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Guan H, Xie Y, Lyu T, Song L, Tong X, Wang J, Zou Y. Radiofrequency ablation with or without conventional transarterial chemoembolization for subcapsular versus nonsubcapsular hepatocellular carcinoma within Milan criteria: a propensity score-matched study. Int J Hyperthermia 2025; 42:2452930. [PMID: 40010696 DOI: 10.1080/02656736.2025.2452930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 12/10/2024] [Accepted: 01/08/2025] [Indexed: 02/28/2025] Open
Abstract
OBJECTIVE Our study was to compare the therapeutic outcomes of radiofrequency ablation (RFA) with or without conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC) within Milan criteria in subcapsular versus nonsubcapsular locations by using propensity score matching. MATERIALS AND METHODS This retrospective study included 171 consecutive HCC patients meeting Milan criteria who initially received RFA with or without cTACE at a tertiary academic center between January 2017 to December 2022. Technical success rate, progression-free survival (PFS) were recorded. Factors predicting PFS after RFA with or without cTACE were investigated through a Cox proportional hazard model. RESULTS The cumulative 1-, 3-, and 5-year PFS were 73.9%%, 27.7%%, and 7.7%, respectively. The cumulative PFS rates were 76.1% and 17.3% at 1 and 3 years, respectively, in the subcapsular group and 71.8% and 37.2% in the nonsubcapsular group (p = 0.034). Matching yielded 49 matched pairs of patients. In the matched group, corresponding cumulative PFS rates were 75.6% and 14.6% at 1 and 3 years, respectively, in the subcapsular group and 69.6% and 30.2% in the nonsubcapsular group (p = 0.156). Multivariate analysis confirmed that subcapsular tumor location was not an independent risk factor for PFS. Additionally, differences in technical success rate were not significant between groups. CONCLUSION The differences in PFS rates and technical success rate in HCC patients within the Milan criteria who received RFA with or without cTACE were not significant between the subcapsular and non-subcapsular groups. Future larger prospective multicenter trials are needed to validate these findings.
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Affiliation(s)
- Haitao Guan
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Yong Xie
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Tianshi Lyu
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Li Song
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Xiaoqiang Tong
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Jian Wang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Yinghua Zou
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
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Wang Y, Pan J, Zhao Q, Dong G, Ren Z, Zhang W, Aji T, Ji J, Jiang TA, Xu M. Irreversible Electroporation vs. Radiofrequency Ablation for Subcapsular Hepatocellular Carcinoma: A Propensity Score Analysis. Acad Radiol 2025:S1076-6332(25)00209-0. [PMID: 40164535 DOI: 10.1016/j.acra.2025.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Revised: 03/08/2025] [Accepted: 03/08/2025] [Indexed: 04/02/2025]
Abstract
RATIONALE AND OBJECTIVES The therapeutic efficacy of irreversible electroporation (IRE) for treating subcapsular hepatocellular carcinoma (HCC) remains under-explored. The current study aimed to compare IRE and radiofrequency ablation (RFA) outcomes in an HCC patient group. MATERIALS AND METHODS In this retrospective cohort study, we analyzed 213 patients with subcapsular HCC who met the Milan criteria and underwent either IRE (n = 80) or RFA (n = 133). We assessed local tumor progression (LTP), recurrence-free survival (RFS), overall survival (OS), and complications rates, using inverse probability of treatment weighting (IPTW). RESULTS After a median follow-up of 22 months, patients in the IRE group showed significantly lower LTP rates (1-year: 6.2% [95% CI: 2.1-14.0%], 2-year: 8.8% [95% CI: 3.6-17.2%] vs. RFA 18.0% [95% CI: 11.9-25.6%], 21.1% [95% CI: 14.5-29.0%]; P = 0.008) and higher RFS rates (1-year: 75.0% [95% CI: 64.1-84.0%], 2-year: 67.5% [95% CI: 56.1-77.6%] vs. RFA 60.9% [95% CI: 52.1-69.2%], 51.9% [95% CI: 43.1-60.6%]; P = 0.003). However, 2-year OS remained comparable across groups (IRE 100% [95.5-100%] vs. RFA 99.1% [95.9-100%]; P = 0.990). IPTW-adjusted analyses confirmed these findings. We determined that treatment modality was an independent influencing factor for LTP (RFA vs. IRE HR [95% CI]: 2.46 [1.05, 5.74], P = 0.037) and RFS (RFA vs. IRE HR [95% CI]: 1.62 [1.01, 2.61], P = 0.046). However, the complication rate (6.3% vs. 9.8%) and median hospital stay (3 vs. 3 days) were similar across groups (both P > 0.05). CONCLUSION For patients with subcapsular HCC meeting the Milan criteria, IRE demonstrated significantly improved LTP and RFS compared to RFA. These results may suggest that IRE is a viable therapeutic alternative for this tumor subtype.
