失代偿期肝硬化患者肝细胞癌的微波消融与射频消融对比研究

Microwave ablation versus radiofrequency ablation for hepatocellular carcinoma in patients with decompensated cirrhosis.

作者信息

Yu Hongli, Yang Yao, Lin Xinran, Xu Yinling, Ying Anna, Lu Boling, Feng Yuemin, Zhao Xinya, Zhu Qiang, Zheng Hang

机构信息

Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.

Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China; Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University People's Hospital, Beijing, 100044, China.

出版信息

HPB (Oxford). 2025 Mar;27(3):377-384. doi: 10.1016/j.hpb.2024.12.010. Epub 2024 Dec 15.

DOI:10.1016/j.hpb.2024.12.010

PMID:39741059

Abstract

BACKGROUND

The efficacy of microwave ablation (MWA) and radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients with decompensated cirrhosis remains unclear.

METHODS

A total of 315 patients with decompensated cirrhosis and HCC who underwent MWA or RFA were recruited. Recurrence beyond the Milan criteria (RBM), local tumor progression (LTP), overall survival (OS), and complications were evaluated and compared.

RESULTS

After propensity score matching, the overall liver-related complication rates were 12.1 % in the current study. The cumulative RBM rates were lower in patients treated with MWA compared to those treated with RFA (21.9 % vs. 23.4 % at 1 year; 42.3 % vs. 66.8 % at 5 years; p = 0.016). In addition, lower cumulative rates of LTP were found in patients treated with MWA compared to those treated with RFA (6.2 % vs. 19.9 % at 1 year; 14.7 % vs. 27.8 % at 3 years; p = 0.032). The OS rates at 1 and 5 years were 89.9 % and 58.9 % in the MWA group, and 80.7 %, and 38.9 % in the RFA group, respectively (p = 0.105).

CONCLUSION

HCC patients with decompensated cirrhosis can undergo MWA or RFA with acceptable mortality, morbidity and liver-rated complications rates. MWA demonstrates superiority over RFA in tumor control.

摘要

背景

微波消融（MWA）和射频消融（RFA）在失代偿期肝硬化肝细胞癌（HCC）患者中的疗效尚不清楚。

方法

共纳入315例接受MWA或RFA治疗的失代偿期肝硬化合并HCC患者。评估并比较米兰标准以外的复发（RBM）、局部肿瘤进展（LTP）、总生存期（OS）和并发症。

结果

倾向评分匹配后，本研究中肝脏相关并发症的总发生率为12.1%。与接受RFA治疗的患者相比，接受MWA治疗的患者累积RBM发生率较低（1年时分别为21.9%和23.4%；5年时分别为42.3%和66.8%；p = 0.016）。此外，与接受RFA治疗的患者相比，接受MWA治疗的患者LTP累积发生率较低（1年时分别为6.2%和19.9%；3年时分别为14.7%和27.8%；p = 0.032）。MWA组1年和5年的OS率分别为89.9%和58.9%，RFA组分别为80.7%和38.9%（p = 0.105）。