High local recurrence of early-stage hepatocellular carcinoma after percutaneous thermal ablation in routine clinical practice
High local recurrence of early-stage hepatocellular carcinoma after percutaneous thermal ablation in routine clinical practice
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DOI：
10.1097/meg.0000000000000270
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发表时间：
2015-03-01
影响因子：
2.1
通讯作者：
Wigg, Alan J.
中科院分区：
文献类型：
--
作者：
Chinnaratha, Mohamed A.;Sathananthan, Dharshan;Wigg, Alan J.
背景和目的：经皮热消融（PTA）治疗早期肝细胞癌（HCC）后局部肿瘤进展（LTP）的风险和预测LTP的因素尚未在非试验环境中得到充分研究，可能被低估。我们的目的是评估这些结果在multicentriclestudy.Patients和方法这是一个回顾性研究的连续患者与早期肝细胞癌治疗的治疗意图在2006年和2012年之间的三个三级澳大利亚中心与射频消融或微波消融。主要终点是LTP和多变量分析进行，以确定LTP的独立predictors.Results在126例患者（78%的男性，平均+/- SD年龄62 +/- 10岁），平均+/- SD随访13.5 +/- 13个月，共145个肝癌结节进行了治疗。局部复发率为23.4%（34/145）。平均+/- SD无LTP生存期为46.9 +/- 3.6个月。对于2 cm或更小的HCC结节，局部复发率较低（15.9%），平均+/- SD无LTP生存期为48.8 +/- 4.2个月。低分化HCC [风险比（95%置信区间）= 4.8（1.1-20.4），P = 0.032]和治疗前甲胎蛋白> 50 kIU/l [8.2（1.7-39.0），P = 0.008]是LTP的独立预测因素。射频消融组和微波消融组的LTP发生率无显著差异（22.8 vs. 25.8%，P = 0.7）。有6例（4.8%）手术相关的不良事件，但没有死亡。结论PTA后局部复发的早期肝癌是在常规的临床实践中。低分化HCC和治疗前甲胎蛋白是LTP的重要独立预测因子。需要进一步进行设计良好的随机对照试验，使用辅助治疗联合PTA降低LTP率，样本量更大。版权所有（C）2015威科医疗集团All rights reserved.
Background and aim The risk of local tumour progression (LTP) and factors predicting LTP following percutaneous thermal ablation (PTA) of early-stage hepatocellular carcinoma (HCC) have not been well studied in non-trial settings and may be underestimated. We aimed to assess these outcomes in a multicentre study.Patients and methods This was a retrospective review of consecutive patients with early-stage HCC treated with a curative intent across three tertiary Australian centres between 2006 and 2012 with either radiofrequency ablation or microwave ablation. The primary endpoint was LTP and multivariate analysis was carried out to identify the independent predictors of LTP.Results In total 145 HCC nodules were treated in 126 patients (78% men, mean +/- SD age 62 +/- 10 years) with a mean +/- SD follow-up of 13.5 +/- 13 months. Local recurrence was observed in 23.4% (34/145). Mean +/- SD LTP-free survival was 46.9 +/- 3.6 months. For HCC nodules 2 cm or less, local recurrence rates were lower (15.9%), with a mean +/- SD LTP-free survival of 48.8 +/- 4.2 months. Poorly differentiated HCC [hazard ratio (95% confidence interval) = 4.8 (1.1-20.4), P = 0.032] and pretreatment alpha-fetoprotein more than 50 kIU/l [8.2 (1.7-39.0), P = 0.008] were independent predictors of LTP. LTP rates were not significantly different between the radiofrequency ablation and the microwave ablation groups (22.8 vs. 25.8%, P = 0.7). There were six (4.8%) procedure-related adverse events, but no deaths.Conclusion Local recurrence after PTA for early-stage HCC is high in routine clinical practice. Poorly differentiated HCC and pretreatment a-fetoprotein are important, independent predictors of LTP. Further well-designed randomized controlled trials with larger sample sizes using adjuvant therapies in combination with PTA to decrease LTP rates are warranted. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.