Recurrence patterns and survival outcomes after irreversible electroporation for hepatocellular carcinoma: a 6-year multicenter experience.

IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Min Xu, Shanyu Yin, Qiyu Zhao, Guo Tian, Jinhua Pan, Gang Dong, Wu Zhang, Tuerganaili Aji, Jiansong Ji, Xinhua Chen, Danxia Xu, Tian'an Jiang
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引用次数: 0

Abstract

Objectives: Irreversible electroporation (IRE) is a relatively recent non-thermal ablation technique for hepatocellular carcinoma (HCC) in high-risk anatomical locations, but post-procedural recurrence limits long-term survival. This study aimed to investigate the risk factors, patterns, and outcomes of post-IRE recurrence.

Materials and methods: This study retrospectively analyzed 180 patients with solitary HCC (≤ 5 cm) who underwent IRE at five centers. Recurrence was categorized as local tumor progression (LTP), intrahepatic distant recurrence (IDR), aggressive intrasegmental recurrence (AIR), and extrahepatic distant recurrence (EDR). Competing-risk regression models and dynamic risk curves were utilized to assess risk factors and temporal trends.

Results: Over a mean follow-up of 40.9 ± 12.6 months, 50.6% of patients developed recurrence. IDR was the predominant pattern (41.7%), followed by LTP (10.0%), EDR (8.3%), and AIR (1.7%). Multivariate analysis identified cirrhosis and tumor size as predictors of LTP; recurrent HCC and cirrhosis as predictors of IDR; and the male sex, cirrhosis, and tumor size as predictors of EDR (all p < 0.05). Only EDR was an independent risk factor for worse overall survival (p < 0.001). Recurrence risk demonstrated a bimodal pattern, with peaks at 21 and 33 months.

Conclusion: IDR is the dominant post-IRE recurrence pattern, but only EDR predicts survival. The identified risk factors and bimodal recurrence peaks contribute to guiding stratified therapeutic strategies for HCC in high-risk locations.

Key points: Question Current knowledge of post-ablation recurrence patterns for hepatocellular carcinoma is primarily derived from thermal ablation, lacking data for non-thermal irreversible electroporation. Findings Intrahepatic distant recurrence was the most common recurrence pattern, while only extrahepatic distant recurrence predicted worse survival. Clinical relevance Irreversible electroporation provided excellent local control for high-risk hepatocellular carcinoma but struggled with recurrence. While extrahepatic distant recurrence predicted reduced survival, local or intrahepatic recurrences yielded favorable outcomes with salvage therapy.

不可逆电穿孔治疗肝细胞癌后的复发模式和生存结果:6年多中心经验。
目的:不可逆电穿孔(IRE)是一种相对较新的非热消融技术,用于治疗高危解剖部位的肝细胞癌(HCC),但手术后复发限制了长期生存。本研究旨在探讨ire后复发的危险因素、模式和结果。材料和方法:本研究回顾性分析了180例在5个中心接受IRE治疗的单发HCC(≤5 cm)患者。复发分为局部肿瘤进展(LTP)、肝内远处复发(IDR)、侵袭性节段内复发(AIR)和肝外远处复发(EDR)。竞争风险回归模型和动态风险曲线用于评估风险因素和时间趋势。结果:平均随访40.9±12.6个月,50.6%的患者复发。IDR为主要类型(41.7%),其次是LTP(10.0%)、EDR(8.3%)和AIR(1.7%)。多因素分析发现肝硬化和肿瘤大小是LTP的预测因素;复发性HCC和肝硬化作为IDR的预测因子结论:IDR是ire后主要的复发模式,但只有EDR能预测生存率。确定的危险因素和双峰复发高峰有助于指导高危部位HCC的分层治疗策略。目前关于肝细胞癌消融后复发模式的知识主要来自热消融,缺乏非热不可逆电穿孔的数据。发现肝内远端复发是最常见的复发方式,而只有肝外远端复发预后较差。临床意义不可逆电穿孔对高危肝细胞癌提供了良好的局部控制,但难以复发。虽然肝外远端复发预测生存率降低,但局部或肝内复发在补救性治疗中获得了良好的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
European Radiology
European Radiology 医学-核医学
CiteScore
11.60
自引率
8.50%
发文量
874
审稿时长
2-4 weeks
期刊介绍: European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.
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