经肝动脉化疗栓塞术序贯双极针射频消融治疗高危部位肝细胞癌的效果观察

梁宏元; 郭启勇; 毛晓楠; 孙巍; 赵罡; 王希海; 刘臻; 温锋; 卢再鸣

doi:10.3969/j.issn.1001-5256.2018.07.020

经肝动脉化疗栓塞术序贯双极针射频消融治疗高危部位肝细胞癌的效果观察

DOI: 10.3969/j.issn.1001-5256.2018.07.020

中国医科大学附属盛京医院放射科

基金项目:

国家自然科学基金资助项目(81771947)；

详细信息

中图分类号: R735.7
计量
- 文章访问数: 2164
- HTML全文浏览量: 38
- PDF下载量: 362
- 被引次数: 0
出版历程
- 收稿日期: 2018-01-31
- 出版日期: 2018-07-20

Clinical effect of sequential therapy with transarterial chemoembolization and bipolar-needle radiofrequency ablation in treatment of hepatocellular carcinoma in high-risk locations

Department of Radiology, Shengjing Hospital of China Medical University

Research funding:

摘要

摘要: 目的探讨经肝动脉化疗栓塞术（TACE）序贯双极针射频消融（RFA）治疗高危部位肝细胞癌（HCC）的临床应用。方法收集2014年1月-2015年6月于中国医科大学附属盛京医院就诊的初治高危部位HCC患者,首先实施TACE治疗,1560 d后联合CT引导的双极针RFA序贯治疗。术后随访236个月,评价临床疗效。计量资料组间比较采用t检验;计数资料组间比较采用χ2检验或Fisher精确概率法。采用Kaplan-Meier法进行生存分析。结果共纳入35例HCC患者,40枚病灶,行TACE和双极针RFA序贯治疗,技术成功率为100%。最大直径≤3 cm的病灶完全消融率为100%（28/28）,高于病灶最大直径>3 cm的完全消融率66.7%（8/12）（P=0.005）。随访至2017年6月,中位生存时间为27.6个月,1、2年生存率分别为94.3%、65.7%。靠近被膜的病灶完全消融率高于其他高危部位病灶的完全消融率（95%vs 85%）,且并发症发生率更低（15%vs 35%）,但差异均无统计学意义（P值均>0.0...
- 癌,肝细胞 /
- 化学栓塞,治疗性 /
- 导管消融术 /
- 治疗结果
Abstract: Objective To investigate the clinical effect of sequential therapy with transarterial chemoembolization ( TACE) and bipolar-needle radiofrequency ablation ( RFA) in the treatment of hepatocellular carcinoma ( HCC) in high-risk locations. Methods A total of 35 previously untreated patients with HCC in high-risk locations who visited Shengjing Hospital of China Medical University from January 2014 to June 2015 were enrolled. They were given TACE for 15-60 days, followed by CT-guided bipolar-needle FRA. The patients were followed up for 2-36 months after surgery, and the clinical outcomes were evaluated. The t-test was used for comparison of continuous data between groups, and the chi-square test or Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used for survival analysis. Results A total of 35 HCC patients with 40 lesions were enrolled and given the sequential therapy with TACE and bipolar-needle RFA, and the technical success rate was 100%. The lesions with a maximum diameter of ≤3 cm achieved a complete ablation rate of 100% ( 28/28) , and those with a maximum diameter of > 3 cm achieved a complete ablation rate of66. 7% ( 8/12) ; there was a significant difference between these two groups ( P = 0. 005) . The patients were followed up to June 2017; the median survival time was 27. 6 months, and the 1-and 2-year survival rates were 94. 3% and 65. 7%, respectively. The lesions close to the capsule had a higher complete ablation rate than those in other locations ( 95% vs 85%, P > 0. 05) , as well as a lower incidence rate of complications ( 15% vs 35%, P > 0. 05) . There was a significant difference in mean ablation time between the lesions with > 50% lipiodol deposition and those with < 50% lipiodol deposition ( 24. 2 ± 6. 7 min vs 30. 1 ± 10. 2 min, t = 2. 163, P = 0. 037) . No patients experienced serious complications; mild complications included slight subcapsular hemorrhage in three patients, slight abdominal hemorrhage in one patient, subcutaneous hematoma in one patient, mild pneumothorax with slight abdominal hemorrhage in one patient, mild pneumothorax in two patients, and mild hemothorax in two patients, and all these complications were relieved after conservative treatment. Conclusion Sequential therapy with TACE and CT-guided bipolar-needle RFA is safe and effective in patients with HCC in high-risk locations, and may have a better therapeutic effect on subcapsular lesions than on the lesions in other high-risk locations.
- carcinoma, hepatocellular /
- chemoembolization, therapeutic /
- catheter ablation /
- treatment outcome

