跳到主要內容

臺灣博碩士論文加值系統

(3.237.38.244) 您好!臺灣時間:2021/07/24 17:03
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:黃振義
研究生(外文):Hwang, Jen-I
論文名稱:經皮射頻消融術治療肝細胞癌的療效評估及預測--以臺灣中部某醫學中心病患為例
論文名稱(外文):Evaluation And Prediction Of The Outcome Of Hepatocellular Carcinoma Treated With Percutaneous Radiofrequency Ablation At One Medical Center In Mid-Taiwan
指導教授:王立志王立志引用關係
指導教授(外文):Wang, Li-Chih
口試委員:李三剛黃欽印
口試委員(外文):Lee, San-KanHuang, Chin-Yin
口試日期:2012-07-03
學位類別:碩士
校院名稱:東海大學
系所名稱:工業工程與經營資訊學系
學門:工程學門
學類:工業工程學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:46
中文關鍵詞:肝細胞癌射頻消融術電腦斷層攝影導引模式樹療效預測
外文關鍵詞:hepatocellular carcinomaradiofrequency ablationcomputed tomography guidedeffectiveness prediction
相關次數:
  • 被引用被引用:0
  • 點閱點閱:283
  • 評分評分:
  • 下載下載:36
  • 收藏至我的研究室書目清單書目收藏:0
射頻消融術(RFA)乃治療肝細胞癌眾多非手術治療方法中最有效者,近年來已被廣泛採用,尤其對於三公分以下肝腫瘤療效尤佳。本研究分析台灣中部某醫學中心收治病患,評估射頻消融術治療肝細胞癌的長期療效及併發症,並利用統計分析及分類法中的M5’模式樹,嘗試找出最佳的療效時間與消融次數,以供初學者參考,並期望能提升台灣治療肝細胞癌的治療成果。
本研究收集個案醫院2003年6月至2011年5月,共210位病患於8年中接受324次RFA治療358顆肝細胞癌,腫瘤大小0.8公分~10公分,平均2.69公分。所有病患皆接受電腦斷層導引射頻消融治療,並於術後立即追蹤雙相對比劑電腦斷層攝影,然後於術後2個月及每隔3個月定期追蹤其AFP、肝功能及CT。結果顯示,我們整體的手術併發症是1.2%(4/324),一年、三年及五年的存活率為91.9%、53.2%及35.7%。若以術後2個月CT評估腫瘤壞死率,則小於或等於3公分的腫瘤有95%達到完全壞死,若腫瘤小於或等於5公分則有89%腫瘤完全壞死。腫瘤的局部復發率分別是一年11.7%及三年17.6%。進一步利用決策樹及M5’模式樹來分類與分析,我們發現若腫瘤靠近超過3mm以上的肝內血管,較容易治療不完全及產生局部復發。若以3公分水冷式消融探針為例,2.5公分以下肝腫瘤,單針一次消融即可治癒肝腫瘤,但若腫瘤大於2.5公分或靠近3mm以上大血管,則需二次以上的消融治療方能克竟全功。
利用電腦斷層導引的射頻消融術是一種既安全又有效的非手術治療肝細胞癌的主要方法,尤其是小於3公分的肝癌,RFA的治療效果與手術切除無異,值得推廣採用以降低病患的手術風險及健保與病患的財務負擔。為了降低局部復發率,其消融灶應至少比腫瘤邊緣多5毫米以上,尤其是靠近3mm以上肝內血管的肝細胞癌。

