肝细胞癌射频消融治疗后肿瘤残留的危险因素及预后分析

目的 探讨肝细胞癌(HCC)射频消融(RFA)治疗后肿瘤残留的危险因素及预后.方法 回顾性分析2001年5月至2007年3月114例经RFA治疗的HCC患者临床资料,分析可能与RFA后肿瘤残留有关的临床因素以及残留HCC的预后.结果 114例HCC患者经RFA治疗一次后,完全消融90例,肿瘤残留24例.90例肿瘤完全消融患者的中位生存期为40个月,24例肿瘤残留患者的中位生存期为29个月,二者差异无统计学意义(P=0.242).在24例肿瘤残留患者中,经再次治疗后达到无肿瘤残留者11例,其中位生存期为53个月;经再次治疗后仍有残留者13例,其中位生存期为28个月.RFA治疗一次后肿瘤完全消融患者与再次治疗后达到无肿瘤残留患者的中位生存期比较,差异无统计学意义(P=0.658);与再次治疗后仍有肿瘤残留患者的中位生存期比较,差异有统计学意义(P=0.012).多因素分析表明,肿瘤＞3 cm(P=0.007)和靠近大血管(P=0.042)是HCC经RFA治疗后肿瘤残留的独立危险因素.结论 肿瘤＞3 cm和靠近大血管是HCC行RFA治疗后肿瘤残留的独立危险因素.对未能达到完全消融的HCC患者,应积极采取进一步治疗措施,争取达到完全根治肿瘤,以改善预后.     

大功率微波与射频消融治疗较大肝癌的近期疗效研究

目的 探讨大功率微波消融(microwave ablation,MWA)与射频消融(radiofrequency ablation,RFA)治疗较大肝癌的近期临床疗效及术后复发转移相关危险因素.方法 对101例未行其他治疗的原发性肝癌患者中45例(病灶数n=60)行大功率MWA治疗(80 ～ 100 W),56例(病灶数n=68)行RFA治疗.肿瘤直径范围为3～8cm,依据肿瘤直径分为两组:肿瘤直径3～ ＜5cm组及肿瘤直径≥5 cm组.消融后1月行超声造影、增强CT或MRI检查.观察治疗后两组患者肿瘤完全坏死率、局部复发率、并发症、生存情况,随访评价两种手术方式疗效并分析肝癌复发转移的相关危险因素.结果 大功率MWA与RFA对于3～ ＜5cm病灶1次完全坏死率分别为82.6％ (38/46)、80.0％ (40/50);2次完全坏死率分别为100.0％ (46/46)、98.0％ (49/50).MWA与RFA对于≥5cm病灶1次完全坏死率分别为64.3％ (9/14)、33.3％ (6/18);2次完全坏死率分别为85.7％ (12/14)、50.0％ (9/18).MWA与RFA组术后2年总复发率分别为40.0％ (18/45)、42.9％(24/56).MWA与RFA组术后1、2年生存率分别为95.6％ (43/45)、86.7％(39/45)及94.6％(53/56)、89.3％(50/56).两组患者并发症差异无统计学意义(P=0.802).单因素分析示术后复发转移与肿瘤个数(P=0.025)、术前AFP值(P=0.031)、乙肝HBV-DNA载量(P =0.035)及肿瘤病灶邻近危险区域(P=0.001)有关.多因素分析提示,乙肝HBV-DNA载量(P=0.023)与肿瘤病灶邻近危险区域(P=0.001)是肝癌消融治疗术后复发转移的独立危险因素.结论 MWA治疗较大肝癌的完全坏死率比RFA高,局部复发率比RFA低.肿瘤个数、术前AFP值、患者HBV-DNA病毒载量以及肿瘤病灶邻近危险区域都是肝癌术后复发转移的危险因素,其中后两者是独立危险因素.     

