MRI 引导下经皮热消融作为肝切除术后复发性肝恶性肿瘤的一线治疗：单中心长期经验。

MRI-guided percutaneous thermoablation as first-line treatment of recurrent hepatic malignancies following hepatic resection: single center long-term experience.

机构信息

Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany.

Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.

出版信息

Int J Hyperthermia. 2021;38(1):1401-1408. doi: 10.1080/02656736.2021.1979257.

DOI:10.1080/02656736.2021.1979257

PMID:34542009

Abstract

PURPOSE

Hepatic recurrence of liver malignancies is a leading problem in patients after liver resection with curative intention. Thermoablation is a promising treatment approach for patients after hepatic resection, especially in liver-limited conditions. This study aimed to investigate safety, survival, and local tumor control rates of MRI-guided percutaneous thermoablation of recurrent hepatic malignancies following hepatic resection.

MATERIAL AND METHODS

Data from patients with primary or secondary hepatic malignancies treated between 2004 and 2018 with MRI-guided percutaneous thermoablation of hepatic recurrence after prior hepatic resection were retrospectively analyzed. Disease-free survival and overall survival rates were calculated using the Kaplan-Meier method.

RESULTS

A total of 57 patients with hepatic recurrence (mean tumor size = 18.9 ± 9.1 mm) of colorectal cancer liver metastases ( = 27), hepatocellular carcinoma ( = 17), intrahepatic recurrence of cholangiocellular carcinoma ( = 9), or other primary malignant tumor entities ( = 4) were treated once or several times with MR-guided percutaneous radiofrequency ( = 52) or microwave ablation ( = 5) (range: 1-4 times). Disease progression occurred due to local recurrence at the ablation site in nine patients (15.8%), non-local hepatic recurrence in 33 patients (57.9%), and distant malignancy in 18 patients (31.6%). The median overall survival for the total cohort was 40 months and 49 months for the colorectal cancer group, with a 5-year overall survival rate of 40.7 and 42.5%, respectively. The median disease-free survival was 10 months for both the total cohort and the colorectal cancer group with a 5-year disease-free survival rate of 15.1 and 14.8%, respectively. The mean follow-up time was 39.6 ± 35.7 months.

CONCLUSION

MR-guided thermoablation is an effective and safe approach in the treatment of hepatic recurrences in liver-limited conditions and can achieve long-term survival.

摘要

目的

肝脏恶性肿瘤的肝内复发是根治性肝切除术后患者面临的主要问题。热消融是肝切除术后患者的一种很有前途的治疗方法，尤其适用于肝局限性疾病。本研究旨在探讨 MRI 引导下经皮热消融治疗肝切除术后肝内复发性恶性肿瘤的安全性、生存率和局部肿瘤控制率。

材料与方法

回顾性分析了 2004 年至 2018 年间，57 例经 MRI 引导下经皮热消融治疗肝切除术后肝内复发性原发性或继发性肝脏恶性肿瘤患者的数据。采用 Kaplan-Meier 法计算无病生存率和总生存率。

结果

27 例结直肠癌肝转移，17 例肝细胞癌，9 例肝内胆管细胞癌，4 例其他原发性恶性肿瘤患者，共 57 例（平均肿瘤直径=18.9±9.1mm），单次或多次接受 MRI 引导下经皮射频消融（=52）或微波消融（=5）治疗（范围：1-4 次）。9 例（15.8%）患者因消融部位局部复发，33 例（57.9%）患者因非局部肝内复发，18 例（31.6%）患者因远处恶性肿瘤进展而导致疾病进展。全组患者中位总生存期为 40 个月，结直肠癌组为 49 个月，5 年总生存率分别为 40.7%和 42.5%。全组和结直肠癌组的中位无病生存期均为 10 个月，5 年无病生存率分别为 15.1%和 14.8%。平均随访时间为 39.6±35.7 个月。