射频消融中期和长期预后治疗早期肝细胞癌

StephenW

Early Hepatocellular Carcinoma Treated by Radiofrequency Ablation-Mid- and Long-Term Outcomes
Amar Mukund  1 , Prayas Vats  1 , Ankur Jindal  2 , Yashwant Patidar  1 , Shiv K Sarin  2
Affiliations
Affiliations

    1
    Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
    2
    Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.

    PMID: 33311893 PMCID: PMC7719976 (available on 2021-11-01) DOI: 10.1016/j.jceh.2020.04.016

Abstract

Background: Radiofrequency ablation (RFA) is a standard treatment for small inoperable hepatocellular carcinoma (HCC). Studies on mid- and long-term outcome of RFA as first-line therapy for HCC from India are limited.

Methods: We evaluated consecutive HCC patients who underwent RFA as primary treatment modality at our institute between July 2009 and April 2016. The median follow-up period was 26 months, range 1-84 months. We evaluated post-RFA tumor response, disease-free survival (DFS), overall survival (OS), and local tumor progression (LTP). Prognostic factors were also analyzed.

Results: In 147 patients (male:female = 121:26; mean age, 59.2 years), 209 RFA sessions were done for 228 lesions (mean size of 21.5 ± 8.3 mm, range 10-50 mm). Primary success rate was 94.2%. The estimated cumulative proportion survival at 1, 3, and 5 years was 90.2%, 63.8%, and 60.2%, respectively. The cumulative incidence of LTP estimated at 1, 3, and 5 years was 13.1%, 19.7%, and 20.1%, respectively. The mean estimate of LTP-free survival was 53.6 months (95% confidence interval: 0.49-0.58) which is 58.2 months in <3 cm lesions and 20.4 months in >3 cm lesions (P < 0.01). There was no significant difference in LTP rates between lesions in perivascular versus nonperivascular location (P = 0.71) and surface versus parenchymal lesions (P = 0.66). The mean DFS was 30.3 months (95% CI: 25.6-35.0). For OS, age and Child-Turcotte-Pugh class B were significant factors while for LTP, tumor size >3 cm was significant. Higher baseline alpha-fetoprotein level and LTP were poor predictors for DFS. Complication rate per RFA session was 7/209 (3.3%).

Conclusions: RFA is a safe and effective curative modality for first-line treatment of HCC < 3 cm.

Keywords: AASLD, The American Association for the Study of Liver Diseases; AFP, Alpha-fetoprotein; ALT, Alanine aminotransferase; AST, Aspartate aminotransferase; BCLC, Barcelona Clinic Liver Cancer; CTP, Child–Turcotte–Pugh score; DFS, Disease-free survival; FNAC, Fine needle aspiration cytology; HBV, Hepatitis B virus; HCC, Hepatocellular carcinoma; HCV, Hepatitis C virus; INR, International normalized ratio; LT, Liver transplantation; LTP, Local tumor progression; MELD, Model for end-stage liver disease; MWA, Microwave ablation; NASH, Nonalcoholic steatohepatitis; OS, Overall survival; PIVKA-II, Protein induced by vitamin K absence-II; PS, Performance status; RFA, Radio-frequency ablation; SIR, Society of Interventional Radiology; TACE, Transarterial chemoembolization; TIPS, Transjugular intrahepatic portosystemic shunt; USG, Ultrasonography; alpha-fetoprotein; cirrhosis; hepatocellular carcinoma; mRECIST, Modified response evaluation criteria in solid tumors; radiofrequency ablation.

© 2020 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.

StephenW

射频消融中期和长期预后治疗早期肝细胞癌
Amar Mukund 1，Prayas Vats 1，Ankur Jindal 2，Yashwant Patidar 1，Shiv K Sarin 2
隶属关系
隶属关系

    1个
    印度新德里，肝胆科学研究所介入放射学系，印度110070。
    2
    印度新德里，肝脏和胆科学研究所，肝病科，110070。

    PMID：33311893 PMCID：PMC7719976（2021-11-01可用）DOI：10.1016 / j.jceh.2020.04.016

抽象

背景：射频消融（RFA）是不可手术的小型肝细胞癌（HCC）的标准治疗方法。作为印度HCC的一线治疗，RFA的中长期结果的研究非常有限。

方法：我们对2009年7月至2016年4月间在我院接受RFA作为主要治疗方式的连续HCC患者进行了评估。中位随访期为26个月，范围1-84个月。我们评估了RFA后的肿瘤反应，无病生存期（DFS），总生存期（OS）和局部肿瘤进展（LTP）。还分析了预后因素。

结果：在147例患者中（男性：女性= 121：26；平均年龄，59.2岁），对228个病变进行了209次RFA治疗（平均大小21.5±8.3 mm，范围10-50 mm）。小学成功率为94.2％。在1年，3年和5年时，估计的累积比例生存率分别为90.2％，63.8％和60.2％。在1年，3年和5年时，LTP的累积发生率分别为13.1％，19.7％和20.1％。无LTP生存的平均估计为53.6个月（95％置信区间：0.49-0.58），在<3 cm病变中为58.2个月，在> 3 cm病变中为20.4个月（P <0.01）。在血管周围和非血管周围位置的病变（P = 0.71）与表面病变和实质病变（P = 0.66）之间的LTP率无显着差异。平均DFS为30.3个月（95％CI：25.6-35.0）。对于OS，年龄和Child-Turcotte-Pugh B级是重要因素，而对于LTP，> 3 cm的肿瘤大小是重要的。较高的基线甲胎蛋白水平和LTP是DFS的不良预测指标。每个RFA会话的并发症发生率为7/209（3.3％）。

结论：RFA是一线治疗HCC <3 cm的安全有效的方法。

关键字：AASLD，美国肝病研究协会； AFP，甲胎蛋白； ALT，丙氨酸转氨酶； AST，天冬氨酸转氨酶； BCLC，巴塞罗那临床肝癌； CTP，Child–Turcotte–Pugh得分； DFS，无病生存； FNAC，细针抽吸细胞学； HBV，乙型肝炎病毒； HCC，肝细胞癌； HCV，丙型肝炎病毒； INR，国际标准化比率； LT，肝移植； LTP，局部肿瘤进展； MELD，晚期肝病模型； MWA，微波消融； NASH，非酒精性脂肪性肝炎； OS，总体生存率； PIVKA-II，维生素K缺乏II诱导的蛋白质； PS，性能状态； RFA，射频消融； SIR，介入放射学学会； TACE，经动脉化学栓塞； TIPS，经颈静脉肝内门体分流； USG，超声检查；甲胎蛋白肝硬化肝细胞癌； mRECIST，改良的实体瘤反应评估标准；射频消融。

©2020印度国家肝脏研究协会。由Elsevier B.V.发布。保留所有权利。