Abstract

Purpose: To determine the effectiveness of ablation for pulmonary metastases (PM) from hepatocellular carcinoma (HCC).

Methods: Between 2010 and 2017, the study analyzed 39 patients who had a median age of 59 years. Primary HCC was under control and the number of PM was less than 5 (median: 2), with a maximum diameter of ≤60 mm (median: 15 mm). The primary endpoints were overall survival (OS) and local tumor progression-free survival (LTPFS). Secondary endpoints included technique success (TS), complication and tumor response. TS referred to PM treated using the treatment protocol. Multivariate analysis using the Cox proportional hazard model was conducted on the potential risk factors (univariate: p < 0.5) to determine the independent factors (multivariate: p < 0.05).

Results: The TS rate was 100%. Major complications included pneumothorax (n = 3) requiring chest tube placement and pleural effusion requiring drainage (n = 2). Complete ablation was achieved in 32/38 patients (valid percent: 84.2%) at 1 month after ablation. The 1-, 3- and 5-year OS rates were 79.8, 58 and 30.9%, respectively. The 1-, 3- and 5-year LTPFS rates were 60.7, 34.2 and 22.8%, respectively. The extent (unilateral vs. bilateral) of PM (hazard ratio (HR): 0.197, 95% confidence interval (CI): 0.043–0.890, p = 0.035) and the number (≤2 vs. >2) of PM (HR: 0.555, 95% CI: 0.311–0.991, p = 0.047) were found to be the independent risk factors for predicting OS.

Conclusion: Percutaneous thermal ablation is a safe and effective treatment for PM from HCC.

摘要

目的：确定消融对肝细胞癌（HCC）肺转移（PM）的有效性。

方法： 2010年至2017年间，该研究分析了39名中位年龄为59岁的患者。原发性肝癌已得到控制，PM数量少于5（中位数：2），最大直径≤60mm（中位数：15 mm）。主要终点为总体生存期（OS）和局部无肿瘤进展生存期（LTPFS）。次要终点包括技术成功率（TS），并发症和肿瘤反应。TS指使用治疗方案治疗的PM。使用Cox比例风险模型对潜在风险因素（单变量：p  <0.5）进行多变量分析，以确定独立因素（多变量：p  <0.05）。

结果： TS率为100％。主要并发症包括 需要放置胸管的气胸（n = 3）和需要引流的胸腔积液（n  = 2）。消融后1个月，有32/38例患者完全消融（有效百分比：84.2％）。1年，3年和5年OS率分别为79.8％，58和30.9％。1年，3年和5年LTPFS率分别为60.7、34.2和22.8％。PM的程度（单侧或双侧）（危险比（HR）：0.197，95％置信区间（CI）：0.043–0.890，p  = 0.035）和PM的数量（≤2对> 2） ：0.555，95％CI：0.311–0.991，p  = 0.047）是预测OS的独立危险因素。

结论：经皮热消融术是治疗HCC患者PM的安全有效方法。