Christou Anna S, Lee Katerina Hoowon, Varble Nicole A, Borde Tabea, Arrichiello Antonio, de Ruiter Quirina M, Parker Olivia, Lencioni Riccardo, Xu Sheng, Turkbey Evrim, Wood Bradford J
Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland.
Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland; Philips Research North America, Cambridge, Massachusetts.
J Vasc Interv Radiol. 2025 Jul 1. doi: 10.1016/j.jvir.2025.06.019.
To evaluate the association of 3-dimensional (3D) undertreated volume and tumor features to local recurrence and survival in patients with hepatocellular carcinoma (HCC) treated with radiofrequency (RF) ablation.
A total of 556 patients with well-defined solitary large HCC tumors (3-7 cm) treated with RF ablation alone or RF ablation plus ThermoDox from a multicenter trial between 2014 and 2018 were retrospectively considered for this study. Each patient had pre-RF ablation and 28-day post-RF ablation computed tomography (CT) with sufficient quality. Overall, 185 patients (61 years [SD ± 11]; female, 24%) were included in this study. The mean tumor volume was 31.8 cm (SD ± 27.6). The percent of the tumor covered by the ablation zone was determined by semimanual 3D tumor and devascularized ablation zone segmentation with subsequent elastic registration. Tumor and ablation zone overlap and tumor morphology were compared with local recurrence and survival by univariate and multivariate statistical analyses.
There was a difference between percent overlap volume, with the RF ablation-alone group showing a higher overlap volume compared with RF ablation + ThermoDox group (73% [SD ± 17] vs 66% [SD ± 22], P = .02). Local recurrence was associated with a larger tumor volume (P = .004) and a higher tumor flatness (P = .034). A modest trend existed between survival and a lower absolute overlap volume (P = .068), lower absolute undertreated volume (P = .063), and lower tumor volume (P = .067).
The correlations between tumor-ablation zone overlap and local recurrence and survival suggests that 3D preablation and postablation image registration could aid in verification of adequate treatment coverage or to predict recurrence. Image assessment and registration with ablation may support standardization, tailored treatment approaches, and outcome prediction.
评估三维（3D）治疗不足体积与肿瘤特征与接受射频（RF）消融治疗的肝细胞癌（HCC）患者局部复发和生存的相关性。
本研究回顾性纳入了2014年至2018年一项多中心试验中556例经单纯射频消融或射频消融联合ThermoDox治疗的边界清晰的孤立性大HCC肿瘤（3 - 7厘米）患者。每位患者在射频消融术前和术后28天均有质量足够的计算机断层扫描（CT）。总体而言，本研究纳入了185例患者（年龄61岁[标准差±11]；女性占24%）。平均肿瘤体积为31.8立方厘米（标准差±27.6）。通过半自动三维肿瘤和去血管化消融区分割以及随后的弹性配准来确定消融区覆盖肿瘤的百分比。通过单因素和多因素统计分析比较肿瘤与消融区的重叠情况以及肿瘤形态与局部复发和生存的关系。
重叠体积百分比存在差异，单纯射频消融组的重叠体积高于射频消融 + ThermoDox组（73%[标准差±17]对66%[标准差±22]，P = 0.02）。局部复发与更大的肿瘤体积（P = 0.004）和更高的肿瘤扁平度（P = 0.034）相关。生存与更低的绝对重叠体积（P = 0.068）、更低的绝对治疗不足体积（P = 0.063）和更低的肿瘤体积（P = 0.067）之间存在适度趋势。
肿瘤 - 消融区重叠与局部复发和生存之间的相关性表明，三维消融术前和术后图像配准有助于验证治疗覆盖范围是否足够或预测复发。图像评估以及与消融的配准可能支持标准化、个性化治疗方法和结果预测。
