Abstract：
Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the liver\'s two most common malignant neoplasms. Liver-directed therapies such as ablation have become part of multidisciplinary therapies despite a paucity of data. Therefore, an expert panel was convened to develop evidence-based recommendations regarding the use of microwave ablation (MWA) and radiofrequency ablation (RFA) for HCC or CRLM less than 5 cm in diameter in patients ineligible for other therapies.
A systematic review was conducted for six key questions (KQ) regarding MWA or RFA for solitary liver tumors in patients deemed poor candidates for first-line therapy. Subject experts used the GRADE methodology to formulate evidence-based recommendations and future research recommendations.
The panel addressed six KQs pertaining to MWA vs. RFA outcomes and laparoscopic vs. percutaneous MWA. The available evidence was poor quality and individual studies included both HCC and CRLM. Therefore, the six KQs were condensed into two, recognizing that these were two disparate tumor groups and this grouping was somewhat arbitrary. With this significant limitation, the panel suggested that in appropriately selected patients, either MWA or RFA can be safe and feasible. However, this recommendation must be implemented cautiously when simultaneously considering patients with two disparate tumor biologies. The limited data suggested that laparoscopic MWA of anatomically more difficult tumors has a compensatory higher morbidity profile compared to percutaneous MWA, while achieving similar overall 1-year survival. Thus, either approach can be appropriate depending on patient-specific factors (very low certainty of evidence).
Given the weak evidence, these guidelines provide modest guidance regarding liver ablative therapies for HCC and CRLM. Liver ablation is just one component of a multimodal approach and its use is currently limited to a highly selected population. The quality of the existing data is very low and therefore limits the strength of the guidelines.
A systematic review was conducted for six key questions (KQ) regarding MWA or RFA for solitary liver tumors in patients deemed poor candidates for first-line therapy. Subject experts used the GRADE methodology to formulate evidence-based recommendations and future research recommendations.
The panel addressed six KQs pertaining to MWA vs. RFA outcomes and laparoscopic vs. percutaneous MWA. The available evidence was poor quality and individual studies included both HCC and CRLM. Therefore, the six KQs were condensed into two, recognizing that these were two disparate tumor groups and this grouping was somewhat arbitrary. With this significant limitation, the panel suggested that in appropriately selected patients, either MWA or RFA can be safe and feasible. However, this recommendation must be implemented cautiously when simultaneously considering patients with two disparate tumor biologies. The limited data suggested that laparoscopic MWA of anatomically more difficult tumors has a compensatory higher morbidity profile compared to percutaneous MWA, while achieving similar overall 1-year survival. Thus, either approach can be appropriate depending on patient-specific factors (very low certainty of evidence).
Given the weak evidence, these guidelines provide modest guidance regarding liver ablative therapies for HCC and CRLM. Liver ablation is just one component of a multimodal approach and its use is currently limited to a highly selected population. The quality of the existing data is very low and therefore limits the strength of the guidelines.
摘要：
背景：原发性肝细胞癌（HCC）和结直肠肝转移（CRLM）是肝脏两种最常见的恶性肿瘤。尽管缺乏数据，但诸如消融之类的肝定向治疗已成为多学科治疗的一部分。因此,我们召集了一个专家小组,就直径小于5cm的HCC或CRLM不适合接受其他治疗的患者使用微波消融(MWA)和射频消融(RFA)提出循证建议.
方法：对单发肝肿瘤患者的MWA或RFA的六个关键问题（KQ）进行了系统评价。主题专家使用GRADE方法来制定基于证据的建议和未来的研究建议。
结果：小组讨论了与MWA和RFA结果和腹腔镜与经皮MWA.现有证据质量差，个别研究包括HCC和CRLM。因此,六个KQ被浓缩为两个，认识到这是两个不同的肿瘤组，这种分组有点武断。有了这个显著的限制，小组建议，在适当选择的患者中，MWA或RFA都是安全可行的。然而,当同时考虑患有两种不同肿瘤生物制剂的患者时,必须谨慎实施这一建议.有限的数据表明，与经皮MWA相比，腹腔镜MWA对解剖学上更困难的肿瘤具有代偿性更高的发病率，同时实现相似的1年总生存率。因此，根据患者的具体因素(证据的确定性非常低),任何一种方法都可能是合适的.
结论：鉴于证据薄弱，这些指南为HCC和CRLM的肝脏消融治疗提供了适度的指导.肝脏消融只是多模式方法的一个组成部分，其使用目前仅限于高度选择的人群。现有数据的质量很低，因此限制了准则的强度。
方法：对单发肝肿瘤患者的MWA或RFA的六个关键问题（KQ）进行了系统评价。主题专家使用GRADE方法来制定基于证据的建议和未来的研究建议。
结果：小组讨论了与MWA和RFA结果和腹腔镜与经皮MWA.现有证据质量差，个别研究包括HCC和CRLM。因此,六个KQ被浓缩为两个，认识到这是两个不同的肿瘤组，这种分组有点武断。有了这个显著的限制，小组建议，在适当选择的患者中，MWA或RFA都是安全可行的。然而,当同时考虑患有两种不同肿瘤生物制剂的患者时,必须谨慎实施这一建议.有限的数据表明，与经皮MWA相比，腹腔镜MWA对解剖学上更困难的肿瘤具有代偿性更高的发病率，同时实现相似的1年总生存率。因此，根据患者的具体因素(证据的确定性非常低),任何一种方法都可能是合适的.
结论：鉴于证据薄弱，这些指南为HCC和CRLM的肝脏消融治疗提供了适度的指导.肝脏消融只是多模式方法的一个组成部分，其使用目前仅限于高度选择的人群。现有数据的质量很低，因此限制了准则的强度。
