后在常规临床实践经皮穿刺热消融的高局部复发早期肝癌

StephenW

European Journal of Gastroenterology & Hepatology:
March 2015 - Volume 27 - Issue 3 - p 349–354
doi: 10.1097/MEG.0000000000000270
Original Articles: Hepato-Cellular Carcinoma
High local recurrence of early-stage hepatocellular carcinoma after percutaneous thermal ablation in routine clinical practice

Chinnaratha, Mohamed A.a,e; Sathananthan, Dharshanc; Pateria, Puraskarf; Tse, Edmundc; MacQuillan, Gerryf,g; Mosel, Leighb; Pathi, Ramonb; Madigan, Dand; Wigg, Alan J.a,e

Abstract

Background and aim: The risk of local tumour progression (LTP) and factors predicting LTP following percutaneous thermal ablation (PTA) of early-stage hepatocellular carcinoma (HCC) have not been well studied in non-trial settings and may be underestimated. We aimed to assess these outcomes in a multicentre study.

Patients and methods: This was a retrospective review of consecutive patients with early-stage HCC treated with a curative intent across three tertiary Australian centres between 2006 and 2012 with either radiofrequency ablation or microwave ablation. The primary endpoint was LTP and multivariate analysis was carried out to identify the independent predictors of LTP.

Results: In total 145 HCC nodules were treated in 126 patients (78% men, mean±SD age 62±10 years) with a mean±SD follow-up of 13.5±13 months. Local recurrence was observed in 23.4% (34/145). Mean±SD LTP-free survival was 46.9±3.6 months. For HCC nodules 2 cm or less, local recurrence rates were lower (15.9%), with a mean±SD LTP-free survival of 48.8±4.2 months. Poorly differentiated HCC [hazard ratio (95% confidence interval)=4.8 (1.1–20.4), P=0.032] and pretreatment α-fetoprotein more than 50 kIU/l [8.2 (1.7–39.0), P=0.008] were independent predictors of LTP. LTP rates were not significantly different between the radiofrequency ablation and the microwave ablation groups (22.8 vs. 25.8%, P=0.7). There were six (4.8%) procedure-related adverse events, but no deaths.

Conclusion: Local recurrence after PTA for early-stage HCC is high in routine clinical practice. Poorly differentiated HCC and pretreatment α-fetoprotein are important, independent predictors of LTP. Further well-designed randomized controlled trials with larger sample sizes using adjuvant therapies in combination with PTA to decrease LTP rates are warranted.

StephenW

欧洲胃肠病学和肝病学：
2015年3月 - 第27卷 - 第3期 - P349-354
DOI：10.1097/ MEG.0000000000000270
原创文章：肝细胞癌
后在常规临床实践经皮穿刺热消融的高局部复发早期肝癌

Chinnaratha，穆罕默德A.A，E; Sathananthan，Dharshanc; Pateria，Puraskarf;谢霆锋，Edmundc; MacQuillan，Gerryf，克;茂矽，Leighb;伯提，Ramonb;马迪根，D键; Wigg，阿兰J.A，电子

抽象

背景和目的：局部肿瘤进展（LTP）及以下的早期肝癌经皮热消融（PTA）（HCC）的因素预测LTP的风险并没有得到很好的研究在非试用设置和可能被低估。我们的目的是在一个多中心研究评估这些结果。

患者和方法：这是连续病人早期肝癌与跨越三个三级澳大利亚中心一个治愈为目的的2006年和2012年之间，无论是射频消融或微波消融治疗的回顾性分析。主要终点是LTP和多因素分析进行了识别LTP的独立预测因子。

结果：共有145个肝癌结节126例（78％为男性，平均±SD年龄62±10岁），平均±SD随访13.5±13个月时治疗。局部复发观察到23.4％（145分之34）。平均值±SD LTP生存率为46.9±3.6个月。肝癌结节2cm以内，局部复发率较低（15.9％），有48.8±4.2个月，平均±SD LTP生存率。低分化肝癌[危险比（95％置信区间）=4.8（1.1-20.4），P =0.032]和预处理α甲胎蛋白超过50 KIU/升[8.2（1.7-39.0），P= 0.008]的独立预测因素的LTP。 LTP率不是射频消融和微波消融组（22.8与25.8％，P= 0.7）之间显著不同。有六（4.8％）手术相关的不良事件，但没有人死亡。

结论：PTA后局部复发的早期肝癌高在常规临床实践。低分化HCC和预处理α胎蛋白是LTP的重要独立危险因素。进一步精心设计的随机对照试验使用与PTA联合辅助治疗，以减少LTP率保证较大的样本量。