Long-term Favorable Outcomes of Radiofrequency Ablation for Hepatocellular Carcinoma as an Initial Treatment: A Single-center Experience Over a 10-Year Period
Long-term Favorable Outcomes of Radiofrequency Ablation for Hepatocellular Carcinoma as an Initial Treatment: A Single-center Experience Over a 10-Year Period
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DOI：
10.21873/anticanres.12321
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发表时间：
2018-02-01
影响因子：
2
通讯作者：
Baba, Hideo
中科院分区：
文献类型：
--
作者：
Tsukamoto, Masayo;Yamashita, Yo-Ichi;Baba, Hideo
背景：射频消融（RFA）是肝切除术的替代方案，是肝细胞癌（HCC）的主要治疗方案之一。在这里，我们研究了RFA作为HCC初始治疗的长期结果。患者和方法：2000年1月至2014年12月，我们在熊本大学医院治疗了1043例肝癌RFA患者；其中327例（31.4%）接受了原发性HCC治疗。在排除75名接受联合治疗的患者后，对252名患者的数据进行了检查。我们回顾性分析了RFA的长期预后，并确定了预后不良的因素。结果：15 min时血小板计数中位数为9.1 × 10(4)/ μ l，凝血酶原活性中位数为83%，吲哚菁绿保留率为26%。5年总生存率（OS）为69%，中位生存时间为7.0年。5年无复发生存率（RFS）为17%，中位RFS为2.0年。多因素分析显示，年龄> ~ 80岁[危险比(HR)=7.76, p=0.011]、肿瘤直径> ~ 2 cm （HR=1.68, p=0.047）和多发肿瘤（HR=1.87, p=0.014）是预后不良的独立因素。对于RFS，去- γ -羧基凝血酶原(DCP) =40 mAU/ml （HR=1.47, p=0.038）和多发性肿瘤（HR=1.63, p=0.0056）是独立预后因素。33/252例患者（13%）和33/372例肿瘤（8.9%）在消融部位发生局部复发。结论：虽然我们的队列包括肝功能相对较差的患者，但RFA获得了69%的有利5年生存率。DCP >= 40 mAU/ ml和多发hcc导致复发风险增高。因此，有这些因素的患者应密切随访。
Background: Radiofrequency ablation (RFA) is an alternative to hepatic resection and one of the major therapeutic options for hepatocellular carcinoma (HCC). Here, we investigated the long-term outcomes of RFA as an initial treatment for HCC. Patients and Methods: From January 2000 to December 2014, we treated 1,043 patients with RFA for HCC at the Kumamoto University Hospital; 327 of these patients (31.4%) were treated for primary HCC. After exclusion of 75 patients who underwent combined therapy, data for 252 patients were examined. We retrospectively analyzed the long-term outcomes of RFA and identified factors of poor prognosis. Results: The median platelet count, prothrombin activity and indocyanine green retention rate at 15 min were 9.1x10(4)/mu l, 83% and 26%, respectively. The 5-year overall survival (OS) rate was 69% and the median survival time was 7.0 years. The 5-year recurrence-free survival (RFS) rate was 17%, and the median RFS was 2.0 years. A multivariate analysis revealed that age >80 years [hazard ratio (HR)=7.76, p=0.011], tumor diameter >2 cm (HR=1.68, p=0.047) and multiple tumors (HR=1.87, p=0.014) were independent prognostic factors for poor OS. For RFS, des-gamma-carboxy prothrombin (DCP) =40 mAU/ml (HR=1.47, p=0.038) and multiple tumors (HR=1.63, p=0.0056) were independent prognostic factors. Local recurrence at the ablated site occurred in 33/252 patients (13%), and in 33/372 tumors (8.9%). Conclusion: Although our cohort included patients with relatively worse liver function, a favorable 5-year survival rate 69% was obtained by RFA. DCP >= 40 mAU/ ml and multiple HCCs contribute to a higher risk of recurrence. Patients with these factors should therefore be followed-up intensively.