CAJ | 학술논문

目的探讨甲胎蛋白(AFP)阴性肝细胞癌(HCC)患者在射频消融(RFA)获得影像学完全消融后,以安全边界(SM)≥1 cm为目标的巩同性重复RFA(CRRFA)对于局部肿瘤进展的影响.方法课题组在2002年7月至2009年7月间,共收治152例完全消融的AFP阴性HCC.其中,影像学分析显示肿瘤周边部分区域SM＜1 cm者110例,所有区域SM≥1 cm者42例.在SM＜1 cm的110例患者中,59例在首次RFA后6个月内接受了CRRFA,其余51例选择了临床观察随访.然后,据此将符合纳入标准的病例分为窄SM-CRRFA组(n=41)和窄SM-单次RFA组(n=37).此外,还从42例SM≥1.0 cm者,选择符合纳入标准的病例纳入宽SM-单次RFA组(n=30).对三组患者的局部无瘤生存率进行了比较.结果窄SM-CRRFA组1年、2年、3年、4年和5年局部无瘤生存率分别为97.1%、90.9%、69.6%、47.2%和33.0%;窄SM-单次RFA组分别为85.9%、66.5%、43.5%、15.8%和0.0%;宽SM-单次RFA组分别为92.7%、83.7%、59.3%、36.9%和9.2%.三组间局部无瘤生存率差异有统计学意义(χ2=14.789,P=0.001).两两比较结果显示,窄SM-CRRFA组和宽SM-单次RFA组的累积局部无瘤生存率均明显高于窄SM-单次RFA组(χ2分别为9.353和5.375,P值分别为0.002和0.020);窄SM-CRRFA组与宽SM-单次RFA组局部无瘤生存率差异无统计学意义(χ2=1.785,P=0.182).结论对于直径3～5 cm的AFP阴性HCC,RFA治疗后SM≥1 cm是影响局部肿瘤控制效果的重要因素;对于SM＜1 cm者,CRRFA可显著提高局部无瘤生存率.
목적 탐토갑태단백(AFP)음성간세포암(HCC)환자재사빈소융(RFA)획득영상학완전소융후,이안전변계(SM)≥1 cm위목표적공동성중복RFA(CRRFA)대우국부종류진전적영향.방법 과제조재2002년7월지2009년7월간,공수치152례완전소융적AFP음성HCC.기중,영상학분석현시종류주변부분구역SM＜1 cm자110례,소유구역SM≥1 cm자42례.재SM＜1 cm적110례환자중,59례재수차RFA후6개월내접수료CRRFA,기여51례선택료림상관찰수방.연후,거차장부합납입표준적병례분위착SM-CRRFA조(n=41)화착SM-단차RFA조(n=37).차외,환종42례SM≥1.0 cm자,선택부합납입표준적병례납입관SM-단차RFA조(n=30).대삼조환자적국부무류생존솔진행료비교.결과 착SM-CRRFA조1년、2년、3년、4년화5년국부무류생존솔분별위97.1%、90.9%、69.6%、47.2%화33.0%;착SM-단차RFA조분별위85.9%、66.5%、43.5%、15.8%화0.0%;관SM-단차RFA조분별위92.7%、83.7%、59.3%、36.9%화9.2%.삼조간국부무류생존솔차이유통계학의의(χ2=14.789,P=0.001).량량비교결과 현시,착SM-CRRFA조화관SM-단차RFA조적루적국부무류생존솔균명현고우착SM-단차RFA조(χ2분별위9.353화5.375,P치분별위0.002화0.020);착SM-CRRFA조여관SM-단차RFA조국부무류생존솔차이무통계학의의(χ2=1.785,P=0.182).결론 대우직경3～5 cm적AFP음성HCC,RFA치료후SM≥1 cm시영향국부종류공제효과적중요인소;대우SM＜1 cm자,CRRFA가현저제고국부무류생존솔.
Objective To retrospectively evaluate the role of consolidative repeat radiofrequency ablation (CRRFA) based on safety margin (SM) analyses in local tumor control for alpha-fetoprotein (AFP) negative hepatocellular carcinoma (HCC) patients who had been shown to have radiological complete ablation (CA) with radiofrequency ablation (RFA). Methods From July 2002 to July 2009,152 AFP negative HCC patients who were shown to have radiological CA with RFA therapy were retrospectively analyzed. Among them, 110 patients had a SM of less than 1 cm and the other 42 patients had a SM of 1cm or more. Among 110 patients with SM less than 1 cm, fifty nine patients accepted CRRFA within 6 months after the first RFA and 51 did not. From these patients, a narrow SM-CRRFA group (n=41) and a narrow SM-single RFA group (n=37) were enrolled respectively. The wide SM-single RFA group (n= 30) was enrolled from the 42 patients with a SM of 1 cm or more.The LTP (local tumor progression)-free survival rate of the 3 groups were compared with a log-rank test. Results One-, two-, three-, four-, and five-year LTP-free survival rates respectively were 97. 1%, 90.9%, 69.6%, 47.2%, and 33. 0% in the narrow SM-CRRFA patients. 85.9%, 66. 5%,43.5%, 15.8%, and 0. 0%, in the narrow SM-single RFA patients, and were 92.7%, 83.7%,59.3%, 36. 9%, and 9.2% in the wide SM-single RFA patients. There were statistically significant differences (χ2 = 14. 789, P= 0. 001) between the groups. Conclusions An ablation zone with an SM of 1 cm or greater was the most important factor for local control of AFP negative HCC ranging from 3 to 5 cm in diameter. For these patients with a SM of less than 1 cm, CRRFA improved the overall local control outcomes.