Radiofrequency ablation (RFA) has been accepted as the most effective non-surgical method for the treatment of hepatocellular carcinoma (HCC) less than 3cm in size. In this study, we retrospectively review the clinical data and follow-up images of the patients with HCC received RFA in 8 years. The therapeutic effectiveness and complication rate of RFA for managing HCC in this series were evaluated. Further more, we utilize OLAP, CART and M5’ for classification of our patients’ group and try to find the best way for obtaining the better results in the future.
From June 2003 to May 2011, totally 210 patients with 358 HCC lesions were referred to a medical center at Mid-Taiwan for 324 sessions of RFA treatment. The tumor size ranged from 0.8 to 10cm with average of 2.69cm. All patients received CT-guided RFA under local anesthesia with PCA pain control. The dual phases CT scan was performed as well as liver function test and alpha-fetoprotein for follow-up tumor response at immediately, 2 months, and then every 3 months after the procedure. The overall complication rate was 1.2% (4/324 procedures) and the 1, 3 and 5 years of survival rate were 91.9%, 53.2% and 35.7% respectively. The complete tumor necrosis rate of tumors less than 3cm or 5cm were 95% or 89% and the local recurrence rate at 1 and 3 years were 11.7% and 17.6%.
We further classified the patients with OLAP, CART and M5’ to analyze the risk factors of local recurrence and revealed that tumors nearby the vessels larger than 3mm had high risk of local recurrence. If the tumor size is less than 2.5cm without large vessel surrounded, one ablation with 3cm exposed cool-tip needle is enough, otherwise, more than two ablations may be indicated for tumors larger than 2.5cm and/or nearby the large vessels.
In conclusion, CT-guide RFA is a safe and cost-effective non-surgical modality for the treatment of hepatocellular carcinoma, especially for the tumor mass less than 3cm in size. For the purpose of decrease of local tumor recurrence, the safe margin must be 5mm beyond the tumor at least.

目錄
摘要..……………………………………………………………………………………. ..i
ABSTRACT……………………………………………………………………………....ii
致謝詞………………………………………………………………………..………...…iii
目錄..……………………………………………………………………………………...iv
圖目錄……………………………………………………..……………………………....v
表目錄…………………………………………………………………………….............vi
第一章 緒論……………………………………………………………………………....1
1.1 研究背景與動機…………………………… ……………………………….....1
1.2 研究範圍與目的………………………………… ………………………….....2
1.3 研究方法與步驟………………………………… ………………………….....2
1.4 研究架構………………………………………… ………………….................5
第二章 文獻探討………………………… …………………………………………....6
2.1肝細胞癌簡介……………………… ………………………………………......6
2.2肝細胞癌的治療……………………… ………………………………………..6
2.3射頻消融術的影像導引………………… ……………………………………11
2.4射頻消融術的併發症…………………… ……………………………………11
2.5射頻消融術的療效評估與預測………… ……………………………………12
第三章 統計分析………………………………………………………………...……...13
3.1線上分析處理………………..…….……… …………………………...……..13
3.2 Kaplan–Meier 估計法……..…………… ……………………………...……..14
3.3模式樹…………………………...………… ………………………...……......15
第四章 射頻消融療效評估與預測方法………………………………………………..21
4.1 CT-guide RFA治療績效評估與預測方法與步驟…… ……..………………..21
4.2範例說明……………………………………………… …………………...….24
第五章 結果與分析……………………………………………………………………..33
5.1個案病例資料說明…………………...……………… ……………………….33
5.2 RFA療效分析…………………...………………… …………….……...……36
5.3 RFA療效預測…………………...…………………………………………….39
5.4討論…………………...……………………………… ……………………….39
第六章 結論與建議……………………………………………………………………..42
6.1 結論………………………………………………… ……………..………….42
6.2 建議………………………………………………… …………..…………….42
參考文獻……………………………………………………………..…………………..44



圖目錄
圖1.1 研究方法步驟圖.........................................................................................................3
圖1.2 研究架構圖.................................................................................................................5
圖3.1 下鑽的範例...............................................................................................................14
圖3.2 腫瘤大小與併發症之關係.......................................................................................14
圖3.3 存活函數範例...........................................................................................................15
圖4.1 CT-guide RFA治療績效評估與預測方法流程圖...................................................21
圖4.2 資料分類流程圖.......................................................................................................22
圖4.3 決策樹之分類示意圖...............................................................................................23
圖4.4 接收者操作特徵曲線...............................................................................................24
圖4.5 存活率分析圖...........................................................................................................27
圖4.6 決策樹之第一層分類示意圖...................................................................................29
圖4.7 決策樹之第二層分類示意圖...................................................................................29
圖4.8 決策樹各分類節點的預測迴歸式...........................................................................30
圖4.9 最佳切點之示意圖...................................................................................................31
圖4.10 接收者操作特徵曲線...............................................................................................32
圖5.1 復發性肝細胞癌影像追踪圖...................................................................................37

