Treatment strategy for hepatocellular carcinoma: expanding the indications for radiofrequency ablation
Treatment strategy for hepatocellular carcinoma: expanding the indications for radiofrequency ablation
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DOI：
10.1007/s00535-008-2247-9
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发表时间：
2009-01-01
影响因子：
6.3
通讯作者：
Omata, Masao
中科院分区：
文献类型：
--
作者：
Tateishi, Ryosuke;Shiina, Shuichiro;Omata, Masao
背景肝细胞癌（HCC）的射频消融（RFA）通常适用于3个或更少结节的患者，直径均不超过3 cm。本研究探讨了结节的直径和数量对HCC患者预后的影响是否存在明显的阈值。方法.我们招募了663名初治HCC患者，他们在1999年至2005年期间在我院接受了RFA治疗。以结节直径和数目为协变量，Child-Pugh分级为分层因素，采用多因素考克斯比例回归分析患者的预后。直径和数量分别为5cm和1，2-3，4-5和>5。结果最大结节5 cm患者的校正风险比分别为1、1.51、2.56、2.25和2.71。有1个、2个或3个、4个或5个以及5个以上结节的患者的校正风险比分别为1、1.35、1.70和2.12。因此，有三个或更少结节的患者，直径均不超过5 cm，5年生存率为40%。结论.随着结节直径和数目的增加，患者的预后逐渐恶化。未检测到HCC结节直径或数量的明显阈值。RFA可应用于常规适应症之外。
Background. Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is ordinarily indicated for those with three or fewer nodules, none of which exceeds 3 cm in diameter. This study investigated whether an apparent threshold exists in the diameter and number of nodules in terms of the prognosis of patients with HCC. Methods. We enrolled 663 nave patients with HCC who were treated with RFA at our hospital between 1999 and 2005. We analyzed the patients' prognosis using multivariate Cox proportional regression with the diameter and number of nodules as covariates and Child-Pugh class as a stratification factor. The diameter and number were categorized as 5 cm and 1, 2-3, 4-5, and >5, respectively. Results. The adjusted hazard ratio of patients whose largest nodule was 5 cm was 1, 1.51, 2.56, 2.25, and 2.71, respectively. The adjusted hazard ratio of patients with one, two or three, four or five, and more than five nodules was 1, 1.35, 1.70, and 2.12, respectively. Therefore, patients with three or fewer nodules, none of which exceeds 5 cm in diameter, have a 5-year survival of 40%. Conclusions. The prognosis of the patients worsened gradually as the diameter and number of nodules increased. No apparent threshold in the diameter or number of HCC nodules was detected. RFA can be applied beyond the conventional indications.