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Affiliation(s)
- Yujue Wang
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China (Y.W.)
| | - Jinhua Pan
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (J.P., Q.Z., T.J., M.X.)
| | - Qiyu Zhao
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (J.P., Q.Z., T.J., M.X.)
| | - Gang Dong
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.)
| | - Zhigang Ren
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Z.R.)
| | - Wu Zhang
- Shulan Hangzhou Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, China (W.Z.)
| | - Tuerganaili Aji
- Department of Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China (T.A.)
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, The Central Hospital of Zhejiang Lishui, Lishui, China (J.J.)
| | - Tian-An Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (J.P., Q.Z., T.J., M.X.)
| | - Min Xu
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (J.P., Q.Z., T.J., M.X.).
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Ma ZH, Lin XL, Liu FH, Zhang JL, Yan ML, Song XC, Guo L, Xue J, Lu CD, Shi J, Meng Y, Cheng SQ, Guo WX. Radiofrequency ablation versus stereotactic body radiotherapy for recurrent hepatocellular carcinoma: a multicenter, propensity score matching analysis. BMC Cancer 2025; 25:424. [PMID: 40057688 PMCID: PMC11889815 DOI: 10.1186/s12885-025-13800-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 02/24/2025] [Indexed: 05/13/2025] Open
Abstract
PURPOSE This study aimed at analyzing and comparing the clinical efficacy and prognosis of stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) in the treatment of recurrent hepatocellular carcinoma (RHCC). METHODS Clinicopathological data of RHCC patients who underwent RFA or SBRT as treatment from three medical centers were retrospectively reviewed. The survival outcomes of patients who underwent SBRT were compared with those who underwent RFA. Using the Kaplan-Meier method, survival curves for the two groups of patients were generated, and the log-rank test was used to compare survival differences. Propensity score matching (PSM) analysis was used to match patients of the SBRT and RFA groups in a 1:1 ratio. RESULTS The SBRT group had a significantly better overall survival (OS) than the RFA group and no statistical differences were found in disease-free survival (DFS) in the two groups before and after PSM. After PSM, subgroup analysis demonstrated that, compared with the RFA group, the SBRT group had a significantly better OS in terms of tumor location in the subphrenic or subcapsular area, tumor size > 2.5 cm, and tumor proximity to major vessels ≤ 1 cm. CONCLUSIONS SBRT appears to be an effective priority to RFA for RHCC patients especially when RFA is not feasible due to tumor location, size, and proximity to major vessels.
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Affiliation(s)
- Zi-Hui Ma
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Xiao-Lu Lin
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Feng-Hua Liu
- Department of Radiation Oncology, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Jing-Lei Zhang
- Department of Ultrasonic Intervention, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Mao-Lin Yan
- Department of Hepatobiliary and Pancreatic Surgery, Fujian Provincial Hospital, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xing-Chao Song
- Department of Hepatobiliary and Pancreatic Surgery, Xuzhou Municipal First People's Hospital, Xuzhou, China
| | - Lei Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Jie Xue
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Chong-De Lu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Yan Meng
- Department of Radiation Oncology, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China.
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China.
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China.
| | - Wei-Xing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China.
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China.