单次经皮射频消融治疗小肝癌的预后及复发危险因素分析

背景与目的:射频消融( radiofrequency ablation, RFA)治疗作为肝癌局部治疗的新技术,近年得到了广泛的应用.本研究分析肝癌 RFA治疗的疗效和复发相关因素,并探索 RFA治疗的适应证.方法:采用回顾性队列研究方法,分析 2001年 1月至 2003年 12月期间, 94例在中山医院肝癌研究所行 RFA治疗的原发性小肝癌患者的 102个病灶,随访期至 2004年 3月.采用 SPSS 11.5统计软件对数据进行处理.结果: 94例患者的中位随访期为 16个月, RFA治疗后的 1年累积生存率为 85.5%, 2年累积生存率为 75.6%; 1年累积无瘤生存率为 31.3%, 2年累积无瘤生存率为 10.4%.共有 62例患者( 66.0%)复发.单因素分析显示复发与下列 3个因素有关:肿瘤近血管 (P< 0.01)、位于肝包膜下 (P< 0.05)、直径 >3 cm (P< 0.05);而与性别、 Child分级、 AFP值、是否联合瘤内无水乙醇注射治疗无关. Cox多因素分析显示:肿瘤近血管 (P=0.000, 95%可信区间为 2.102～ 7.899)、位于肝包膜下 (P=0.001, 95%可信区间为 1.672～ 6.289)是 RFA治疗后复发的独立危险因素.较严重并发症的发生率为 2.1% (2/94,胆道出血 1例,膈下积液 1例 ).未发生与手术相关的死亡.结论: RFA是一种安全的肝癌治疗方法.直径≤ 3 cm、不近肝内血管、非包膜下肿块是肝肿瘤 RFA治疗的适应证.     

射频治疗肝癌术后复发的相关因素

射频消融治疗肝癌已经成为目前治疗肝癌的主要非手术方法之一，但术后较高的复发率受到关注。本文根据近年来的文献，对射频毁损术后复发的危险因素做一综述。结果显示，肿瘤直径〉3cm、肿瘤位置临近大血管或肝脏包膜下、不足够的治疗范围、以及术者经验缺乏是使局部复发率升高的危险因素，而血清甲胎蛋白水平高、术前肝功能分级差、肿瘤病理分期晚等因素是肝内远处复发的危险因素。     

射频消融治疗26例第二肝门区肝癌

[目的]探讨第二肝门区肝癌射频消融的治疗结局。[方法]2006年1月～2008年1月26例第二肝门区肝癌患者的32个肿瘤接受了35次超声引导下经皮穿刺射频消融。[结果]26例患者初次射频消融第二肝门区肿瘤30个,22例患者的25个肿瘤完全消融,完全消融率84.6%。<3cm、3～4cm和>4cm的肿瘤完全消融率分别为91.3%、66.7%和0,差异有显著性(P=0.027)。26例中的9例因局部肿瘤残留、复发、新生等原因接受多次射频消融,26例患者共接受35次射频消融,32个肿瘤中完全消融29个,总体完全消融率90.6%(29/32)。无射频相关死亡发生,2例发生明显胸水,1例发生胆脂瘤并发肝内感染,3例发生局部复发。全组5例死亡,总体存活率80.8%。1年总体生存率86.7%,1年无复发生存率为71.4%。[结论]在熟知第二肝门区解剖特征、射频消融操作水平较好的情况下,射频消融治疗第二肝门区肝癌疗效确切、安全可靠。     

射频消融治疗原发性肝癌疗效分析

[目的]评价原发性肝癌射频消融治疗的效果及其影响因素.[方法]对63例原发性肝癌病人共81个肝癌结节进行射频消融治疗.[结果]进行一次射频消融治疗后,直径≤4cm和直径>4cm的肿瘤的完全毁损率分别为80.6%和24.0%(P<0.01);经过多次射频消融后,肿瘤完全毁损率分别为93.5%和42.0%(P<0.01).平均随访时间为13个月,直径≤4cm和直径>4cm的肿瘤的局部复发率分别为6.9%和14.2%(P>0.05).12个月和18个月的生存率分别为81.0%和71.4%,生存率与肿瘤大小和Child-Pugh分级有关(P<0.05).[结论]对于肿瘤≤4cm和Child-Pugh分级A的肝癌病人,射频消融治疗的局部效果和长期生存率均较好.     