HTML全文

参考文献(31)

[1]SANGIOVANNI A, DEL NINNO E, FASANI P, et al.Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance[J].Gastroenterology, 2004, 126 (4) :1005-1014.

[2]IKEDA K, OSAKI Y, NAKANISHI H, et al.Recent progress in radiofrequency ablation therapy for hepatocellular carcinoma[J].Oncology, 2014, 87 (Suppl 1) :73-77.

[3]FONSECA AZ, SANTIN S, GOMES LG, et al.Complications of radiofrequency ablation of hepatic tumors:Frequency and risk factors[J].World J Hepatol, 2014, 6 (3) :107-113.

[4]KIM GM, WON JY, KIM MD, et al.Cryoablation of hepatocellular carcinoma with high-risk for percutaneous ablation:Safety and efficacy[J].Cardiovasc Intervent Radiol, 2016, 39 (10) :1447-1454.

[5]LU DS, YU NC, RAMAN SS, et al.Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation[J].Hepatology, 2005, 41 (5) :1130-1137.

[6]LU DS, RAMAN SS, LIMANOND P, et al.Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors[J].J Vasc Interv Radiol, 2003, 14 (10) :1267-1274.

[7]MULIER S, NI Y, JAMART J, et al.Local Local recurrence after hepatic radiofrequency coagulation:Multivariate meta-analysis and review of contributing factors[J].Ann Surg, 2005, 242 (2) :158-171.

[8]LENCIONI R, CIONI D, CROCETTI L, et al.Early-stage hepatocellular carcinoma in patients with cirrhosis:Long-term results of percutaneous image-guided radiofrequency ablation[J].Radiology, 2005, 234 (3) :961-967.

[9]WONG SN, LIN CJ, LIN CC, et al.Combined percutaneous radiofrequency ablation and ethanol injection for hepatocellular carcinoma in high-risk locations[J].AJR Am J Roentgenol, 2008, 190 (3) :w187-w195.

[10]ZHI-YU H, PING L, XIAO-LING Y, et al.A clinical study of thermal monitoring techniques of ultrasound-guided microwave ablation for hepatocellular carcinoma in high-risk locations[J].Sci Rep, 2017, 7:41246.

[11]TANG Z, FANG H, KANG M, et al.Percutaneous radiofrequency ablation for liver tumors:Is it safer and more effective in low-risk areas than in high-risk areas?[J].Hepatol Res, 2011, 41 (7) :635-640.

[12]FUJIMORI M, TAKAKI H, NAKATSUKA A, et al.Survival with up to 10-year follow-up after combination therapy of chemoembolization and radiofrequency ablation for the treatment of hepatocellular carcinoma:Single-center experience[J].J Vasc Interv Radiol, 2013, 24 (5) :655-666.

[13]ZHANG L, YIN X, GAN YH, et al.Radiofrequency ablation following first-line transarterial chemoembolization for patients with unresectable hepatocellular carcinoma beyond the Milan criteria[J].BMC Gastroenterol, 2014, 14:11.

[14]LU Z, WEN F, GUO Q, et al.Radiofrequency ablation plus chemoembolization versus radiofrequency ablation alone for hepatocellular carcinoma:A meta-analysis of randomized-controlled trials[J].Eur J Gastroenterol Hepatol, 2013, 25 (2) :187-194.

[15]LIAO M, HUANG J, ZHANG T, et al.Transarterial chemoembolization in combination with local therapies for hepatocellular carcinoma:A meta-analysis[J].PLo S One, 2013, 8 (7) :e68453.