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Ma Z, Lin X, Zhang J, Song X, Yan M, Guo L, Xue J, Lu C, Shi J, Cheng S, Guo W. Repeat laparoscopic hepatectomy versus radiofrequency ablation for recurrent hepatocellular carcinoma: A multicenter, propensity score matching analysis. Biosci Trends 2025; 18:563-575. [PMID: 39631886 DOI: 10.5582/bst.2024.01224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
Abstract
This study aimed at analyzing and comparing the clinical efficacy and prognosis of repeat laparoscopic hepatectomy (r-LH) and radiofrequency ablation (RFA) in treating recurrent hepatocellular carcinoma (RHCC). Clinicopathological data of RHCC patients who underwent r-LH or RFA as treatment from three medical centers were retrospectively reviewed. Baseline characteristics at the recurrence time after initial hepatectomy and clinical outcomes following treatment of RHCC were compared between the two groups. Using the Kaplan-Meier method, survival curves for the two groups of patients were generated, and the log-rank test was used to compare survival differences. Propensity score matching (PSM) analysis was used to match patients of the r-LH and RFA groups in a 1:1 ratio. A total of 272 patients were enrolled, including 133 patients who underwent r-LH and 139 patients who received RFA. After PSM, 76 patients were matched in each study group. Compared with the r-LH group, the RFA group had shorter hospitalization and fewer postoperative complications. However, the r-LH group had significantly better overall survival (OS) and disease-free survival (DFS) than the RFA group before and after PSM. Subgroup analysis demonstrated that RHCC patients with solitary tumor or those with tumors located near the diaphragm, visceral surface or vessels, had survival benefits from r-LH. When tumor diameter ≤ 5 cm, r-LH appears to be an effective priority to RFA with a significantly higher OS and DFS rate in treating RHCC patients, especially for patients with solitary tumor and those with tumors located near the diaphragm, visceral surface or vessels.
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Affiliation(s)
- Zihui Ma
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Xiaolu Lin
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Jinglei Zhang
- Department of Ultrasonic Intervention, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Xingchao Song
- Department of Hepatobiliary and Pancreatic Surgery, Xuzhou Municipal First People's Hospital, Xuzhou, China
| | - Maolin Yan
- Department of Hepatobiliary and Pancreatic Surgery, Fujian Provincial Hospital, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Lei Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Jie Xue
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Chongde Lu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Shuqun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Weixing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Military Medical University, Shanghai, China
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Ju S, Duan X, Wang Y, Zhang M, Bai Y, He X, Wang C, Liu J, Yao W, Zhou C, Xiong B, Zheng C. Blocking TGFβR synergistically enhances anti-tumor effects of anti-PD-1 antibody in a mouse model of incomplete thermal ablation. Int Immunopharmacol 2024; 138:112585. [PMID: 38950456 DOI: 10.1016/j.intimp.2024.112585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024]
Abstract
The mechanism of early tumor recurrence after incomplete microwave ablation (iMWA) is poorly understood. The anti-programmed cell death protein 1 (anti-PD-1) monotherapy is reported to be ineffective to prevent the progression of residual tumor resulted from iMWA. Transforming growth factor-β (TGFβ) signaling pathway plays an important role in tumorigenesis and development. We assume blocking transforming growth factor-β receptor (TGFβR) after incomplete iMWA may synergistically enhance the effect of anti-PD-1 antibody to prevent the progression of residual tumor. We construct an iMWA model with mice harboring Hepa1-6 derived xenograft. The Tgfb1 expression and phosphorylated-Smad3 protein expression is upregulated in the residual tumor after iMWA. With the application of TGFβR inhibitor SB431542, the cell proliferation potential, the tumor growth, the mRNA expression of epithelial mesenchymal transition (EMT) markers including Cdh2, and Vim, and cancer stem cell marker Epcam, and the infiltrating Treg cells are reduced in the residual tumor tissue. In addition, iMWA combined with TGFβR blocker and anti-PD-1 antibody further decreases the cell proliferation, tumor growth, expression of EMT markers and cancer stem cell marker, and the infiltrating Treg cells in the residual tumor tissue. Blocking TGFβR may alleviate the pro-tumoral effect of tumor microenvironment thereby significantly prevents the progression of residual tumor tissue. Our study indicates that blocking TGFβR may be a novel therapeutic strategy to enhance the effect of anti-PD-1 antibody to prevent residual hepatocellular carcinoma (HCC) progression after iMWA.
