Percutaneous ablation of hepatocellular carcinoma: state-of-the-art.
Percutaneous ablation of hepatocellular carcinoma: state-of-the-art.
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DOI：
10.1002/lt.20043
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发表时间：
2004-02-01
期刊：
影响因子：
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通讯作者：
Bartolozzi, Carlo
中科院分区：
文献类型：
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作者：
Lencioni, Riccardo;Cioni, Dania;Bartolozzi, Carlo
经皮消融被认为是不适合手术切除或肝移植的早期肝细胞癌（HCC）患者的最佳治疗选择。已经开发了几种方法，包括瘤内注射乙醇或乙酸，以及射频、激光、微波或冷冻手术的热消融。经皮乙醇注射（PEI）是最广泛使用的技术。多个系列提供了间接证据表明 PEI 可改善 HCC 的自然史。 Child-Pugh A 级肝硬化患者，单个肿瘤小于 5 cm 或多达三个病灶且每个小于 3 cm 的患者的 5 年生存率可达 50%。 PEI的主要局限性是局部复发率高，可达33-43%。射频 (RF) 消融已成为经皮消融最有效的替代方法。最近的研究表明，射频消融比 PEI 可以以更少的治疗次数实现更有效的局部肿瘤控制。在一项随机试验中，接受射频消融的患者的局部无复发生存率显着高于接受 PEI 治疗的患者，并且多变量分析证实治疗分配是一个独立的预后因素。因此，射频消融可被视为早期肿瘤患者的经皮治疗选择。需要进一步研究来澄清当前的射频技术是否可以为中期 HCC 患者提供改善的结果。
Percutaneous ablation is considered the best treatment option for patients with early-stage hepatocellular carcinoma (HCC) who are not candidates for surgical resection or liver transplantation. Several methods have been developed, including intratumoral injection of ethanol or acetic acid, and thermal ablation with radiofrequency, laser, microwaves, or cryosurgery. Percutaneous ethanol injection (PEI) has been the most widely used technique. Several series have provided indirect evidence that PEI improves the natural history of HCC. Patients with Child-Pugh class A cirrhosis and either a single tumor smaller than 5 cm or as many as three lesions each smaller than 3 cm may achieve a 5-year survival of 50%. The major limitation of PEI is the high local recurrence rate, which may reach 33-43%. Radiofrequency (RF) ablation has emerged as the most powerful alternate method for percutaneous ablation. Recent studies have shown that RF ablation can achieve more effective local tumor control than PEI with fewer treatment sessions. In a randomized trial, local recurrence-free survival rates were significantly higher in patients who received RF ablation than in those treated by PEI, and treatment allocation was confirmed as an independent prognostic factor by multivariate analysis. RF ablation could therefore be considered as the percutaneous treatment of choice for patients with early-stage tumors. Further investigation is warranted to clarify whether current RF technology could offer improved results in patients with intermediate-stage HCC.