经皮射频消融治疗肝细胞癌的疗效：电极类型和放置方法的影响。
Treatment Outcomes of Percutaneous Radiofrequency Ablation for Hepatocellular Carcinomas: Effects of the Electrode Type and Placement Method.
机构信息
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Health Sciences and Technology, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
出版信息
Korean J Radiol. 2023 Aug;24(8):761-771. doi: 10.3348/kjr.2023.0022.
OBJECTIVE
To investigate the association among the electrode placement method, electrode type, and local tumor progression (LTP) following percutaneous radiofrequency ablation (RFA) for small hepatocellular carcinomas (HCCs) and to assess the risk factors for LTP.
MATERIALS AND METHODS
In this retrospective study, we enrolled 211 patients, including 150 males and 61 females, who had undergone ultrasound-guided RFA for a single HCC < 3 cm. Patients were divided into four combination groups of the electrode type and placement method: 1) tumor-puncturing with an internally cooled tip (ICT), 2) tumor-puncturing with an internally cooled wet tip (ICWT), 3) no-touch with ICT, and 4) no-touch with ICWT. Univariable and multivariable Cox proportional-hazards regression analyses were performed to evaluate the risk factors for LTP. The major RFA-related complications were assessed.
RESULTS
Overall, 83, 34, 80, and 14 patients were included in the ICT, ICWT, no-touch with ICT, and no-touch with ICWT groups, respectively. The cumulative LTP rates differed significantly among the four groups. Compared to tumor puncturing with ICT, tumor puncturing with ICWT was associated with a lower LTP risk (adjusted hazard ratio [aHR] = 0.11, 95% confidence interval [CI] = 0-0.88, = 0.034). However, the cumulative LTP rate did not differ significantly between tumor-puncturing with ICT and no-touch RFA with ICT (aHR = 0.34, 95% CI = 0.03-1.62, = 0.188) or ICWT (aHR = 0.28, 95% CI = 0-2.28, = 0.294). An insufficient ablative margin was a risk factor for LTP (aHR = 6.13, 95% CI = 1.41-22.49, = 0.019). The major complication rates were 1.2%, 0%, 2.5%, and 21.4% in the ICT, ICWT, no-touch with ICT, and no-touch with ICWT groups, respectively.
CONCLUSION
ICWT was associated with a lower LTP rate compared to ICT when performing tumor-puncturing RFA. An insufficient ablation margin was a risk factor for LTP.
目的
研究经皮射频消融（RFA）治疗小肝细胞癌（HCC）后电极放置方法、电极类型与局部肿瘤进展（LTP）之间的关系，并评估 LTP 的危险因素。
材料与方法
本回顾性研究纳入了 211 例接受超声引导下 RFA 治疗的单个<3cm HCC 的患者，包括 150 例男性和 61 例女性。患者被分为四组，分别为：1）经皮穿刺内冷探头（ICT）消融组，2）经皮穿刺内冷湿探头（ICWT）消融组，3）无接触 ICT 消融组，4）无接触 ICWT 消融组。采用单变量和多变量 Cox 比例风险回归分析评估 LTP 的危险因素。评估主要与 RFA 相关的并发症。
结果
ICT、ICWT、无接触 ICT 和无接触 ICWT 组分别纳入 83、34、80 和 14 例患者。四组的累积 LTP 率差异有统计学意义。与 ICT 经皮穿刺相比，ICWT 经皮穿刺与较低的 LTP 风险相关（调整后的危险比[aHR] = 0.11，95%置信区间[CI] = 0-0.88， = 0.034）。然而，ICT 经皮穿刺与无接触 ICT 消融（aHR = 0.34，95%CI = 0.03-1.62， = 0.188）或 ICWT 消融（aHR = 0.28，95%CI = 0-2.28， = 0.294）之间的累积 LTP 率差异无统计学意义。消融范围不足是 LTP 的危险因素（aHR = 6.13，95%CI = 1.41-22.49， = 0.019）。ICT、ICWT、无接触 ICT 和无接触 ICWT 组的主要并发症发生率分别为 1.2%、0%、2.5%和 21.4%。
结论
与 ICT 经皮穿刺相比，ICWT 行肿瘤穿刺 RFA 与较低的 LTP 率相关。消融范围不足是 LTP 的危险因素。
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