局部消融治疗，包括射频消融（RFA）、微波消融和冷冻消融，已成为治疗小肝细胞癌（HCC）的重要策略，补充肝切除和移植。本综述深入探讨了肿瘤大小、位置和生物学对指导接受局部消融治疗的 HCC 治疗决策的临床意义，重点关注小于 3 cm 的肿瘤。肿瘤大小显着影响治疗结果，由于创造足够的消融边缘的挑战以及微血管侵犯和肿瘤周围卫星结节的可能性，较大的肿瘤与较差的局部肿瘤控制相关。先进的消融技术，例如使用多个电极的向心或非接触式 RFA、使用多个冷冻探头的冷冻消融以及微波消融，为 HCC 治疗提供了多种选择。值得注意的是，与传统 RFA 相比，非接触式 RFA 通过实现足够的消融边缘，表现出优越的局部肿瘤控制能力，这使得它对于肝顶病变或具有侵袭性生物学的肿瘤特别有希望。腹腔镜 RFA 被证明有益于治疗前膈下 HCC，而人工胸腔积液辅助 RFA 可有效控制后膈下 HCC。然而，与 RFA 相比，手术切除通常可为门静脉周围 HCC 提供更好的生存结果。对于邻近血管周围或导管周围区域的 HCC，冷冻消融的血管或胆道并发症发生率低于 RFA。此外，可以使用磁共振成像结果和血清肿瘤标志物来预测侵袭性肿瘤生物学，例如微血管侵袭。侵袭性 HCC 亚型经常在磁共振成像上表现出肝脏成像报告和数据系统 M 特征，有助于预后。全面了解肿瘤大小、位置和生物学对于优化局部消融治疗在 HCC 治疗中的益处至关重要。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

Local ablation therapy, encompassing radiofrequency ablation (RFA), microwave ablation, and cryoablation, has emerged as a crucial strategy for managing small hepatocellular carcinomas (HCCs), complementing liver resection and transplantation. This review delves into the clinical significance of tumor size, location, and biology in guiding treatment decisions for HCCs undergoing local ablation therapy, with a focus on tumors smaller than 3 cm. Tumor size significantly influences treatment outcomes, with larger tumors associated with poorer local tumor control due to challenges in creating sufficient ablative margins and the likelihood of microvascular invasion and peritumoral satellite nodules. Advanced ablation techniques such as centripetal or no-touch RFA using multiple electrodes, cryoablation using multiple cryoprobes, and microwave ablation offer diverse options for HCC treatment. Notably, no-touch RFA demonstrates superior local tumor control compared with conventional RFA by achieving sufficient ablative margins, making it particularly promising for hepatic dome lesions or tumors with aggressive biology. Laparoscopic RFA proves beneficial for treating anterior subphrenic HCCs, whereas artificial pleural effusion-assisted RFA is effective for controlling posterior subphrenic HCCs. However, surgical resection generally offers better survival outcomes for periportal HCCs compared with RFA. Cryoablation exhibits a lower incidence of vascular or biliary complications than RFA for HCCs adjacent to perivascular or periductal regions. Additionally, aggressive tumor biology, such as microvascular invasion, can be predicted using magnetic resonance imaging findings and serum tumor markers. Aggressive HCC subtypes frequently exhibit Liver Imaging Reporting and Data System M features on magnetic resonance imaging, aiding in prognosis. A comprehensive understanding of tumor size, location, and biology is imperative for optimizing the benefits of local ablation therapy in managing HCCs.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.