Influence of larze peritumoral vessels on outcome of radiofrequency ablation of liver tumors
Influence of larze peritumoral vessels on outcome of radiofrequency ablation of liver tumors
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DOI：
10.1097/01.rvi.0000092666.72261.6b
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发表时间：
2003-10-01
影响因子：
2.9
通讯作者：
Sayre, J
中科院分区：
文献类型：
--
作者：
Lu, DSK;Raman, SS;Sayre, J
目得：大血管（大于或等于3毫米）毗邻肝肿瘤的影响进行了评估，就临床肿瘤复发率后，射频（RF）ablation.MATERIALS和方法：第一个105恶性肝肿瘤射频消融治疗在我们的机构与病理分析或至少6个月的临床随访进行了审查。由对病例设盲的放射科医生审查原始治疗前影像学研究，并根据病变与血管的连续性至少3 mm，将病变分类为血管周围或非血管周围。然后比较两组之间关于局部肿瘤复发的治疗结果。Logistic回归分析，考虑到其他变量，并确定这种分类是否是一个独立的预测治疗outcome.Results：有74个非血管周围肿瘤和31血管周围肿瘤。平均肿瘤大小为2.4 cm，平均随访时间为11.3个月。105例中有20例（19%）有残留或局部复发肿瘤。在非血管周围组中，74例中有5例（7%）肿瘤治疗不完全（6个月内出现）或局部复发超过6个月。在血管周围组，31例中有15例（48%）治疗不完全或局部复发（P <0.001）。病变大小的亚组分析（61个肿瘤小于或等于2.5 cm，33个肿瘤2.6-4 cm，11个肿瘤>4 cm），肿瘤类型（40例肝细胞癌、48例结直肠转移和17例其他转移），（53例术中，52例经皮）和射频器械（45个放射治疗电极，18个Rita电极和42个Radionics电极）显示了相似的结果。多变量Logistic回归分析表明，存在或不存在一个大的瘤周血管是一个独立的，占主导地位的，预测治疗outcome.CONCLUSION：血管的存在至少3毫米的大小毗邻肝肿瘤是一个强大的独立预测不完全的肿瘤破坏射频消融。应考虑修改消融策略，以改善这些肿瘤的破坏。
PURPOSE: The effect of large vessels (greater than or equal to3 mm) contiguous to hepatic tumors was evaluated with respect to clinical tumor recurrence rates after radiofrequency (RF) ablation.MATERIALS AND METHODS: The first 105 malignant liver tumors treated by RF ablation therapy at our institution with pathologic analysis or a minimum of 6 months of clinical follow-up were reviewed. The original pretreatment imaging studies were reviewed by a radiologist who was blinded to the cases, and, based on lesion contiguity to vessels of at least 3 mm, the lesions were categorized as perivascular or nonperivascular. Treatment outcomes with respect to local tumor recurrence between these two groups were then compared. Logistic regression analysis was performed to take into account other variables and to determine whether this categorization was an independent predictor of treatment outcome.RESULTS: There were 74 nonperivascular tumors and 31 perivascular tumors. Mean tumor size was 2.4 cm and mean follow-up was 11.3 months. Residual or locally recurrent tumors were documented in 20 of 105 cases (19%). In the nonperivascular group, five of 74 (7%) had either incompletely treated tumor (manifested within 6 months) or local recurrence beyond 6 months. In the perivascular group, 15 of 31 (48%) had incompletely treated or locally recurrent tumor (P < .001). Subanalysis of lesion size (61 tumors less than or equal to2.5 cm, 33 tumors 2.6-4 cm, and 11 tumors >4 cm), tumor type (40 hepatocellular carcinomas, 48 colorectal metastases, and 17 other metastases), access (53 intraoperative, 52 percutaneous), and RF device (45 Radiotherapeutics electrodes, 18 Rita electrodes, and 42 Radionics electrodes) showed similar results. Multivariate logistic regression analysis showed that presence or absence of a large peritumoral vessel is an independent, and the dominant, predictor of treatment outcome.CONCLUSION: The presence of vessels at least 3 mm in size contiguous to hepatic tumors is a strong independent predictor of incomplete tumor destruction by RF ablation. Modified ablation strategies should be considered to improve destruction of these tumors.