Percutaneous radiofrequency ablation for early hepatocellular carcinoma: Risk factors for survival

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art_KIKUCHI_Percutaneous_radiofrequency_ablation_for_early_hepatocellular_carcinoma_Risk_2014.PDF (1.12 MB)
Citações na Scopus
20
Tipo de produção
article
Data de publicação
2014
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
BAISHIDENG PUBL GRP CO LTD
Autores
DINIZ, Marcio A.
Citação
WORLD JOURNAL OF GASTROENTEROLOGY, v.20, n.6, p.1585-1593, 2014
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
AIM: To evaluate outcomes of radiofrequency ablation (RFA) therapy for early hepatocellular carcinoma (HCC) and identify survival-and recurrence-related factors. METHODS: Consecutive patients diagnosed with early HCC by computed tomography (CT) or magnetic resonance imaging (MRI) (single nodule of <= 5 cm, or multi-(up to 3) nodules of <= 3 cm each) and who underwent RFA treatment with curative intent between January 2010 and August 2011 at the Instituto do Cancer do Estado de Sao Paulo, Brazil were enrolled in the study. RFA of the liver tumors (with 1.0 cm ablative margin) was carried out under CT-fluoro scan and ultrasonic image guidance of the percutaneous ablation probes. Procedure-related complications were recorded. At 1-mo post-RFA and 3-mo intervals thereafter, CT and MRI were performed to assess outcomes of complete response (absence of enhancing tissue at the tumor site) or incomplete response (enhancing tissue remaining at the tumor site). Overall survival and disease-free survival rates were estimated by the Kaplan-Meier method and compared by the log rank test or simple Cox regression. The effect of risk factors on survival was assessed by the Cox proportional hazard model. RESULTS: A total of 38 RFA sessions were performed during the study period on 34 patients (age in years: mean, 63 and range, 49-84). The mean follow-up time was 22 mo (range, 1-33). The study population showed predominance of male sex (76%), less severe liver disease (Child-Pugh A, n = 26; Child-Pugh B, n = 8), and single tumor (65%). The maximum tumor diameters ranged from 10 to 50 mm (median, 26 mm). The initial (immediately post-procedure) rate of RFA-induced complete tumor necrosis was 90%. The probability of achieving complete response was significantly greater in patients with a single nodule (vs patients with multi-nodules, P = 0.04). Two patients experienced major complications, including acute pulmonary edema (resolved with intervention) and intestinal perforation (led to death). The 1- and 2-year overall survival rates were 82% and 71%, respectively. Sex, tumor size, initial response, and recurrence status influenced survival, but did not reach the threshold of statistical significance. Child-Pugh class and the model for end-stage liver disease score were identified as predictors of survival by simple Cox regression, but only Child-Pugh class showed a statistically significant association to survival in multiple Cox regression analysis (HR = 15; 95% CI: 3-76 mo; P = 0.001). The 1- and 2-year cumulative disease-free survival rates were 65% and 36%, respectively. CONCLUSION: RFA is an effective therapy for local tumor control of early HCC, and patients with preserved liver function are the best candidates.
Palavras-chave
Hepatocellular carcinoma, Radiofrequency ablation, Overall survival, Disease-free survival
URI
https://observatorio.fm.usp.br/handle/OPI/5451
Referências
  1. Borie F, 2008, J SURG ONCOL, V98, P505, DOI 10.1002/jso.21159
  2. Bosch FX, 2004, GASTROENTEROLOGY, V127, pS5, DOI 10.1053/j.gastro.2004.09.011
  3. Bouza C, 2009, BMC GASTROENTEROL, V9, DOI 10.1186/1471-230X-9-31
  4. Bruix J, 2011, HEPATOLOGY, V53, P1020, DOI 10.1002/hep.24199
  5. Duan CY, 2013, WORLD J SURG ONCOL, V11, DOI 10.1186/1477-7819-11-190
  6. Llovet JM, 2012, J HEPATOL, V56, P908
  7. Forner A, 2012, LANCET, V379, P1245, DOI 10.1016/S0140-6736(11)61347-0
  8. Gillmore R, 2011, J HEPATOL, V55, P1309, DOI 10.1016/j.jhep.2011.03.007
  9. Kaibori M, 2013, WORLD J SURG, V37, P820, DOI 10.1007/s00268-013-1902-3
  10. Kikuchi Luciana, 2013, Antivir Ther, V18, P445, DOI 10.3851/IMP2602
  11. Kim JH, 2011, ANN SURG ONCOL, V18, P1624, DOI 10.1245/s10434-011-1673-8
  12. Koike Y, 2000, HEPATOLOGY, V32, P1216, DOI 10.1053/jhep.2000.20237
  13. Lausen B, 1994, CONTR STAT, P483
  14. Lencioni R, 2010, HEPATOLOGY, V52, P762, DOI 10.1002/hep.23725
  15. Lencioni R, 2005, RADIOLOGY, V234, P961, DOI 10.1148/radiol.2343040350
  16. Livraghi T, 2003, RADIOLOGY, V226, P441, DOI 10.1148/radiol.2262012198
  17. Mazzaferro V, 2004, ANN SURG, V240, P900, DOI 10.1097/01.sla.0000143301.56154.95
  18. Minagawa M, 2003, ANN SURG, V238, P703, DOI 10.1097/01.sla.0000094549.11754.e6
  19. Ni JY, 2013, WORLD J GASTROENTERO, V19, P3872, DOI 10.3748/wjg.v19.i24.3872
  20. N'Kontchou G, 2009, HEPATOLOGY, V50, P1475, DOI 10.1002/hep.23181
  21. Orlando A, 2009, AM J GASTROENTEROL, V104, P514, DOI 10.1038/ajg.2008.80
  22. Peng ZW, 2012, RADIOLOGY, V262, P689, DOI 10.1148/radiol.11110637
  23. Piscaglia F, 2013, DIGEST LIVER DIS, V45, P852, DOI 10.1016/j.dld.2013.03.002
  24. Pompili M, 2013, J HEPATOL, V59, P89, DOI 10.1016/j.jhep.2013.03.009
  25. Sala M, 2004, HEPATOLOGY, V40, P1352, DOI 10.1002/hep.20465
  26. Shiina S, 2012, AM J GASTROENTEROL, V107, P569, DOI 10.1038/ajg.2011.425
  27. Takahashi S, 2007, ONCOLOGY-BASEL, V72, P98, DOI 10.1159/000111714
  28. Tateishi R, 2005, CANCER, V103, P1201, DOI 10.1002/cncr.20892
  29. Yan K, 2008, EUR J RADIOL, V67, P336, DOI 10.1016/j.ejrad.2007.07.007

Coleções
Artigos e Materiais de Revistas Científicas - FM/MPT
Artigos e Materiais de Revistas Científicas - FM/MGT
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InRad
Artigos e Materiais de Revistas Científicas - LIM/07
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