Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea.
Department of Internal Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea.
Abdom Radiol (NY). 2023 Oct;48(10):3243-3252. doi: 10.1007/s00261-023-03987-x. Epub 2023 Jun 30.
To evaluate the incidence, risk factors, and prognosis associated with peritoneal seeding after percutaneous radiofrequency ablation (RFA) for HCC, focusing on viable tumors after previous locoregional treatment, including TACE and RFA.
Exactly 290 patients (mean age, 67.9 years ± 9.74; 223 men) with 383 HCCs (mean size, 15.9 mm ± 5.49) who underwent RFA between June 2012 and December 2019 were included in this retrospective study. Among them, 158 had history of previous treatment (mean number, 1.3 ± 1.8) with 109 viable HCCs. Cumulative seeding after RFA was estimated using the Kaplan-Meier method. Independent factors affecting seeding were investigated using multivariable Cox proportional hazards regression analysis.
Median follow-up was 1175 days (range: 28-4116). Seeding incidence was 4.1 (12/290) and 4.7% (17/383) per patient and tumor, respectively. The median time interval between RFA and detection of seeding was 785 days (range: 81-1961). Independent risk factors for seeding included subcapsular tumor location (hazard ratio [HR] 4.2; 95% confidence interval [CI] 1.4, 13.0; p = 0.012) and RFA for viable HCC after previous locoregional treatment (HR 4.5; 95% CI 1.7, 12.3; p = 0.003). Subgroup analysis for viable tumors, revealed no significant difference in cumulative seeding rates between the TACE and RFA groups (p = 0.078). Cumulative overall survival rates differed significantly between patients with and without seeding metastases (p < 0.001).
Peritoneal seeding after RFA is a rare, delayed complication. Subcapsular-located and viable HCC after previous locoregional treatment are potential risk factors for seeding. Seeding metastases could affect the prognosis of patients who cannot receive local therapy.
评估经皮射频消融（RFA）治疗 HCC 后发生腹膜播种的发生率、相关风险因素和预后，重点关注先前局部区域治疗（包括 TACE 和 RFA）后有活力的肿瘤。
本回顾性研究共纳入 290 例（平均年龄 67.9±9.74 岁，223 例男性）383 个 HCC 患者，这些患者于 2012 年 6 月至 2019 年 12 月期间接受了 RFA 治疗。其中 158 例有既往治疗史（平均数量 1.3±1.8 次），其中 109 个 HCC 为有活力的肿瘤。采用 Kaplan-Meier 法估计 RFA 后播种的累积发生率。使用多变量 Cox 比例风险回归分析调查影响播种的独立因素。
中位随访时间为 1175 天（范围：28-4116 天）。播种发生率为 4.1（12/290）和 4.7%（17/383）/患者和肿瘤。RFA 与播种检测之间的中位时间间隔为 785 天（范围：81-1961 天）。播种的独立危险因素包括肿瘤位于肝包膜下（危险比[HR] 4.2；95%置信区间[CI] 1.4-13.0；p=0.012）和 RFA 治疗先前局部区域治疗后有活力的 HCC（HR 4.5；95%CI 1.7-12.3；p=0.003）。对于有活力的肿瘤的亚组分析，TACE 和 RFA 组之间的累积播种率无显著差异（p=0.078）。有播种转移和无播种转移的患者的总生存累积率有显著差异（p<0.001）。
RFA 后腹膜播种是一种罕见的、延迟发生的并发症。先前局部区域治疗后位于肝包膜下和有活力的 HCC 是播种的潜在危险因素。播种转移可能会影响无法接受局部治疗的患者的预后。