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Affiliation(s)
- Shuguang Ju
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xuhua Duan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, China
| | - Yingliang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mengfan Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, China
| | - Yaowei Bai
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xuelian He
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chaoyang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jiacheng Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wei Yao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Chen Zhou
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Bin Xiong
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
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Chen ZH, Zhou Q, Chen ZB, Xie WX, Song ZM, Lin SR, Wang W, Shen SL, Kuang M. Comparisons of Percutaneous Ablation, Open or Laparoscopic Liver Resection for Barcelona Clinic Liver Cancer Stage 0-A Hepatocellular Carcinoma: A Concurrent Generalized Propensity Score Analysis. J Hepatocell Carcinoma 2024; 11:1459-1472. [PMID: 39081686 PMCID: PMC11287372 DOI: 10.2147/jhc.s477265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024] Open
Abstract
Purpose Liver resection and ablation remain the most common therapeutic options for Barcelona Clinic Liver Cancer (BCLC) stage 0-A hepatocellular carcinoma (HCC), but there is a lack of evidence to show which is the most suitable therapy. This study aimed to make concurrent multi-arm comparisons of the short-term and long-term outcomes of percutaneous ablation (PA), open (OLR) or laparoscopic liver resection (LLR) for these patients. Patients and Methods This was a retrospective observational cohort study. A series of generalized propensity score methods for multiple treatment groups were performed to concurrently compare the clinical outcomes of these three treatment options to balance potential confounders. Regression standardization was used to account for hazard of all-cause mortality and recurrence of intergroup differences. Results Of the 1778 patients included, 1237, 307 and 234 underwent OLR, LLR and PA, respectively. After overlap weighting, which was the optimal adjustment strategy, patients in the minimally invasive group (LLR and PA groups) had few postoperative complications and short postoperative hospital stays (both P < 0.001). The 5-year recurrence-free survival (RFS) rate and 5-year overall survival (OS) rate were significantly higher in the LLR group when compared with the OLR and PA groups (RFS: 55.6% vs 48.0% vs 30.2%, P < 0.001; OS: 89.1% vs 79.7% vs 84.0%, P = 0.020). Multivariable Cox analysis and regression standardization showed that LLR was an independent factor for better RFS when compared with OLR and PA. In subgroup analysis, the long-term outcomes of patients with BCLC stage A HCC were consistent with the whole population. Conclusion In the observational study using various covariate adjustment analysis with excellent balance, LLR is not only minimally invasive, but also provides better RFS and equivalent OS for patients with BCLC stage 0-A HCC when compared with OLR and PA.
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Affiliation(s)
- Zhi-Hang Chen
- Department of Liver Surgery, Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China
| | - Ze-Bin Chen
- Department of Liver Surgery, Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China
| | - Wen-Xuan Xie
- Department of Liver Surgery, Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China
| | - Zi-Min Song
- Department of Liver Surgery, Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China
| | - Shui-Rong Lin
- Department of Liver Surgery, Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China
| | - Wei Wang
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China
| | - Shun-Li Shen
- Department of Liver Surgery, Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China
| | - Ming Kuang
- Department of Liver Surgery, Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China
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Kulkarni CB, Pullara SK, C S R, Moorthy S. Complications of Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma. Acad Radiol 2024; 31:2987-3003. [PMID: 38092590 DOI: 10.1016/j.acra.2023.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 07/21/2024]
Abstract
Radiofrequency ablation (RFA) is a potentially curative treatment option for early Hepatocellular carcinoma. The RFA is considered safe with a relatively low incidence of complications ranging from 2%-7.9%. Though most of the complications are self-limiting, sometimes they can be life-threatening. The occurrence of the particular complication depends on various factors like tumour location and morphology, underlying disease and ablation technique. A detailed understanding of potential complications along with the associated risk factors will help to employ strategies to prevent them, identify them early and manage them when they occur. This article demonstrates various radiofrequency ablation-related complications and discusses the risk factors and technical strategies to minimise them and achieve complete ablation of the tumour.
