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.
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.