18FDG-PET/CT对评价TACE联合RFA治疗原发性肝癌的效果的价值

背景与目的:原发性肝癌经动脉导管栓塞化疗(transcatheterarterialchemo-embolization,TACE)联合射频消融(radiofrequencyablation,RFA)治疗后,CT扫描对判断是否有肿瘤残留存在一定的困难,而18FDG-PET/CT(18-fluorodeoxyglucose-positronemissiontomograply/CT)在判断肿瘤残留上具有优势。本研究对13例原发性肝癌经TACE联合RFA治疗周后,采用CT和18FDG-PET/CT检查是否存在肿瘤残留,分析CT和18FDG-PET/CT在判断肿瘤残留上的差异,并根据18FDG-PET/CT的结果指导肿瘤治疗。方法:本组13例原发性肝癌患者共有18个病变,肿瘤最长直径为0.8～16.0cm。12例为初治病例;1例为肝癌手术后复发,肝内共发现有3个病变。经过TACE联合RFA治疗后2～3周,对比CT和18FDG-PET/CT检查的结果;如发现有肿瘤残留,在2～3周内对其进一步行RFA治疗。结果:13例患者经一次TACE联合一次RFA治疗2～3周,经病变区域活检及数字减影血管造影等检查发现11例有部分肿瘤残留,肿瘤残留最长直径为1.0～2.1cm;CT增强扫描检查检出5例,18FDG-PET/CT检出有10例残留,CT与18FDG-PET/CT检出率分别为45.4%及90.9%。根据检查结果,在2～3周内经过第二次RFA治疗后,18FDG-PET/CT检查发现10例患者肿瘤无残留,另1例6周后复查18FDG-PET/CT发现肝内病变未控,患者带瘤生存。结论:原发性肝癌经TACE联合RFA治疗以及手术后,18FDG-PET/CT对判断肿瘤残留以及根据检查结果指导RFA治疗较CT检查具有更大的优势。     

原发性中小肝癌手术与射频消融治疗的疗效分析

目的:比较射频消融(radiofrequency ablation,RFA)治疗与手术切除治疗(surgical resection,SR)对于原发性小肝癌的疗效。方法:2003年1月到2009年6月共收治经甲胎蛋白(AFP)联合影像学(MRI或CT)证实的原发性中小肝癌患者125例:RFA组60例(B超引导下经皮射频消融51例,腹腔镜下射频消融6例,CT定位经皮射频消融3例),SR组65例:采用常规手术切除治疗(肿瘤局部挖出48例,肝段切除12例,肝叶切除5例)。评估并比较两组治疗效果。结果:RFA组和SR组术后第1、2和3年生存率分别为88.33%、71.67%、58.33%和93.85%、80.00%和72.31%,两者的生存曲线采用Kaplan-Meier检验有统计学意义(P=0.043)。RFA组和SR组术后第1、2和3年的肿瘤复发率分别为15.00%、31.67%、56.67%和10.77%、24.62%和36.92%,两组比较,复发率差异有统计学意义(P=0.034)。结论:射频消融治疗虽具有术后恢复快、出血量少、住院日短、花费少等微创特点,但在肿瘤复发率和术后生存率方面不如传统手术切除治疗。     

高危部位肝癌射频消融治疗的进展

射频消融(RFA)是目前不能手术的肝恶性肿瘤患者的有效局部治疗方法之一。对于不易消融的高危病灶,如邻近膈肌、消化道、肝门大血管或胆管及肝包膜的病灶,由于无法清晰分辨病灶及容易损伤紧邻组织器官,RFA的严重并发症发生率高、局部复发率高,且死亡率增加。目前高危部位肝癌RFA治疗有诸多探索,包括联合辅助技术、采用新的引导技术、联合其他局部治疗,以期在保证安全治疗的同时提高疗效。这些探索有望增加高危部位RFA的治疗指征,使更多患者获益。本文主要对高危部位肝恶性肿瘤的射频消融治疗进展作一综述。     

射频消融术加肝动脉化疗栓塞术治疗原发性肝癌

目的探讨超声导向射频消融术(RFA)联合肝动脉化疗栓塞(TACE)治疗原发性肝癌的治疗效果。方法应用超声引导下对80例原发性肝癌患者进行RFA联合TACE(治疗组)和对70例肝癌患者进行射频消融术,比较观察该法治疗组与单纯射频消融治疗组治疗前、后肿瘤大小、血供变化及临床疗效。结果该法治疗组与单纯射频消融治疗组术后肿瘤血供消失和减少率分别为95%、70%;3个月复查彩超肿瘤缩小25%以上者分别为90%、85.7%。结论射频消融联合肝动脉化疗栓塞术是一种有效治疗肝癌的新方法。同时,彩超为实时观察肝癌血供状态,声像图变化提供重要依据,在指导治疗和判定疗效方面有重要意义。     

Recurrence-free survival after radiofrequency ablation of hepatocellular carcinoma. A registry report of the impact of risk factors on outcome

