3D visualization ablation planning system assisted microwave ablation for hepatocellular carcinoma (Diameter >3): a precise clinical application
3D visualization ablation planning system assisted microwave ablation for hepatocellular carcinoma (Diameter >3): a precise clinical application
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3D可视化消融规划系统辅助微波消融治疗肝细胞癌（直径>3）：精准临床应用
DOI：
10.1186/s12885-020-6519-y
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发表时间：
2020-01-20
期刊：
影响因子：
3.8
通讯作者：
Liang, Ping
中科院分区：
文献类型：
--
作者：
An, Chao;Li, Xin;Liang, Ping
背景本回顾性研究的目的是比较三维可视化消融计划系统（3DVAPS）辅助下超声引导经皮微波消融（US-PMWA）与传统二维计划治疗直径> 3 cm肝细胞癌（HCC）的可行性和有效性。方法回顾性分析2015年4月至2018年8月期间130例符合入选标准的223个HCC结节（直径5.0 ± 1.5 cm，[3.0-10.0 cm]）患者，分为3D和2D计划组。比较消融参数和肿瘤学结局，包括总生存期（OS）、无复发生存期（RFS）和局部肿瘤进展（LTP）。对临床病理变量进行多因素分析，以确定OS和LTP的危险因素。结果随访3-44个月，中位随访21个月。插入次数（5.4 +/- 1.2 vs. 4.5 +/- 0.9，P = 0.034），消融时间（1249.2 +/- 654.2 s vs. 1082.4 +/- 584.7 s，P = 0.048），消融能量3D计划组的消融能量（57，000 +/-11，892 J vs. 42，600 +/-10，271 J，P = 0.038）和首次消融成功率（95.0% vs. 85.7%，P = 0.033）均高于2D计划组。两组的OS、RFS差异无统计学意义（P = 0.995，P = 0.845）。3D计划组LTP发生率低于2D计划组（16.5%VS41.2%，P = 0.003）。多因素分析显示肿瘤最大直径（P < 0.001）、肿瘤数量（P = 0.003）和术前TACE（P < 0.001）是OS的预测因素，而疗程（P = 0.024）、甲胎蛋白水平（P = 0.004）和术前计划（P = 0.002）分别是LTP的预测因素。结论3DVAPS提高了超声引导下消融的精确性，对于直径大于3cm的肝癌患者，LTP较低，5 mm-AM较高。
Background The aim of this retrospective study was to compare the feasibility and efficiency of ultrasound-guided percutaneous microwave ablation (US-PMWA) assisted by three-dimensional visualization ablation planning system (3DVAPS) and conventional 2D planning for hepatocellular carcinoma (HCC) (diameter > 3 cm). Methods One hundred thirty patients with 223 HCC nodules (5.0 +/- 1.5 cm in diameter, [3.0-10.0 cm]) who met the eligibility criteria divided into 3D and 2D planning group were reviewed from April 2015 to August 2018. Ablation parameters and oncological outcomes were compared, including overall survival (OS), recurrence-free survival (RFS), and local tumor progression (LTP). Multivariate analysis was performed on clinicopathological variables to identify the risk factors for OS and LTP. Results The median follow-up period was 21 months (range 3-44). Insertion number (5.4 +/- 1.2 VS. 4.5 +/- 0.9, P = 0.034), ablation time (1249.2 +/- 654.2 s VS. 1082.4 +/- 584.7 s, P = 0.048), ablation energy (57,000 +/- 11,892 J VS. 42,600 +/- 10,271 J, P = 0.038) and success rate of first ablation (95.0% VS. 85.7%, P = 0.033) were higher in the 3D planning group compared with those in 2D planning group. There was no statistical difference in OS, and RFS between the two groups (P = 0.995, P = 0.845). LTP rate of 3D planning group was less than that of 2D planning group (16.5% VS 41.2%, P = 0.003). Multivariate analysis showed tumor maximal diameters (P < 0.001), tumor number (P = 0.003) and preoperative TACE (P < 0.001) were predictors for OS and sessions (P = 0.024), a-fetoprotein level (P = 0.004), and preoperative planning (P = 0.002) were predictors for LTP, respectively. Conclusions 3DVAPS improves precision of US guided ablation resulting in lower LTP and higher 5 mm-AM for patients with HCC lesions larger than 3 cm in diameter.