经皮微波消融治疗肝癌寡转移瘤的临床疗效：一项回顾性、多中心研究。

Clinical outcomes of percutaneous microwave ablation for pulmonary oligometastases from hepatocellular carcinoma: a retrospective, multicenter study.

机构信息

Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, 16766 Jingshi Road, 250021, Jinan, Shandong, China.

Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China.

出版信息

Cancer Imaging. 2024 Mar 4;24(1):34. doi: 10.1186/s40644-024-00679-7.

DOI:10.1186/s40644-024-00679-7

PMID:38438879

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10913397/

Abstract

BACKGROUND

Pulmonary oligometastases are common in hepatocellular carcinoma (HCC), however, the existing therapeutic options have several limitations. This study aimed to assess the safety and efficacy of microwave ablation (MWA) in the treatment of HCC-originating pulmonary oligometastases.

METHODS

A total of 83 patients, comprising 73 males and 10 females with a median age of 57 years, who had pulmonary oligometastases from HCC, underwent MWA treatment at four different medical institutions. Inclusion criteria for patients involved having primary HCC under control and having less than three oligometastases with a maximum diameter of ≤ 5 cm in the unilateral lung or less than five oligometastases with a maximum diameter of ≤ 3 cm in the bilateral lung. A total of 147 tumors were treated with MWA over 116 sessions. The primary endpoints assessed included technical success, treatment efficacy, and local progression rate, while secondary endpoints encompassed complications, clinical outcomes, overall survival (OS), local progression-free survival (LPFS), and prognostic factors.

RESULTS

The technical success rate for MWA was 100% (116/116 sessions), and the treatment efficacy rate was 82.3% (121/147 tumors). Six months after MWA, the local progression rate was 23.1% (18/147 tumors). Complications were observed in 10.3% (major) and 47.4% (minor) of the 116 sessions, with no cases of ablation-related deaths. The median follow-up period was 21.6 months (range: 5.7-87.8 months). Median OS was 22.0 months, and the 1-, 2-, and 3-year OS rates were 82.6%, 44.5%, and 25.2%, respectively. Median LPFS was 8.5 months. Multivariate Cox regression analysis identified α-fetoprotein (AFP) levels during initial diagnosis and the number of oligometastases as potential independent prognostic factors for OS (p = 0.017 and 0.045, respectively).

CONCLUSION

Percutaneous MWA is a safe and effective treatment modality for pulmonary oligometastases originating from HCC.

摘要

背景

肺寡转移在肝细胞癌（HCC）中很常见，然而，现有的治疗方案存在多种局限性。本研究旨在评估微波消融（MWA）治疗 HCC 肺寡转移的安全性和疗效。

方法

共有 83 名患者（73 名男性和 10 名女性），中位年龄为 57 岁，这些患者均患有 HCC 肺寡转移，在 4 家不同的医疗机构接受 MWA 治疗。纳入标准包括：原发性 HCC 得到控制，单侧肺内最大直径≤5cm 的寡转移灶少于 3 个，或双侧肺内最大直径≤3cm 的寡转移灶少于 5 个。共 147 个肿瘤在 116 次治疗中接受了 MWA 治疗。主要终点评估包括技术成功率、治疗效果和局部进展率，次要终点包括并发症、临床结果、总生存期（OS）、局部无进展生存期（LPFS）和预后因素。

结果

MWA 的技术成功率为 100%（116/116 次），治疗效果率为 82.3%（121/147 个肿瘤）。MWA 治疗后 6 个月，局部进展率为 23.1%（18/147 个肿瘤）。116 次治疗中，并发症发生率为 10.3%（主要）和 47.4%（次要），无与消融相关的死亡病例。中位随访时间为 21.6 个月（范围：5.7-87.8 个月）。中位 OS 为 22.0 个月，1、2 和 3 年 OS 率分别为 82.6%、44.5%和 25.2%。中位 LPFS 为 8.5 个月。多因素 Cox 回归分析显示，初诊时的甲胎蛋白（AFP）水平和寡转移灶数量是 OS 的独立预后因素（p=0.017 和 0.045）。