Interventional Radiology Unit, Department of Diagnostic Medicine and Radiology, UOC Radiology, Sapienza University of Rome, Rome, Italy.
Diagnostic Imaging and Interventional Radiology, University Hospital of Rome Tor Vergata, Rome, Italy.
Radiol Med. 2024 Oct;129(10):1543-1554. doi: 10.1007/s11547-024-01877-w. Epub 2024 Sep 16.
Percutaneous thermal segmentectomy is a single-step combination of microwave ablation, performed during arterial occlusion obtained with a balloon micro catheter, followed in the same session by balloon-occluded TACE. The aim of this multicenter retrospective study is to report the mid-term oncological performance of this technique for liver malignancies > 3.0 cm and to identify risk factors for the loss of sustained complete response.
Oncological results were evaluated with CT or MRI according to m-RECIST (HCC) and RECISTv1.1 (metastasis/intra-hepatic cholangiocarcinoma, iCC) at 1-month, 3-6-month and then at regular-6-month intervals. To identify predictive variables associated with not achieving or losing complete response two mixed-effects multivariable logistic regression models were constructed.
Sixty-three patients (40/23, male/female) with primary liver malignancies (HCC = 49; iCC = 4) and metastasis (n = 10) were treated. Median diameter of target lesion was 4.5 cm (range 3.0-7.0 cm). The median follow-up time was 9.2 months. At one-month follow-up, 79.4% of patients presented with a complete response and the remaining 20.6% were partial responders. At the 3-6-month follow-up, reached by 59 of the initial 63 patients, 83.3% showed a sustained complete response, while 10.2% had a partial response and 8.5% a local recurrence. At the last follow-up, 69.8% of the lesions showed a complete response. The initial diameter of the target lesion ≥ 5.0 cm was the only independent variable associated with the risk of failure in maintaining a complete response at 6 months (OR = 8.58, 95% CI 1.38-53.43; P = 0.02).
Percutaneous thermal segmentectomy achieves promising oncological results in patients with tumors > 3.0 cm, with tumor dimension ≥ 5.0 cm being the only risk factor associated with the failure of a sustained complete response.
经皮热段切除术是微波消融与球囊微导管动脉阻断的单次联合，在同一治疗过程中再进行球囊阻断 TACE。本多中心回顾性研究的目的是报告该技术治疗直径大于 3.0cm 的肝恶性肿瘤的中期肿瘤学结果，并确定持续完全缓解丧失的危险因素。
根据 m-RECIST（HCC）和 RECISTv1.1（转移/肝内胆管癌，iCC），在术后 1 个月、3-6 个月以及之后每 6 个月定期进行 CT 或 MRI 评估肿瘤学结果。为了确定与未达到或失去完全缓解相关的预测变量，构建了两个混合效应多变量逻辑回归模型。
63 名原发性肝恶性肿瘤（HCC=49；iCC=4）和转移患者（n=10）接受了治疗。靶病变的中位直径为 4.5cm（范围 3.0-7.0cm）。中位随访时间为 9.2 个月。在术后 1 个月时，79.4%的患者表现为完全缓解，其余 20.6%为部分缓解。在最初的 63 名患者中的 59 名接受了 3-6 个月的随访，83.3%的患者持续完全缓解，10.2%为部分缓解，8.5%为局部复发。在末次随访时，69.8%的病变表现为完全缓解。肿瘤直径≥5.0cm是与 6 个月时完全缓解失败风险相关的唯一独立变量（OR=8.58，95%CI 1.38-53.43；P=0.02）。
经皮热段切除术在肿瘤直径大于 3.0cm 的患者中取得了有前景的肿瘤学结果，肿瘤尺寸≥5.0cm 是与持续完全缓解失败相关的唯一危险因素。
