Safety and Efficacy of Irreversible Electroporation for the Treatment of Hepatocellular Carcinoma Not Amenable to Thermal Ablation Techniques: A Retrospective Single-Center Case Series
Safety and Efficacy of Irreversible Electroporation for the Treatment of Hepatocellular Carcinoma Not Amenable to Thermal Ablation Techniques: A Retrospective Single-Center Case Series
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DOI：
10.1148/radiol.2017161413
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发表时间：
2017-09-01
期刊：
影响因子：
19.7
通讯作者：
Seror, Olivier
中科院分区：
文献类型：
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作者：
Sutter, Olivier;Calvo, Joyce;Seror, Olivier
目的：评价不可逆电穿孔(IRE)治疗不符合热消融技术条件的不能手术的肝细胞癌患者的安全性和有效性。材料和方法：这项回顾性研究获得伦理审查委员会的批准，免除了获得知情书面同意的要求。自2012年3月至2015年6月，58例肝硬变患者(中位年龄65.4岁，年龄41.6-90岁)接受IRE治疗75例肝癌。肿瘤平均直径为24 mm(范围690 mm)。选择IRE是因为肿瘤的位置(48例)或患者的一般情况较差(10例)。在治疗后1个月和此后每3个月进行磁共振成像评估治疗反应。使用Kaplan Meier方法评估每个结节(包括初始治疗失败)的总体局部肿瘤无进展生存期(PFS)。使用边际COX比例风险模型评估与总体局部肿瘤PFS相关的因素。结果：75个肿瘤中，58个(77.3%)、67个(89.3%)和69个(92%)分别在1次、2次和3次IRE手术后完全消融。中位随访9个月(3天至31个月)，75个治疗结节的6个月和12个月总的局部肿瘤PFS率分别为87%(95%可信区间：77%，93%)和70%(95%可信区间：56%，81%)。消融前血清Ato蛋白水平高于200 ng/m L(危险比：9.94[95%CI：2.82，35.06]，P=.0004)是唯一与局部肿瘤PFS相关的因素。发生并发症11例(19%)，其中I级3例，II级5例，IV级2例，V级1例。3例(5.2%)III级以上并发症为ChildPugh B级病变患者发生肝功能衰竭，1例死亡。结论：IRE可以安全、彻底地消融那些有其他常用消融技术禁忌症的患者的肝细胞癌。(C)RSNA，2017年
Purpose: To assess the safety and efficacy of irreversible electroporation (IRE) in the treatment of patients with inoperable hepatocellular carcinoma (HCC)who are ineligible for thermal ablative techniques.Materials and Methods: This retrospective study was approved by an ethics review board, and the requirement to obtain informed written consent was waived. From March 2012 to June 2015, 58 patients (median age, 65.4 years; range 41.6-90 years) with cirrhosis received IRE for the treatment of 75 HCC tumors. The median tumor diameter was 24 mm (range, 690 mm). IRE was selected because of tumor location (48 patients) or the patient's poor general condition (10 patients). Treatment response was assessed with magnetic resonance (MR) imaging 1 month after treatment and every 3 months thereafter. Overall local tumor progressionfree survival (PFS) per nodule (including initial treatment failures) was assessed by using the KaplanMeier method. The marginal Cox proportional hazards model was used to assess the factors associated with overall local tumor PFS. Complications were recorded and graded according to the ClavienDindo classification.Results: Of 75 tumors, 58 (77.3%), 67 (89.3%), and 69 (92%) were completely ablated after one, two, and three IRE procedures, respectively. After a median follow-up of 9 months (range, 3 days to 31 months), the 6 and 12month overall local tumor PFS rates for the 75 treated nodules were 87% (95% confidence interval [CI]: 77%, 93%) and 70% (95% CI: 56%, 81%), respectively. A preablative serum afetoprotein level higher than 200 ng/mL (hazard ratio: 9.94 [95% CI: 2.82, 35.06], P =.0004) was the only factor linked with overall local tumor PFS. Complications occurred in 11 of the 58 patients (19%) and were classified as grade I in three patients, grade II in five patients, grade IV in two patients, and grade V in one patient. The three (5.2%) complications classified as grade III or higher were liver failures occurring in patients with ChildPugh class B disease; one led to death.Conclusion: IRE offers safe, complete ablation of HCC tumors in patients with contraindications to other commonly used ablative techniques. (C) RSNA, 2017