Percutaneous CT-guided radiofrequency ablation for patients with extrahepatic oligometastases of hepatocellular carcinoma: long-term results
Percutaneous CT-guided radiofrequency ablation for patients with extrahepatic oligometastases of hepatocellular carcinoma: long-term results
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DOI：
10.1080/02656736.2017.1318332
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发表时间：
2018-01-01
影响因子：
3.1
通讯作者：
Zhao, Ming
中科院分区：
文献类型：
--
作者：
Mu, Luwen;Sun, Lin;Zhao, Ming
背景资料：本研究的目的是评估经皮CT（CT）引导下射频消融（RFA）治疗肝外少转移肝细胞癌（HCC）的疗效。方法：本回顾性研究获得了机构审查委员会的批准，所有患者均提供了书面知情同意书。2004年4月至2015年12月期间，79例连续HCC患者（73例男性和6例女性;平均年龄，50.3岁± 13.0岁）的116例寡转移（直径，5-50 mm; 20.3 ± 10.4）接受了RFA治疗。我们重点研究了局限于1-2个器官（包括肺、肾上腺、骨、淋巴结和胸膜/腹膜）的1-3处肝外转移（EHM）患者，这些患者接受了初治治疗，目的是治愈。对生存率、技术成功率和安全性进行了评价。结果：无即刻技术失败，术后1个月技术有效率为95.8%。中位随访时间为28.0个月（范围：6-108个月），1、2和3年总生存率（OS）分别为91%、70%和48%，中位生存时间为33.5个月。非寡转移进展时间（TTUP）小于6个月（p < 0.001）和Child-Pugh评分大于5（p = 0.001）是OS较短的重要指标。1年、2年和3年无病生存率（DFS）分别为34%、21%和8%，中位DFS时间为6.8个月。肺转移患者的DFS更好（p = 0.006）。主要并发症发生在9个（9.5%，9/95）RFA会话没有治疗相关mortality.Conclusions：CT引导下的射频消融治疗寡转移性肝癌可能提供有利的疗效和技术成功的微创方法。
Background: The aim of this study was to evaluate the therapeutic outcome of percutaneous computed tomography (CT)-guided radiofrequency ablation (RFA) for extrahepatic oligometastases of hepatocellular carcinoma (HCC).Methods: Institutional review board approval was obtained for this retrospective study, and all patients provided written informed consent. Between April 2004 and December 2015, 116 oligometastases (diameter, 5-50 mm; 20.3 +/- 10.4) in 79 consecutive HCC patients (73 men and 6 women; average age, 50.3 years +/- 13.0) were treated with RFA. We focussed on patients with 1-3 extrahepatic metastases (EHM) confined to 1-2 organs (including the lung, adrenal gland, bone, lymph node and pleura/peritoneum) who were treated naive with curative intent. Survival, technical success and safety were evaluated. The log-rank test and Cox proportional hazards regression models were used to analyse the survival data.Results: No immediate technical failure occurred, and at 1 month, the technique effectiveness rate was determined to be 95.8%. After a median follow-up time of 28.0 months (range, 6-108 months), the 1-, 2- and 3-year overall survival (OS) rates were 91, 70 and 48%, respectively, with a median survival time of 33.5 months. Time to unoligometastatic progression (TTUP) of less than 6 months (p < 0.001) and a Child-Pugh score of more than 5 (p = 0.001) were significant indicators of shorter OS. The 1-, 2- and 3-year disease free survival (DFS) rates were 34, 21 and 8%, respectively, with a median DFS time of 6.8 months. DFS was better for those with lung metastases (p = 0.006). Major complication occurred in nine (9.5%, 9/95) RFA sessions without treatment-related mortality.Conclusions: CT-guided RFA for oligometastatic HCC may provide favourable efficacy and technical success with a minimally invasive approach.