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Affiliation(s)
- Chinmay Bhimaji Kulkarni
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India.
| | - Sreekumar Karumathil Pullara
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
| | - Rajsekar C S
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
| | - Srikanth Moorthy
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
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Xiang S, Li J, Zhang M. TGF-β1 inhibitor enhances the therapeutic effect of microwave ablation on hepatocellular carcinoma. Int J Hyperthermia 2024; 41:2359496. [PMID: 38909985 DOI: 10.1080/02656736.2024.2359496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/20/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Microwave ablation (MWA) is a widely adopted treatment technique for hepatocellular carcinoma (HCC). However, MWA alone is of limited use and has a high recurrence rate. Transforming growth factor-β1 (TGF-β1) is recognized as a potential therapeutic target for HCC patients. Therefore, this study was designed to investigate whether the TGF-β1 inhibitor could increase the efficacy of MWA therapy for HCC treatment. METHODS In vitro, HCC cells challenged with TGF-β1 inhibitor (SB-525334), or normal saline were then heated by microwave. Methyl tetrazolium assays were performed to detect cell survival rate and half-maximal drug inhibitory concentration (IC50). Cell viability and apoptosis were detected by cell counting kit-8 assays, flow cytometry and western blotting. In vivo, the mice injected with HepG2 cells received oral gavage of SB-525334 (20 mg/kg) or normal saline and MWA at a power of 15 W. Tumor volume was recorded. Expression of Ki67 and apoptosis-related proteins were detected by immunohistochemistry and western blotting. TUNEL assays were used to detect cell death ratio. Histopathological changes were examined by hematoxylin and eosin staining. The mechanisms associated with the function of MWA combined with TGF-β1 inhibitor in HCC development were explored by western blotting. RESULTS Combination of MWA and SB-525334 decreased the survival rate and promoted the apoptosis of HCC cells compared with MWA alone. SB-525334 enhanced the suppressive effect of MWA on tumor growth and amplified cell apoptosis. Mechanistically, MWA collaborated with SB-525334 inhibitor inactivated the TGF-β1/Smad2/Smad3 pathway. CONCLUSION TGF-β1 inhibitor enhances the therapeutic effect of MWA on HCC.
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Affiliation(s)
- Shufang Xiang
- Department of Ultrasound, The First Affiliated Hospital of Yangtze University, Jingzhou City, P. R.China
| | - Juan Li
- Department of Ultrasound, The First Affiliated Hospital of Yangtze University, Jingzhou City, P. R.China
| | - Mei Zhang
- Department of Ultrasound, The First Affiliated Hospital of Yangtze University, Jingzhou City, P. R.China
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Xing Y, Liu ZR, Li YG, Zhang HY. Efficacy and safety of percutaneous transhepatic biliary radiofrequency ablation in patients with malignant obstructive jaundice. World J Clin Cases 2024; 12:2983-2988. [PMID: 38898847 PMCID: PMC11185359 DOI: 10.12998/wjcc.v12.i17.2983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 04/18/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Percutaneous transhepatic cholangiodrainage (PTCD) and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice, yet the safety and effect of endobiliary radiofrequency ablation (EB-RFA) combined PTCD is rarely reported, in this article, we report our experience of EB-RFA combined PTCD in such patients. AIM To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice. METHODS Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected, the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases. The general conditions of all patients, preoperative tumour markers, total bilirubin (TBIL), direct bilirubin (DBIL), albumin (ALB), alkaline phosphatase (ALP), and glutamyl transferase (GGT) before and on the 7th day after the procedure, as well as perioperative complications, stent patency time and patient survival were recorded. RESULTS All patients successfully completed the operation, TBIL and DBIL decreased significantly in all patients at the 7th postoperative day (P = 0.009 and 0.006, respectively); the values of ALB, ALP and GGT also decreased compared with the preoperative period, but the difference was not statistically significant. Perioperative biliary bleeding occurred in 2 patients, which was improved after transfusion of blood and other conservative treatments, pancreatitis appeared in 1 patient after the operation, no serious complication and death happened after operation. Except for 3 patients with loss of visits, the stent patency rate of the remaining 14 patients was 100% 71% and 29% at the 1st, 3rd, and 6th postoperative months respectively, with a median survival of 4 months. CONCLUSION EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety, which is worthy of further clinical practice.
