Continuing Control for Recurrent Tumors Provide Survival Benefits in Early Stage Hepatocellular Carcinoma Patients Treated with Radiofrequency Ablation

針對復發病灶施予有效之重複局部治療對接受射頻燒灼之早期肝癌病患可增加存活機會

陳宗勉(Tsung-Ming Chen) ； 黃彼得(Pi-Teh Huang)

《臺灣消化醫學雜誌》 28卷4期 (2011/12) Pp. 359-370

https://doi.org/10.6557/GJT.201112_28(4).0005

摘要

目的：本研究探討早期肝癌病患接受射頻燒灼治療之成效，特別著重在針對復發病灶施予重複治療對病患之影響。方法：共有135位早期肝癌病患接受射頻燒灼治療，並對其126次新再發之腫瘤給予重複之局部治療。結果：本研究系列顯示，整體存活率在1, 3 and 5年分別是88.7%, 69.0%,和59.7%。多變項分析顯示，肝功能（Child-Turcotte-Pugh class B versus class A， hazard ratio [HR]， 3.39；95% confidence interval [CI]，1.09-10.60，P=0.036），腫瘤直徑大於2.5公分（HR，4.57；95% CI，1.87-11.19；P=0.001）與，針對第一次或再發腫瘤經局部治療仍無效（HR，2.94；95% CI，1.39-6.23；P=0.005）等3項變數對存活有不利之獨立影響。早期肝癌病患及便有腫瘤復發，只要施予重複治療並獲得療效其存活機會與無復發之病患相當（P=0.380），並明顯優於治療效果失敗者（P=0.001）.結論：針對復發病灶施予有效之重複局部治療對早期肝癌病患可增加存活機會。

關鍵字

肝癌 ； 射頻燒灼 ； 復發 ； 存活率

並列摘要

Aims: In this study we evaluated the efficacy of radiofrequency ablation (RFA) as first-line therapies for patients with early stage hepatocellular carcinoma (HCC). We also tried to appraise the benefits of continuing local tumor control with iterative therapies when subsequent HCC new recurrences or local progression occurred.Methods: A total of 135 patients with early stage HCC having 162 tumors underwent index local therapies for initial tumors during the study period, and received iterative treatments for subsequent 126 new recurrences.Results: The cumulative overall survival rates at 1, 3 and 5 years were 88.7%, 69.0%, and 59.7%, respectively. With multivariate analysis, Child-Turcotte-Pugh class B (versus class A, hazard ratio [HR], 3.39; 95% confidence interval [CI], 1.09-10.60, P=0.036), maximum tumor size more than 2.5 cm (HR, 4.57; 95% CI, 1.87-11.19; P=0.001) and having any treatment failure for initial treatments and/or subsequent recurrences (HR, 2.94; 95% CI, 1.39-6.23; P=0.005) were found as independent unfavorable predictors of overall survival. Patients who experienced any recurrence but finally remained disease-free after successful treatment had similar survival outcome compared to those without any recurrence (P=0.380), but had better survival outcome than those with treatment failure (P=0.001).Conclusions: Continuing tumor control with iterative therapies for subsequent recurrence provided survival benefit in these patients with early stage HCC.

並列關鍵字

hepatocellular carcinoma ； radiofrequency ablation ； recurrence ； survival rate