[16]MORIMOTO M, NUMATA K, KONDOU M, et al.Midterm outcomes in patients with intermediate-sized hepatocellular carcinoma:A randomized controlled trial for determining the efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization[J].Cancer, 2010, 116 (23) :5452-5460.

[17]PENG ZW, ZHANG YJ, CHEN MS, et al.Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma:A prospective randomized trial[J].J Clin Oncol, 2013, 31 (4) :426-432.

[18]XIE H, WANG H, AN W, et al.The efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization for primary hepatocellular carcinoma in a cohort of 487 patients[J].PLo S One, 2014, 9 (2) :e89081.

[19]YAMAKADO K, NAKATSUKA A, TAKAKI H, et al.Subphrenic versus nonsubphrenic hepatocellular carcinoma:Combined therapy with chemoembolization and radiofrequency ablation[J].AJR Am J Roentgenol, 2010, 194 (2) :530-535.

[20]Ministry of Health of the People's Republic of China.Diagnosis, management, and treatment of hepatocellular carcinoma (V2011) [J].J Clin Hepatol, 2011, 27 (11) :1141-1159. (in Chinese) 中华人民共和国卫生部.原发性肝癌诊疗规范 (2011年版) [J].临床肝胆病杂志, 2011, 27 (11) :1141-1159.

[21]LIN JW, LIN CC, CHEN WT, et al.Combining radiofrequency ablation and ethanol injection may achieve comparable long-term outcomes in larger hepatocellular carcinoma (3.1-4 cm) and in high-risk locations[J].Kaohsiung J Med Sci, 2014, 30 (8) :396-401.

[22]LIANG HY, GUO QY, SUN W, et al.Sequential use of transhepatic arterial chemoembolization and bipolar radiofrequency ablation in the clinical therapy of hepatocellular carcinoma[J].Cancer Biother Radiopharm, 2015, 30 (10) :427-432.

[23]LENCIONI R, LLOVET JM.Modified RECIST (mRECIST) assessment for hepatocellular carcinoma[J].Semin Liver Dis, 2010, 30 (1) :52-60.

[24]SARTORI S, TOMBESI P, MACARIO F, et al.Subcapsular liver tumors treated with percutaneous radiofrequency ablation:A prospective comparison with nonsubcapsular liver tumors for safety and effectiveness[J].Radiology, 2008, 248 (2) :670-679.

[25]CASPANI B, IERARDI AM, MOTTA F, et al.Small nodular hepatocellular carcinoma treated by laser thermal ablation in high risk locations:Preliminary results[J].Eur Radiol, 2010, 20 (9) :2286-2292.

[26]CHO YK, RHIM H, AHN YS, et al.Percutaneous radiofrequency ablation therapy of hepatocellular carcinoma using multitined expandable electrodes:Comparison of subcapsular and nonsubcapsular tumors[J].AJR Am J Roentgenol, 2006, 186 (5 Suppl) :s269-s274.

[27]HYUN D, CHO SK, SHIN SW, et al.Treatment of small hepatocellular carcinoma (≤2 cm) in the caudate lobe with sequential transcatheter arterial chemoembolization and radiofrequency ablation[J].Cardiovasc Intervent Radiol, 2016, 39 (7) :1015-1022.

[28]LEE CH, CHEN WT, LIN CC, et al.Radiofrequency ablation assisted by real-time virtual sonography for hepatocellular carcinoma inconspicuous under sonography and high-risk locations[J].Kaohsiung J Med Sci, 2015, 31 (8) :413-419.

[29]LIU CH, YU CY, CHANG WC, et al.Computed tomographicguided percutaneous radiofrequency ablation with hydrodissection of hepatic malignancies in the subcapsular location:Evaluation of safety and technical efficacy[J].J Chin Med Assoc, 2016, 79 (2) :93-100.

[30]TERATANI T, YOSHIDA H, SHIINA S, et al.Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations[J].Hepatology, 2006, 43 (5) :1101-1108.

[31]KANG TW, LIM HK, LEE MW, et al.Long-term therapeutic outcomes of radiofrequency ablation for subcapsular versus nonsubcapsular hepatocellular carcinoma:A propensity score matched study[J].Radiology, 2016, 280 (1) :300-312.

施引文献

资源附件(0)

访问统计