wakayama Medical University Wakayama Japan.
Department of Hepatology Wakayama Rosai Hospital Wakayama Japan.
JGH Open. 2021 Mar 1;5(4):478-485. doi: 10.1002/jgh3.12519. eCollection 2021 Apr.
Percutaneous radiofrequency ablation (RFA) is a minimally invasive and curative local treatment for hepatocellular carcinoma (HCC). However, serious concerns remain regarding critical recurrences such as metastasis, dissemination, and/or seeding due to RFA. In August 2006, we introduced selective feeding artery ablation before tumor ablation to reduce the risk of critical recurrence by blocking tumor blood flow. The aim of the present study was to clarify whether feeding artery ablation before tumor ablation can reduce the risk of critical recurrence after RFA.
This study retrospectively analyzed 279 patients with primary, solitary, and hypervascular HCC ≤5 cm in diameter who were treated with RFA alone between April 2001 and August 2013. Critical recurrence was defined as intra- or extrahepatic metastasis, dissemination, or seeding that was difficult to treat radically.
Of the 279 HCC patients, 157 patients were treated with conventional RFA alone, and 122 patients underwent RFA with prior feeding artery ablation. Although no significant differences were seen in the rates of local tumor progression-free survival, overall recurrence-free survival, or overall survival between a conventional RFA group and a prior feeding artery ablation group, significant differences were seen in rates of critical recurrence-free survival and cancer-specific survival (5-year, 69 81%, = 0.01 and 76 88%, = 0.03, respectively). On multivariate analysis, prior feeding artery ablation, tumor diameter, and alpha-fetoprotein were independent factors related to critical recurrence.
Feeding artery ablation before tumor ablation may reduce the risk of critical recurrence.
经皮射频消融术（RFA）是一种用于肝细胞癌（HCC）的微创根治性局部治疗方法。然而，对于因RFA导致的转移、播散和/或种植等严重复发问题，仍存在严重担忧。2006年8月，我们在肿瘤消融前引入选择性供血动脉消融，以通过阻断肿瘤血流降低严重复发风险。本研究的目的是阐明肿瘤消融前进行供血动脉消融是否能降低RFA术后严重复发的风险。
本研究回顾性分析了2001年4月至2013年8月期间接受单纯RFA治疗的279例直径≤5 cm的原发性、孤立性、富血管性HCC患者。严重复发定义为肝内或肝外转移、播散或种植，难以进行根治性治疗。
279例HCC患者中，157例仅接受传统RFA治疗，122例在RFA前进行了供血动脉消融。虽然传统RFA组和供血动脉消融前组在局部无瘤进展生存率、总无复发生存率或总生存率方面未见显著差异，但在无严重复发生存率和癌症特异性生存率方面存在显著差异（5年时分别为69%对81%，P = 0.01；76%对88%，P = 0.03）。多因素分析显示，供血动脉消融前治疗、肿瘤直径和甲胎蛋白是与严重复发相关的独立因素。
肿瘤消融前进行供血动脉消融可能降低严重复发的风险。
