European Radiology:微波消融与射频消融在包膜下HCC中的应用

2022-05-11 shaosai MedSci原创

热消融术是一种创伤较小的手术,可以作为肝癌患者的替代治疗方案来推荐。

众所周知肿瘤的位置是肝细胞癌(HCC)患者预后和治疗选择的一个重要因素,手术切除(SR)是首选的治疗手段。然而,临床上门静脉高压症或术后肝脏储备不足往往限制了SR。热消融术是一种创伤较小的手术,可以作为这些患者的替代治疗方案来推荐。

研究报道,热消融,如射频消融(RFA)和微波消融(MWA),对包膜下HCC是有效安全的。然而,文献并没有提供足够的数据来比较热消融对包膜下和非包膜下HCC的作用。因此,RFA在包膜下HCC中仍是一种有争议的治疗方法,而且可能增加并发症的发生率。据我们所知,目前还没有研究比较MWA与RFA在治疗包膜下HCC患者方面的疗效和安全性。

近日,发表在European Radiology杂志的一项研究对米兰标准范围内的包膜下HCC患者进行了回顾性分析,并使用倾向性评分匹配(PSM)来尽量减少潜在的选择和混杂偏差,为该类患者术式的最佳选择提供了有价值的参考标准。

本研究总共包括195名符合米兰标准并接受MWA或RFA的包膜下HCC患者。比较了这些患者的局部肿瘤进展(LTP)、总生存期(OS)、超出米兰标准的复发(RBM)以及并发症。 

经过倾向性评分匹配,MWA组的1年、3年和5年累积LTP率分别为6.7%、9.6%和11.4%,RFA组为13.4%、24.6%和29.1%(P = 0.006)。接受MWA治疗的患者的RBM累积率低于接受RFA治疗的患者(1年时4.4%对12%;3年时14.5%对23.0%;5年时37.4%对53.9%;P = 0.03)。MWA组1年、3年和5年的OS率分别为97.1%、85.9%和73.4%,RFA组为95.6%、80.4%和61.4%(p = 0.36)。主要并发症的发生率在MWA组和RFA组之间没有显著差异(17.4%对11.6%,P = 0.33)。 

 
米兰标准内的包膜下肝细胞肝癌患者的总生存曲线。在总队列和PSM队列中,MWA组和RFA组的总生存曲线没有显著差异(P = 0.27。 p = 0.36)

本研究表明,在米兰标准范围内,MWA对包膜下HCC的肿瘤控制比RFA更好。关于并发症方面,MWA的总体并发症发生率比RFA高,但主要并发症发生率并没有明显的差异。

 

原文出处:

Hang Zheng,Kaiwen Liu,Yao Yang,et al.Microwave ablation versus radiofrequency ablation for subcapsular hepatocellular carcinoma: a propensity score-matched study.DOI:10.1007/s00330-022-08537-5.

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    2022-05-26 仁医06
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    2022-05-11 ms4000001126411322

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    2022-05-08 jiyangfei
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