Long-term survival after radiofrequency ablation of complex unresectable liver tumors
Long-term survival after radiofrequency ablation of complex unresectable liver tumors
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DOI：
10.1001/archsurg.141.6.581
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发表时间：
2006-06-01
影响因子：
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通讯作者：
Bilchik, Anton J.
中科院分区：
文献类型：
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作者：
Amersi, Farin F.;McElrath-Garza, Ana;Bilchik, Anton J.
假设：射频消融术（RFA）可以提高不可切除和难治性肿瘤高危患者的生存率。设计：前瞻性数据库的回顾性分析。设置：三级转诊癌症中心。患者和方法：1997年11月1日至2005年1月31日，我们进行了219次RFA手术，消融了181例患者的521个肝脏肿瘤。结果：在181例患者中，52%为男性，48%为女性，平均年龄为61.3岁（年龄范围：27-91岁）。通过剖腹术（n=135）、腹腔镜（n=48）或经皮穿刺（n=36）进行了射频消融。在106例患者（79%）中，RFA与手术切除联合使用。最常见的肿瘤包括结直肠癌（40.9%）、肝细胞癌（14.9%）、类癌（13.8%）、黑色素瘤（9.4%）和乳腺癌（5.0%）。每例患者的平均肿瘤数量为3.3个肿瘤。每次手术射频治疗的平均病变数量为2.38处病变;平均病变尺寸为3.56 cm（病变尺寸范围，0.8-9.0 cm）。平均随访33.2个月（随访范围12-91个月），类癌的总生存期为48.3个月，肝细胞癌为25.2个月，黑色素瘤为18.5个月，结直肠癌为29.7个月，乳腺癌为30.1个月。78例患者（43%）复发。在接受治疗的521例肿瘤中，125例（24%）复发;大于3 cm的肿瘤局部复发率为28%，小于或等于3 cm的肿瘤局部复发率为18%（P= 0.04）。29例患者接受了连续消融。71例患者（39%）在最后follow-up.Conclusion无病：一个显着数量的肝脏恶性肿瘤是不可切除的或难治性化疗的患者可以考虑RFA作为一个多模态治疗方案的一部分。在这些患者中，RFA是安全的，可以延长生存期。
Hypothesis: Radiofrequency ablation (RFA) may improve survival of high-risk patients with unresectable and refractory tumors.Design: Retrospective analysis of a prospective database.Setting: A tertiary referral cancer center.Patients and Methods: Between November 1, 1997, and January 31, 2005, we performed 219 RFA procedures to ablate 521 hepatic tumors in 181 patients.Results: Of the 181 patients, 52% were male and 48% were female, and the mean age was 61.3 years (age range, 27-91 years). Radiofrequency ablation was performed via celiotomy (n=135), via laparoscopy (n=48), or percutaneously (n=36). In 106 patients (79%), RFA was used in combination with surgical resection. The most common tumors included colorectal cancer (40.9%), hepatocellular carcinoma (14.9%), carcinoid tumor (13.8%), melanoma (9.4%), and breast cancer (5.0%). The average number of tumors per patient was 3.3 tumors. The average number of RFA-treated lesions per procedure was 2.38 lesions; the mean lesion size was 3.56 cm (lesion size range, 0.8-9.0 cm). At a mean follow-up of 33.2 months (follow-up range, 12-91 months), overall survival was 48.3 months for carcinoid tumors, 25.2 months for hepatocellular carcinoma, 18.5 months for melanoma, 29.7 months for colorectal cancer, and 30.1 months for breast cancer. Seventy-eight patients (43%) developed recurrences. Of 521 tumors that were treated, 125 (24%) recurred; the incidence of local recurrence was 28% for tumors larger than 3 cm vs 18% for tumors 3 cm or smaller (P=.04). Twenty-nine patients underwent serial ablations. Seventy-one patients (39%) were disease free at last follow-up.Conclusion: A significant number of patients whose hepatic malignancies are unresectable or refractory to chemotherapy may be considered for RFA as part of a multimodality therapeutic regimen. In these patients, RFA is safe and may prolong survival.