碘油 CT 与超声引导射频消融治疗早期肝细胞癌的比较。
Iodized oil computed tomography versus ultrasound-guided radiofrequency ablation for early hepatocellular carcinoma.
机构信息
Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Road, Taipei, 10002, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
出版信息
Hepatol Int. 2021 Oct;15(5):1247-1257. doi: 10.1007/s12072-021-10236-0. Epub 2021 Aug 2.
BACKGROUND AND PURPOSE
Radiofrequency ablation (RFA) is the standard of care for early stage hepatocellular carcinoma (HCC). However, the clinical outcomes of iodized oil computed tomography (IoCT) versus ultrasound (US)-guided RFA for HCC remain unclear.
METHODS
We retrospectively analyzed consecutive treatment-naïve patients who received curative RFA for HCC within Milan criteria from January 2016 to December 2018. Patients who underwent either IoCT-guided RFA (IoCT group) or US-guided RFA (US group) were included. Various clinical factors, including tumor location, were adjusted with a 1:1 propensity score matching. Subsequently, the cumulative incidence rates for recurrence and hazard ratios for survival were calculated.
RESULTS
We included 184 (37.9%) and 301 (62.1%) patients who received IoCT- and US-guided RFA, respectively. Before propensity score matching, IoCT guidance was significantly associated with multiple tumors, higher body mass index, lower albumin level, and tumors located at S8. After matching, the 1-, 2-, and 3-year local tumor progression rates of the IoCT group were significantly lower than those of the US group (4.4%, 6.9%, and 7.5% vs. 14.4%, 16.3%, and 16.3%, respectively, at p = 0.002, 0.009, and 0.016, respectively). In univariate analyses and multivariate analyses that adjusted for clinical and tumor location-related parameters, the IoCT group had better recurrence-free survival (hazard ratio = 0.581, 95% confidence interval 0.375-0.899) than those with US guidance but not overall survival.
CONCLUSION
IoCT-guided RFA had a lower local tumor progression rate and better recurrence-free survival than did US-guided RFA for HCC within the Milan criteria. CT-guide RFA is a safe and effective alternative to US-guided with similar overall survival. IoCT-guided RFA might have a better local tumor control than US-guided. IoCT-guided RFA may be more suitable for male patients, aged < 70 years, a single tumor measuring 2-5 cm, and a tumor located at the subdiaphragmatic/subcardiac region.
背景与目的
射频消融（RFA）是早期肝细胞癌（HCC）的标准治疗方法。然而，碘化油计算机断层扫描（IoCT）与超声（US）引导下 RFA 治疗 HCC 的临床结果尚不清楚。
方法
我们回顾性分析了 2016 年 1 月至 2018 年 12 月期间接受米兰标准治疗的初治 HCC 患者。纳入接受 IoCT 引导 RFA（IoCT 组）或 US 引导 RFA（US 组）的患者。通过 1:1 倾向评分匹配调整了包括肿瘤位置在内的各种临床因素。随后，计算了复发的累积发生率和生存的风险比。
结果
我们纳入了 184 例（37.9%）和 301 例（62.1%）接受 IoCT 和 US 引导 RFA 的患者。在进行倾向评分匹配之前，IoCT 引导与多发肿瘤、较高的体重指数、较低的白蛋白水平和 S8 部位的肿瘤有关。匹配后，IoCT 组的 1、2 和 3 年局部肿瘤进展率明显低于 US 组（分别为 4.4%、6.9%和 7.5%比 14.4%、16.3%和 16.3%，p=0.002、0.009 和 0.016）。在单变量分析和调整临床和肿瘤位置相关参数的多变量分析中，与 US 引导相比，IoCT 组的无复发生存率更好（风险比=0.581，95%置信区间 0.375-0.899），但总体生存率无差异。
结论
在米兰标准内，IoCT 引导的 RFA 较 US 引导的 RFA 具有更低的局部肿瘤进展率和更好的无复发生存率。CT 引导 RFA 是一种安全有效的替代 US 引导的方法，具有相似的总体生存率。IoCT 引导的 RFA 可能具有比 US 引导更好的局部肿瘤控制效果。IoCT 引导的 RFA 可能更适合男性患者、年龄<70 岁、单发肿瘤 2-5cm 且位于膈下/心下区域的患者。
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