Abstract

Objective

To assess the clinical efficacy and safety of computed tomography-guided radiofrequency ablation(CT-RFA) combined with transarterial embolization(TAE) assisted by a three-dimensional visualization ablation planning system(3DVAPS) for hepatocellular carcinoma(HCC) in challenging locations.

Methods

Data from 62 treatment-naive patients with hepatocellular carcinoma(HCC), with 83 lesions in challenging locations, and who met the Milan criteria and underwent CT-RFA between June 2013 and June 2016 were reviewed. Patients were divided into one of two groups according to different treatment modalities: study group (TAE combined with RFA assisted by 3DVAPS [n = 32]); and control (RFA only [n = 30]). Oncological outcomes included ablation-related complications, local tumor progression (LTP), and overall survival (OS). Univariate and multivariate Cox proportional hazards regression analyses were performed to assess risk factors associated with LTP and OS.

Results

HCC lesions (mean size, 1.9 ± 1.0 mm in diameter) abutting the gastrointestinal tract (n = 25), heart and diaphragm (n = 21), major vessels (n = 13), and gallbladder (n = 3) were treated. A significant difference was detected in LTP between the two groups (P = 0.034), with no significant difference in OS between the two groups (P = 0.193). There were no severe complications related to ablation. Univariate analysis revealed that sex (P = 0.046) and child-turcotte-pugh (CTP) grade (P<0.001) were risk factors for OS, whereas CTP grade and treatment method (P<0.001) were risk factors for LTP. Multivariate analysis revealed that CTP grade B (P = 0.005) was independently associated with poor OS, and RFA alone (P<0.001) was independently associated with poor LTP.

Conclusion

CT-RFA combined with TAE assisted by a 3DVAPS provided ideal clinical efficiency for HCC in challenging locations and was a highly safe treatment modality.

中文翻译：

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计算机断层扫描引导的射频消融联合经动脉栓塞的三维可视化消融计划系统辅助治疗困难地区的肝细胞癌：初步研究

摘要

目的

为了评估计算机断层扫描引导的射频消融（CT-RFA）结合经导管动脉栓塞（TAE）并辅以三维可视化消融计划系统（3DVAPS）来治疗肝癌（HCC）的临床疗效和安全性。

方法

回顾了2013年6月至2016年6月之间62例未经治疗的肝细胞癌（HCC），在具有挑战性的部位有83个病变且符合米兰标准并接受CT-RFA的数据。根据不同的治疗方式将患者分为两组之一：研究组（TAE结合3DVAPS辅助RFA [ n  = 32]）；和控制（仅限RFA [ n  = 30]）。肿瘤学结果包括与消融有关的并发症，局部肿瘤进展（LTP）和总体生存期（OS）。进行单因素和多因素Cox比例风险回归分析以评估与LTP和OS相关的危险因素。

结果

治疗了HCC病变（平均大小，直径为1.9±1.0 mm），其邻接胃肠道（n  = 25），心脏和diaphragm肌（n  = 21），主要血管（n  = 13）和胆囊（n  = 3）。两组之间的LTP差异有统计学意义（P  = 0.034），两组之间的OS差异无统计学意义（P  = 0.193）。没有与消融相关的严重并发症。单因素分析显示，性别（P  = 0.046）和儿童turcotte-pugh（CTP）等级（P <0.001）是OS的危险因素，而CTP等级和治疗方法（P<0.001）是LTP的危险因素。多变量分析表明，CTP B级（P  = 0.005）与不良OS独立相关，而仅RFA（P <0.001）与LTP不良独立相关。

结论

CT-RFA与3DVAPS辅助的TAE相结合，为挑战性地区的HCC提供了理想的临床效率，是一种高度安全的治疗方式。