原发性肝炎相关病因的肝细胞癌的新一代微波热球消融术的临床结果

Clinical Outcomes of Next-Generation Microwave Thermosphere Ablation for Hepatocellular Carcinoma with Primarily Hepatitis-Related Etiology.

作者信息

Nakamura Shinichiro, Tada Toshifumi, Sue Masahiko, Matsuo Yu, Murakami Shiho, Muramatsu Toshiro, Morii Kazuhiko, Okada Hiroyuki

机构信息

Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji 670-8540, Japan.

出版信息

J Clin Med. 2023 Dec 8;12(24):7577. doi: 10.3390/jcm12247577.

DOI:10.3390/jcm12247577

PMID:38137645

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10743866/

Abstract

BACKGROUND AND AIM

We investigated the clinical outcomes of patients with hepatocellular carcinoma (HCC) who underwent next-generation microwave thermosphere ablation (MTA).

METHODS

A total of 429 patients with 607 HCCs (maximum tumor diameter ≤40 mm) were included. We defined the following areas of the liver as those where MTA therapy is difficult to perform: caudate lobe and areas near the primary and secondary branches of the intrahepatic portal vein, inferior vena cava, gallbladder, heart, duodenum, abdominal esophagus, collateral veins around the liver, and spleen. Factors which predisposed patients to local tumor recurrence in the context of tumor location and complications were examined.

RESULTS

The primary etiologies of HCC were hepatitis-related: 259 (60.4%) cases of HCV, 31 (7.3%) cases of HBV, and two instances of both. Median maximum tumor diameter was 15.0 (interquartile range, 10.0-21.0) mm. There were 86 tumors in areas of the liver where MTA is difficult. The most common area was near the primary and secondary branches of the intrahepatic portal vein (26 nodules). The cumulative local tumor recurrence rates at 1, 2, and 3 years were 4.4%, 8.0%, and 8.5%, respectively. The cumulative local tumor recurrence rate differed significantly by tumor size group: 6.6%, 13.8%, and 29.4% at three years in the ≤20 mm group ( = 483), 20-30 mm group ( = 107), and ≥30 mm group ( = 17), respectively ( < 0.001). The cumulative local tumor recurrence rate was similar despite difficult-to-treat status ( = 0.169). In the multivariable analysis, tumor size (>15 mm) (hazard ratio [HR], 2.15; 95% confidence interval [CI], 1.11-4.16; = 0.023) and ablative margin (<3 mm) (HR, 2.94; 95% CI, 1.52-5.71; = 0.001) were significantly associated with local tumor recurrence. Only tumor size (>15 mm) (odds ratio, 3.41 95% CI, 1.53-7.84; = 0.026) was significantly associated with complications.

CONCLUSIONS

MTA is a safe and effective local ablation therapy for HCC, even for tumors located in areas of the liver where local ablation therapy is difficult.

摘要

背景与目的

我们调查了接受新一代微波热消融（MTA）的肝细胞癌（HCC）患者的临床结局。

方法

共纳入429例患者，有607个肝癌病灶（最大肿瘤直径≤40mm）。我们将肝脏的以下区域定义为难以进行MTA治疗的区域：尾状叶以及肝内门静脉一、二级分支附近区域、下腔静脉、胆囊、心脏、十二指肠、腹段食管、肝脏周围的侧支静脉以及脾脏。研究了在肿瘤位置和并发症情况下易导致患者局部肿瘤复发的因素。

结果

HCC的主要病因与肝炎相关：丙型肝炎病毒（HCV）感染259例（60.4%），乙型肝炎病毒（HBV）感染31例（7.3%），两种病毒合并感染2例。最大肿瘤直径中位数为15.0（四分位间距为10.0 - 21.0）mm。在肝脏难以进行MTA治疗的区域有86个肿瘤。最常见的区域是肝内门静脉一、二级分支附近（26个结节）。1年、2年和3年的累积局部肿瘤复发率分别为4.4%、8.0%和8.5%。累积局部肿瘤复发率在不同肿瘤大小组中有显著差异：≤20mm组（n = 483）、20 - 30mm组（n = 107）和≥30mm组（n = 17）3年时分别为6.6%、13.8%和29.4%（P < 0.001）。尽管处于难以治疗的状态，累积局部肿瘤复发率相似（P = 0.169）。多变量分析中，肿瘤大小（>15mm）（风险比[HR]，2.15；95%置信区间[CI]，1.11 - 4.16；P = 0.023）和消融边缘（<3mm）（HR，2.94；95%CI，1.52 - 5.71；P = 0.001）与局部肿瘤复发显著相关。只有肿瘤大小（>15mm）（优势比，3.41；95%CI，1.53 - 7.84；P = 0.026）与并发症显著相关。