肝脏热消融治疗肝细胞癌和结直肠癌肝转移患者的长期疗效与空间特征和肿瘤特异性变量相关。
Long-term results of liver thermal ablation in patients with hepatocellular carcinoma and colorectal cancer liver metastasis regarding spatial features and tumor-specific variables.
机构信息
Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
Hacettepe University Faculty of Medicine, Department of Biostatistics, Ankara, Türkiye
出版信息
Diagn Interv Radiol. 2024 May 13;30(3):183-192. doi: 10.4274/dir.2023.221986. Epub 2023 Mar 20.
PURPOSE
Colorectal cancer liver metastasis (CRLM) and hepatocellular carcinoma (HCC) are widely treated using microwave and radiofrequency ablation. Local tumor progression (LTP) may develop depending on the shortest vascular distance and large lesion diameter. This study aims to explore the effect of these spatial features and to investigate the correlation between tumor-specific variables and LTP.
METHODS
This is a retrospective study covering the period between January 2007 and January 2019. One hundred twenty-five patients (CRLM: HCC: 64:61) with 262 lesions (CRLM: HCC: 142:120) were enrolled. The correlation between LTP and the variables was analyzed using the chi-square test, Fischer's exact test, or the Fisher-Freeman-Halton test where applicable. The local progression-free survival (Loc-PFS) was analyzed using the Kaplan-Meier method. Univariable and multivariable Cox regression analyses were performed to identify prognostic factors.
RESULTS
Significant correlations were observed for LTP in both CRLM and HCC at a lesion diameter of 30-50 mm ( = 0.019 and < 0.001, respectively) and SVD of ≤3 mm ( < 0.001 for both). No correlation was found between the ablation type and LTP (CRLM: = 0.141; HCC: = 0.771). There was no relationship between residue and the ablation type, but a strong correlation with tumor size was observed ( = 0.127 and < 0.001, respectively). In CRLM, LTP was associated with mutant K-ras and concomitant lung metastasis ( < 0.001 and = 0.003, respectively). In HCC, a similar correlation was found for Child-Pugh B, serum alpha-fetoprotein (AFP) level of >10 ng/mL, predisposing factors, and moderate histopathological differentiation ( < 0.001, = 0.008, = 0.027, and < 0.001, respectively). In CRLM, SVD of ≤3 mm proved to be the variable with the greatest negative effect on Loc-PFS ( = 0.007), followed by concomitant lung metastasis ( = 0.027). In HCC, a serum AFP level of >10 ng/mL proved to be the variable with the greatest negative effect on Loc-PFS ( = 0.045).
CONCLUSION
In addition to the lesions' spatial features, tumor-specific variables may also have an impact on LTP.
目的
结直肠癌肝转移（CRLM）和肝细胞癌（HCC）广泛采用微波和射频消融治疗。局部肿瘤进展（LTP）可能因最短血管距离和大病灶直径而发生。本研究旨在探讨这些空间特征的影响，并研究肿瘤特异性变量与 LTP 的相关性。
方法
这是一项回顾性研究，涵盖了 2007 年 1 月至 2019 年 1 月期间的病例。共纳入 125 例患者（CRLM：HCC：64：61），共 262 个病灶（CRLM：HCC：142：120）。采用卡方检验、Fisher 精确检验或 Fisher-Freeman-Halton 检验分析 LTP 与变量之间的相关性，适用时。采用 Kaplan-Meier 法分析局部无进展生存期（Loc-PFS）。采用单变量和多变量 Cox 回归分析确定预后因素。
结果
在病灶直径为 30-50mm（ = 0.019 和 < 0.001）和 SVD ≤3mm（均 < 0.001）时，CRLM 和 HCC 中均观察到 LTP 有显著相关性。消融类型与 LTP 之间无相关性（CRLM： = 0.141；HCC： = 0.771）。残基与消融类型之间无关系，但与肿瘤大小有很强的相关性（ = 0.127 和 < 0.001）。在 CRLM 中，LTP 与突变型 K-ras 和伴发肺转移有关（均 < 0.001）。在 HCC 中，类似的相关性也存在于 Child-Pugh B、血清 alpha-fetoprotein（AFP）水平>10ng/ml、诱发因素和中组织病理学分化（均 < 0.001）。在 CRLM 中，SVD ≤3mm 是对 Loc-PFS 影响最大的变量（ = 0.007），其次是伴发肺转移（ = 0.027）。在 HCC 中，血清 AFP 水平>10ng/ml 是对 Loc-PFS 影响最大的变量（ = 0.045）。
结论
除病灶的空间特征外，肿瘤特异性变量也可能对 LTP 产生影响。
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