Wijnen Niek, Ruijs Emma, Bruijnen Rutger C G, de Bruijne Joep, Hagendoorn Jeroen, Bol Guus M, Intven Martijn P W, Smits Maarten L J
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands.
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands.
Cardiovasc Intervent Radiol. 2025 Aug 26. doi: 10.1007/s00270-025-04167-8.
A tumor diameter > 3 cm is considered a relative contraindication for thermal ablation due to a significant risk of post-ablation recurrence. However, current advanced ablation techniques might allow for successful ablation of larger tumors. This study aimed to evaluate the impact of tumor size on outcomes of Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA).
Patients treated with HepACAGA for hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) between January 2021 and June 2025 were analyzed. All ablations were performed with microwave ablation. Patients were stratified by tumor size: ≤ 2 cm, 2-3 cm, and 3-5 cm. Outcomes assessed included local tumor progression-free survival (LTPFS), local tumor progression (LTP) rate, and complications.
A total of 137 consecutive patients with 265 tumors (152 HCC and 113 CRLM) were included: 187 tumors ≤ 2 cm, 52 tumors 2-3 cm, and 26 tumors 3-5 cm. The 1-year LTPFS was most favorable for tumors ≤ 2 cm (96%; 95% CI: 93-99), followed by 2-3 cm (93%; 95% CI: 85-100), and 3-5 cm (90%; 95% CI: 78-100). No significant differences in LTPFS were found (p = 0.580). Overall, LTP occurred in 5% of tumors. Secondary LTP rates were 3% for tumors ≤ 2 cm and 4% for both tumors 2-3 cm and 3-5 cm (p = 0.966). Complication rates were 4% for tumors ≤ 2 cm, 6% for tumors 2-3 cm, and 13% for tumors 3-5 cm (p = 0.236).
HepACAGA proved to be effective and safe for treating patients with HCC and CRLM across a broad range of tumor sizes. These findings suggest that intermediate-sized tumors (3-5 cm) could be eligible for thermal ablation without compromising post-ablation recurrence.
由于热消融后复发风险显著，肿瘤直径>3 cm被视为热消融的相对禁忌证。然而，当前先进的消融技术可能使更大的肿瘤成功消融。本研究旨在评估肿瘤大小对肝动脉造影和C臂CT引导下消融术（HepACAGA）治疗效果的影响。
分析2021年1月至2025年6月期间接受HepACAGA治疗肝细胞癌（HCC）或结直肠癌肝转移（CRLM）的患者。所有消融均采用微波消融。患者按肿瘤大小分层：≤2 cm、2 - 3 cm和3 - 5 cm。评估的结果包括局部肿瘤无进展生存期（LTPFS）、局部肿瘤进展（LTP）率和并发症。
共纳入137例连续患者的265个肿瘤（152个HCC和113个CRLM）：187个肿瘤≤2 cm，52个肿瘤2 - 3 cm，26个肿瘤3 - 5 cm。1年LTPFS在肿瘤≤2 cm时最为有利（96%；95%CI：93 - 99），其次是2 - 3 cm（93%；95%CI：85 - 100）和3 - 5 cm（90%；95%CI：78 - 100）。未发现LTPFS有显著差异（p = 0.580）。总体而言，5%的肿瘤发生LTP。肿瘤≤2 cm的二次LTP率为3%，2 - 3 cm和3 - 5 cm的肿瘤均为4%（p = 0.966）。肿瘤≤2 cm的并发症发生率为4%，2 - 3 cm的肿瘤为6%，3 - 5 cm的肿瘤为13%（p = 0.236）。
HepACAGA被证明对治疗各种大小肿瘤的HCC和CRLM患者有效且安全。这些发现表明，中等大小的肿瘤（3 - 5 cm）在不影响消融后复发的情况下可以进行热消融。