表目錄
表2.1 HCC治療法比較表...................................................................................................9
表3.1 目前模式樹之相關方法..........................................................................................17
表4.1 步驟一所使用範例基本資料..................................................................................25
表4.2 腫瘤資料形態..........................................................................................................25
表4.3 病人資料形態..........................................................................................................26
表4.4 Session 資料形態....................................................................................................27
表4.5 靠近血管(Vessel=1)之分類表.................................................................................31
表5.1 Clinical findings of 210 patients of HCCs treated with CT-guided RFA……….....33
表5.2 Tumor character of 358 HCCs treated with CT-guided RFA...................................35
表5.3 Primary effectiveness of CT-guided RFA according to tumor size..........................38
表5.4 Overall survival rate of RFA for treatment of HCC.................................................38

Alexander, W. P., & Grimshaw, S. D. (1996). Treed Regression. Computational and Graphical Statistics, 5, pp.156-175.
Breiman, L., Friedman, J. H., Olshen, R. A., & Stone, C. J. (1984). classification and Regression Trees. New Yourk: Chapman & Hall.
Castells, A., Bruix, J., Bru, C., Fuster, J., Vilana, R., Navasa, M., . . . Rodés, J. (1993). Treatment of small hepatocellular carcinoma in cirrhotic patients: a cohort study comparing surgical resection and percutaneous ethanol injection. Hepatology (Baltimore, Md.), 18(5), 1121-1126.
Chaudhuri, P., Huang, M. C., & Loh, W. Y. (1994). Piecewise-polynomial regression trees. Statistica Sinica, 4, pp.143-167.
Cho, Y. K., Rhim, H., & Noh, S. (2011). Radiofrequency ablation versus surgical resection as primary treatment of hepatocellular carcinoma meeting the Milan criteria: a systematic review. J Gastroenterol Hepatol, 26(9), 1354-1360. doi: 10.1111/j.1440-1746.2011.06812.x
de Baere, T., Dromain, C., Lapeyre, M., Briggs, P., Duret, J. S., Hakime, A., . . . Ducreux, M. (2005). Artificially induced pneumothorax for percutaneous transthoracic radiofrequency ablation of tumors in the hepatic dome: initial experience. Radiology, 236(2), 666-670. doi: 10.1148/radiol.2362040992
Dobra, A., & Gehrke, J. E. (2002). SECRET:A Scalable Linear Regression Tree Algorithm,. Paper presented at the Eighth ACM SIGKDD International conference on Knowledge Discovery and Data Mining.
Gür Ali, Ö., Serpil, S., Tom, v. W., & Jan, F. (2009). SKU Demand Forecasting In The Presence Of Promotions. Expert Systems with Applications, 36(10), 12340-12348.
Huang, J., Yan, L., Cheng, Z., Wu, H., Du, L., Wang, J., . . . Zeng, Y. (2010). A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg, 252(6), 903-912. doi: 10.1097/SLA.0b013e3181efc656
00000658-201012000-00003 [pii]
Huang, J. W., Hernandez-Alejandro, R., Croome, K. P., Yan, L. N., Wu, H., Chen, Z. Y., . . . Zeng, Y. (2011). Surgical vs percutaneous radiofrequency ablation for hepatocellular carcinoma in dangerous locations. World J Gastroenterol, 17(1), 123-129. doi: 10.3748/wjg.v17.i1.123
Hung, H. H., Chiou, Y. Y., Hsia, C. Y., Su, C. W., Chou, Y. H., Chiang, J. H., . . . Wu, J. C. (2011). Survival rates are comparable after radiofrequency ablation or surgery in patients with small hepatocellular carcinomas. Clin Gastroenterol Hepatol, 9(1), 79-86. doi: S1542-3565(10)00847-5 [pii]10.1016/j.cgh.2010.08.018
Kampichler, C., Dzeroski, S., & Wieland, R. (2000). Application of Machine Learning Techniques to the Analysis of Soil Ecological Data Bases:Relationships betwen Habitat Features and Collembolan Community Characteristics. Soil Biology & Biochemistry, 32,2, pp.197-209.
