A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies
A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies
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DOI：
10.1001/archsurg.137.12.1332
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发表时间：
2002-12-01
影响因子：
--
通讯作者：
Bismuth, H
中科院分区：
文献类型：
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作者：
Adam, R;Hagopian, EJ;Bismuth, H
假设：经皮冷冻手术（PCS）或经皮射频（PRF）治疗不可切除的肝脏恶性肿瘤的患者的并发症和成功率是相似的。设计：回顾性研究。设置：大学hospital.Patients和方法：六十四例患者进行了治疗与PCS（n = 31）或PRF（n = 33）。患者治疗基于探头的随机可用性。通过盲法比较治疗前和治疗后的螺旋CT扫描评价肿瘤。所有存活患者至少随访6个月。主要结果指标：并发症发生率、初始治疗成功率（肿瘤完全断流）和局部复发率（肿瘤内或周围血管重建）。结果：两组肿瘤类型的分布相似（P = .76）。1例肝硬化患者在PCS后30天死于静脉曲张出血（死亡率为3.2%），而PRF后未观察到死亡（P = 0.48）。PCS术后9例（29%）患者和PRF术后8例（24%）患者发生并发症（P = 0.66）。两个治疗组的初始治疗成功率相当（PCS后30/36例肿瘤[83%] vs PRF后34/41例肿瘤[83%]）。然而，PCS术后局部复发率高于PRF术后（16/30 [53%] vs 6/34 [18%]; P = 0.003）。转移瘤的局部复发率较高（PCS后14例中有10例[71%] vs PRF后16例中有3例[19%]; P = 0.004），而肝细胞癌的局部复发率无显著差异（PCS后16例中有6例[38%] vs PRF后18例中有3例[17%]; P = 0.25）。多因素分析显示，PCS的使用（P =. 003)结论：虽然PCS或PRF后观察到相似的初始治疗成功率和并发症发生率，但PCS后局部复发更频繁，特别是转移瘤。
Hypothesis: The complication and success rates in patients treated with either percutaneous cryosurgery (PCS) or percutaneous radio frequency (PRF) for unresectable hepatic malignancies are similar.Design: Retrospective study.Setting: University hospital.Patients and Methods: Sixty-four patients were treated with either PCS (n = 31) or PRF (n = 33). Patient treatment was based on the random availability of the probes. Tumors were evaluated by a blinded comparison of pretreatment and posttreatment helical computed tomographic scans. All living patients had at least a 6-month follow-up.Main Outcome Measures: Complication rate, initial treatment success (complete devascularization of the tumor), and local recurrence (tumor revascularization within or at its periphery).Results: The distribution of tumor types was similar in the 2 groups (P = .76). One patient with cirrhosis died of variceal hemorrhage on day 30 after PCS (mortality, 3.2%), while no mortality was observed after PRF (P = .48). Complications occurred in 9 (29%) of the patients following PCS and in 8 (24%) of the patients following PRF (P = .66). Initial treatment success was comparable in the 2 treatment groups (30 [83%] of 36 tumors following PCS vs 34 [83%] of 41 tumors following PRF). However, local recurrences occurred more frequently after PCS than after PRF (16 [53%] of 30 vs 6 [18%] of 34; P = .003). The higher rate of local recurrence was identified for metastases (10 [71%] of 14 after PCS vs 3 [19%] of 16 after PRF; P = .004), while the difference was not significant for hepatocellular carcinoma (6 [38%] of 16 after PCS vs 3 [17%] of 18 after PRF; P = .25). Multivariate analysis demonstrated that the use of PCS (P =. 003) and more than 1 treatment (P = .05) were independent risk factors for local tumor recurrence.Conclusion: While similar initial treatment success and complication rates are observed following either PCS or PRF, local recurrences occur more frequently following PCS, particularly for metastases.