BACKGROUND: Despite the high complete necrosis rate of radiofrequency ablation (RFA), tumor recurrence, either local tumor recurrence or new tumor formation, remains a significant problem. Purpose of this study is to evaluate the pattern and risk factors for intrahepatic recurrence after percutaneous RFA for hepatocellular carcinoma (HCC). METHODS: We studied 40 patients with 48 HCCs (< or = 3.5 cm) who were treated with percutaneous RFA. The mean follow-up period was 24.1 +/- 15.7 months. We evaluated the cumulative disease-free survival of overall intrahepatic recurrence, local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Thirty host, tumoral and therapeutic risk factors were reviewed for significant tie-in correlation with recurrence: age; gender; whether RFA was the initial treatment for HCC or not; severity of liver disease; cause of liver cirrhosis; contact of tumor to major hepatic vessels and liver capsule; degree of approximation of tumor to the liver hilum; ablation time; degree of benign pre-ablational enhancement; sufficient safety margin; tumor multinodularity; tumor histological differentiation; tumor segmental location; maximum tumor diameter; degree of tumor pre-ablational enhancement at arterial phase CT, MRI or CT-angiography; and laboratory markers pre- and post-ablation (AFP, PIVKA II, TP, AST, ALT, ALP and TB). RESULTS: The incidence of overall recurrence, LTP and IDR was 65, 23 and 52.5%, respectively. The cumulative disease-free survival rates were 54.6, 74.8 and 78.3% at 1 year, 27.3, 71.9 and 46.3% at 2 years and 20, 71.9 and 29.4 at 3 years, respectively. Univariate and multivariate analysis showed that the significant risk factors for LTP were: tumor size > or = 2.3 cm, insufficient safety margin, multinodular tumor, tumors located at segments 8 and 5, and patient's age > 65 years (P < 0.05). No significant risk factor relationship for IDR could be detected. CONCLUSION: Our results would have clinical implications for advance warning and appropriate management of patients scheduled for RFA. Patients at risk of LTP should be closely monitored in the first year. Furthermore, regular long-term surveillance is essential for early detection and eradication of IDR.     

Risk factors for local progression after percutaneous radiofrequency ablation of lung tumors: evaluation based on a preliminary review of 342 tumors

BACKGROUND: The purpose of the study was to retrospectively evaluate the risk factors for local progression after percutaneous radiofrequency (RF) ablation of lung tumors. METHODS: The study included 128 patients (77 men, 51 women; mean age, 61.3 years) with 342 tumors (25 primary and 317 metastatic lung neoplasms; mean long-axis diameter, 1.7 cm) treated with RF ablation. The overall primary and secondary technique effectiveness rates were estimated using Kaplan-Meier analysis. Multiple variables were analyzed using the log-rank test, followed by multivariate multilevel analysis to determine independent risk factors for local progression. The primary and secondary technique effectiveness rates were again estimated when considering only tumors without independent risk factors. RESULTS: The median follow-up period was 12 months (range, 6-47 months). The overall primary and secondary technique effectiveness rates were 72% and 84% at 1 year, 60% and 71% at 2 years, and 58% and 66% at 3 years, respectively. Larger tumor size (hazard ratio [HR], 1.97; 95% confidence interval [95% CI], 1.47-2.65; P < .00001) and the use of an internally cooled electrode (HR, 2.32; 95% CI, 1.10-4.90; P = .027) were assessed as independent risk factors for local progression. The primary and secondary technique effectiveness rates when considering tumors smaller than 2 cm and treated with a multitined expandable electrode were 89% and 89% at 1 year and 66% and 78% at 2 years, respectively. CONCLUSIONS: Larger tumor size and the use of an internally cooled electrode were independent risk factors for local progression after RF ablation of lung tumors.     

Radiofrequency ablation for hepatocellular carcinoma and metastatic liver tumors: a comparative study

BACKGROUND: This study compared the effectiveness of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and liver metastases. METHODS: We compared the outcomes of 240 patients with HCC and 44 patients with liver metastases treated with RFA. Data were prospectively collected and retrospectively analyzed. Effects of different variables on recurrences were studied. RESULTS: A total of 406 tumor nodules were treated. The median size of the largest ablated tumor was 2.5 cm, and the median tumor number was 1. Complete tumor ablation was achieved in 91.2%. Local recurrence rate was 15.4% after a median follow-up of 24.5 months. There was no significant impact of tumor pathology on local recurrence. However, patients with liver metastasis had higher extrahepatic recurrence rate (P = 0.019) and shorter disease-free survival (P = 0.007). Patients with multiple tumors had higher local (P = 0.047) and extrahepatic (P = 0.019) recurrence rates than those with a solitary tumor. Tumor size had an impact on local recurrence rate only in patients with liver metastasis with a higher rate in those with tumor > 2.5 cm in diameter (P = 0.028). CONCLUSIONS: Tumor pathology does not appear to have a significant impact on local recurrence rates. RFA is effective in local tumor control for both HCC and liver metastasis.     

Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session,single application of percutaneous radiofrequency ablation

BACKGROUND: The objectives of this study were to clarify risk factors for local tumor recurrence and to determine which patients with hepatocellular carcinoma (HCC) are most suitable for a single session, single application of percutaneous radiofrequency (RF) ablation. METHODS: Fifty-six consecutive patients with 65 HCC tumors measuring 2 cm (risk ratio [RR], 4.9; 95%CI, 1.3-16.4; P = 0.019) and subcapsular location (RR, 5.2; 95%CI, 1.7-16.6; P = 0.005) were associated independently with local recurrence. The other four factors were not associated with local recurrence in this study. CONCLUSIONS: A single session, single application of RF ablation produced favorable local control. Patients who have nonsubcapsular HCC tumors measuring 相似文献   

Radiofrequency ablation of malignant liver tumors

The majority of patients with primary or metastatic hepatic tumors are not candidates for resection because of tumor size, location near major intrahepatic blood vessels precluding a margin-negative resection, multifocality, or inadequate hepatic function related to coexistent cirrhosis. Radiofrequency ablation (RFA) is an evolving technology being used to treat patients with unresectable primary and metastatic hepatic cancers. RFA produces coagulative necrosis of tumor through local tissue heating. Liver tumors are treated percutaneously, laparoscopically, or during laparotomy using ultrasonography to identify tumors and guide placement of the RFA needle electrode. For tumors smaller than 2.0 cm in diameter, one or two deployments of the monopolar multiple array needle electrode are sufficient to produce complete coagulative necrosis of the tumor. However, with increasing size of the tumor, there is a concomitant increase in the number of deployments of the needle electrode and the overall time necessary to produce complete coagulative necrosis of the tumor. In general, RFA is a safe, well-tolerated, effective treatment for unresectable hepatic malignancies less than 6.0 cm in diameter. Effective treatment of larger tumors awaits the development of more powerful, larger array monopolar and bipolar RFA technologies.     

经皮射频消融联合瘤内无水酒精注射与单纯射频消融治疗小肝癌的疗效比较

目的比较经皮射频消融联合瘤内无水酒精注射（RFA-PEI）与单纯射频消融（RFA）治疗单发小肝癌的疗效。方法随机应用RFA—PEI和RFA分别治疗小肝癌45例和41例,并按病灶大小分为A组（最大直径≤3．0cm）和B组（最大直径3．1～5．0cm）,以生存率和无局部复发率作为评价指标,比较两种疗法的疗效、结果RFA-PE组和RFA组的6,12,18,24个月生存率分别为88．9％、84．0％、80．6％、73．9％和87．6％、78．3%、73．7％、61.4％（P=0．6181）,无局部复发率分别为95．4％、95．4％、87．8％、73．7％和94．9％、72．7％、68.4％、57.0％（P=0．0393）,其中A组为95．7％、95．7％、79．1％、79．1％和923％、83．2％、81.3％、65．9％（P=0．3679）;B组为95．0％、95．0％、95．0％、72．6％和100．0％、583％、45．4％．45．4％（P=0．0440）结论RFA-PEI治疗肝癌安全有效,操作简单易行,可以提高RFA治疗的疗效, 特别是对于肿瘤直径为3-5cm的病灶,可以减少局部复发率,提高远期生存率。     

超声引导经皮射频消融膈下肝肿瘤的安全性研究及疗效观察

  目的   探究超声引导下经皮射频消融对膈下肝肿瘤疗效及安全性。   方法   射频治疗79例共138个肝肿瘤,其中膈下肿瘤组76个,非膈下肿瘤组62个。比较两组并发症、完全消融、局部肿瘤复发发生率。   结果   两组完全消融率分别为92.1%（70/ 76）、98.4%（61/62）,两组比较差异无统计学意义（χ2=2.49,P=0.12）。随访局部肿瘤复发两组分别19.7%（15/76）、6.5%（4/62）,差异有统计学意义（χ2=5.08,P=0.02）;无瘤生存期分别为膈下肿瘤组（21.0±1.4）个月、非膈下肿瘤组（24.7±1.7）个月,差异有统计学意义（χ2=3.84,P=0.05）。10例患者发生并发症,胸水并发症发生率存在差异（χ2=4.52,P=0.034）,无射频治疗相关死亡,无针道转移发生,消融技术成功率为100%。   结论   射频消融是一种安全有效的微创治疗技术。肿瘤位置影响消融效果,膈下肿瘤较肝中央处肿瘤易发生消融区域肿瘤复发,术中麻醉医生的协作有利于消融的顺利完成。