Radiofrequency ablation following first-line transarterial chemoembolization for patients with unresectable hepatocellular carcinoma beyond the Milan criteria.
Radiofrequency ablation following first-line transarterial chemoembolization for patients with unresectable hepatocellular carcinoma beyond the Milan criteria.
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超出米兰标准的不可切除肝细胞癌患者一线经动脉化疗栓塞后的射频消融
DOI：
10.1186/1471-230x-14-11
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发表时间：
2014-01-10
影响因子：
2.4
通讯作者：
Ren ZG
中科院分区：
文献类型：
--
作者：
Zhang L;Yin X;Gan YH;Zhang BH;Zhang JB;Chen Y;Xie XY;Ge NL;Wang YH;Ye SL;Ren ZG
最近的研究表明，射频消融（RFA）和经动脉化疗栓塞（TACE）联合治疗肝细胞癌（HCC）在理论上可能比单独使用TACE有优势。本研究的目的是评估一线TACE治疗后射频消融治疗超出米兰标准的HCC的有效性和安全性。45例超过米兰标准的HCC患者在一线TACE治疗后连续接受RFA。不完全坏死肿瘤结节患者在TACE治疗后1-2个月内进行RFA。回顾性评价主要疗效、并发症、生存率和预后因素。根据随访1个月的计算机断层扫描/磁共振成像评估，76.2%的病灶完全消融。平均随访时间30.9个月（3 ~ 94个月）。RFA治疗后无重大并发症。中位总生存期为29个月（20-38个月），1年、2年和3年生存率分别为89%、61%和43%。多因素分析显示，肿瘤直径（P = 0.045，危险比[HR] = 0.228, 95%可信区间[CI]: 0.054 ~ 0.968）和预处理血清甲胎蛋白水平（P = 0.024，危险比[HR] = 2.239, 95% CI: 1.114 ~ 4.500）是长期生存的独立预测因素。超出米兰标准的HCC可以在一线TACE治疗后通过射频消融完全安全消融，并发症发生率低，生存预后良好。在米兰标准之外，有必要进一步评估hcc联合治疗的生存益处。
Recent studies suggest that a combination of radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may have theoretical advantages over TACE alone for treatment of hepatocellular carcinoma (HCC). The purpose of this study was to evaluate the effectiveness and safety of radiofrequency ablation following first-line TACE treatment in the management of HCC beyond the Milan Criteria. Forty-five patients who consecutively underwent RFA following first-line TACE treatment for HCC beyond the Milan criteria were enrolled in this study. RFA was performed within 1–2 months after TACE treatment in patients who had incomplete necrotic tumor nodules. Primary effectiveness, complications, survival rates, and prognostic factors were evaluated retrospectively. Complete ablation was achieved in 76.2% of the lesions according to 1-month follow-up computed tomography/magnetic resonance imaging evaluation. The mean follow-up period was 30.9 months (range 3–94 months). There were no major complications after RFA therapy. The median overall survival was 29 months (range 20–38 months), with 1-, 2-, and 3-year survival of 89%, 61%, and 43%, respectively. Multivariate analysis revealed that tumor diameter (P = 0.045, hazard ratio [HR] = 0.228, 95% confidence interval [CI]: 0.054-0.968) and pretreatment serum alpha-fetoprotein level (P = 0.024, HR = 2.239, 95% CI: 1.114-4.500) were independent predictors for long-term survival. HCC beyond the Milan criteria can be completely and safely ablated by radiofrequency ablation following first-line TACE treatment with a low rate of complications and favorable survival outcome. Further assessment of the survival benefits of combination treatment for HCCs beyond the Milan Criteria is warranted.