Karalic, A. (1992). Employing linear regression in regression tree leaves. Paper presented at the 10th European Conference on Artificial Intelligence.
Laspas, F., Sotiropoulou, E., Mylona, S., Manataki, A., Tsagouli, P., Tsangaridou, I., & Thanos, L. (2009). Computed tomography-guided radiofrequency ablation of hepatocellular carcinoma: treatment efficacy and complications. J Gastrointestin Liver Dis, 18(3), 323-328. doi: 10 [pii]
Lencioni, R., Cioni, D., Crocetti, L., Franchini, C., Pina, C. D., Lera, J., & Bartolozzi, C. (2005). Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. [Clinical Trial]. Radiology, 234(3), 961-967. doi: 10.1148/radiol.2343040350
Livraghi, T., Giorgio, A., Marin, G., Salmi, A., de Sio, I., Bolondi, L., . . . Torzilli, G. (1995). Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology, 197(1), 101-108.
Livraghi, T., Goldberg, S. N., Lazzaroni, S., Meloni, F., Solbiati, L., & Gazelle, G. S. (1999). Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology, 210(3), 655-661.
Livraghi, T., Makisalo, H., & Line, P. D. (2011). Treatment options in hepatocellular carcinoma today. Scand J Surg, 100(1), 22-29.
Llovet, J. M., Burroughs, A., & Bruix, J. (2003). Hepatocellular carcinoma. Lancet, 362(9399), 1907-1917. doi: S0140-6736(03)14964-1 [pii]10.1016/S0140-6736(03)14964-1
Llovet, J. M., Ricci, S., Mazzaferro, V., Hilgard, P., Gane, E., Blanc, J. F., . . . Bruix, J. (2008). Sorafenib in advanced hepatocellular carcinoma. N Engl J Med, 359(4), 378-390. doi: 359/4/378 [pii] 10.1056/NEJMoa0708857
Lu, D. S., Raman, S. S., Limanond, P., Aziz, D., Economou, J., Busuttil, R., & Sayre, J. (2003). Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. Journal of Vascular and Interventional Radiology, 14(10), 1267-1274.
Lu, M. D., Yin, X. Y., Xie, X. Y., Xu, H. X., Xu, Z. F., Liu, G. J., . . . Zheng, Y. L. (2005). Percutaneous thermal ablation for recurrent hepatocellular carcinoma after hepatectomy. [Evaluation Studies]. Br J Surg, 92(11), 1393-1398. doi: 10.1002/bjs.5102
Matsui, O., Miyayama, S., Sanada, J., Kobayashi, S., Khoda, W., Minami, T., . . . Gabata, T. (2010). Interventional oncology: new options for interstitial treatments and intravascular approaches: superselective TACE using iodized oil for HCC: rationale, technique and outcome. J Hepatobiliary Pancreat Sci, 17(4), 407-409. doi: 10.1007/s00534-009-0234-z
Park, B. J., Byun, J. H., Jin, Y. H., Won, H. J., Shin, Y. M., Kim, K. W., . . . Kim, P. N. (2009). CT-guided radiofrequency ablation for hepatocellular carcinomas that were undetectable at US: Therapeutic effectiveness and safety. Journal of Vascular and Interventional Radiology, 20(4), 490-499. doi: DOI 10.1016/j.jvir.2009.01.004
Quinlan, J. R. (1992). Learning with Continuous Classes. Paper presented at the 5th Australian Joint Conference on Artificial Intelligence, Hobart, Australia.
Rhim, H., Yoon, K. H., Lee, J. M., Cho, Y., Cho, J. S., Kim, S. H., . . . Byun, J. Y. (2003). Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiographics, 23(1), 123-134; discussion 134-136.
Roiger, R. J., & Geatz, M. W. (2003). Data Mining: A Tutorial-Based Primer. New York: Addison Wesley.
Torgo, L. (1997). Fuctional models for regression tree leaves. Paper presented at the 14th Internaitional Conference on Machine Learning.
Wang, Y., & Witten, I. H. (1997). Inducing Model Trees for Continuous Classes. Paper presented at the the 9th European Conference on Machine Learning, Prague, Czech Republic.
Witten, I. H., & Frank, E. (2005). Data Mining: Practical Machine Learning Tools and Techniques (2nd ed.). San Francisco: Morgan Kaufmann.
Wu, J. H., Hwang, J. I., Hung, S. W., Chou, Y. H., Lee, T., Lee, S. K. (2005). Hepatocellular carcinoma treated with percutaneous radiofrequency ablation: evaluated with sequential biphasic helical CT. Chin J Radiol, 30, 65-74.

連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top