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Affiliation(s)
- Ying Xing
- Department of General Surgery, Tiantan Hospital, Beijing 100170, China
| | - Zheng-Rong Liu
- Department of General Surgery, Tiantan Hospital, Beijing 100170, China
| | - You-Guo Li
- Department of General Surgery, Tiantan Hospital, Beijing 100170, China
| | - Hong-Yi Zhang
- Department of General Surgery, Tiantan Hospital, Beijing 100170, China
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Montalti R, Cassese G, Zidan A, Rompianesi G, Cesare Giglio M, Campanile S, Arena L, Maione M, Troisi RI. Local recurrence risk factors and outcomes in minimally invasive thermal ablation for liver tumors: a single-institution analysis. HPB (Oxford) 2024; 26:682-690. [PMID: 38342647 DOI: 10.1016/j.hpb.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/27/2023] [Accepted: 01/26/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Minimally Invasive thermal ablation (MITA) of liver tumors is a commonly performed procedure, alone or in combination with liver resection. Despite being a first-option strategy for small lesions, it is technically demanding, and many concerns still exist about local disease control. METHODS Consecutive patients undergoing MITA from 1-2019 to 12-2022 were retrospectively enrolled. Risk factors of local recurrence were investigated through univariate and multivariable cox regression analysis. RESULTS At the multivariable analysis of the 207 nodules undergoing MITA, RFA was associated with worse local Recurrence Free Survival (lRFS) than MWA (HR 2.87 [95 % CI 0.96-8.66], p = 0.05), as well as a concomitant surgical resection (HR 3.89 [95 % CI 1.06-9.77], p = 0.02). A concomitant surgical resection showed worse lRFS in the subgroup analysis of both HCC (HR 3.98 [95 % CI 1.16-13.62], p = 0.02) and CRLM patients (HR 2.68 [95 % CI 0.66-5.92], p = 0.04). Interestingly, a tumor size between 30 and 40 mm was not associated to worse lRFS. CONCLUSION MWA may reduce the risk of local recurrence in comparison to RFA, while MITA associated to liver resection may face an increased risk of local recurrence. Further prospective studies are needed to confirm such results.
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Affiliation(s)
- Roberto Montalti
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy; Department of Public Health, Federico II University, Naples, Italy
| | - Gianluca Cassese
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy.
| | - Ahmed Zidan
- Department of Surgery, Assiut University Hospital, Assiut, Egypt
| | - Gianluca Rompianesi
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Silvia Campanile
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Lorenza Arena
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Marco Maione
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, Naples, Italy
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Liu S, Zhou P, Shen Q, Qian G. Efficacy of microwave ablation with parallel acupuncture guided by ultrasound in treating single hepatocellular carcinoma in high-risk areas: A retrospective analysis of 155 patients. J Cancer Res Ther 2024; 20:547-554. [PMID: 38687924 DOI: 10.4103/jcrt.jcrt_1246_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/02/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To investigate the safety and short- and long-term efficacy of ultrasound-guided microwave ablation (MWA) with parallel acupuncture for treating single hepatocellular carcinoma (HCC) in high-risk areas. METHODS Retrospective analysis was performed on 155 patients with single hepatocellular carcinoma who underwent microwave ablation in our hospital between December 2015 and September 2016. Patients with a tumor distance of ≤5 mm from the risk area were included in the observation group. Patients with a tumor distance of >5 mm from the risk area were placed in the control group. The patients' preoperative general health status, tumor site, tumor size, follow-up data, disease-free survival rate, overall survival rates, local tumor progression, and intrahepatic distant recurrence rate were collected and analyzed. RESULTS The 1-, 3-, and 5-year overall survival rates for the observation group were 91.8%, 75.5%, and 59.2%, respectively. The 1-, 3-, and 5-year overall survival rates for the control group were 97.2%, 84.0%, and 66.0%, respectively. There were no significant differences between the two groups (P = 0.522). A tumor size of ≤20 mm (HR = 0.488, 95% CI = 0.254-0.940, P = 0.032) was an independent risk factor affecting the overall survival of patients with solitary HCC treated with MWA. The 1-, 3-, and 5-year recurrence-free survival rates for the observation group were 59.2%, 28.6%, and 18.4%, respectively, and those for the control group were 79.2%, 43.4%, and 31.1%, respectively. There was a statistical difference between the two groups (P = 0.007). Tumor size ≤20 mm (HR = 0.468, 95% CI = 0.303-0.723, P = 0.001), tumor location in a risk area (HR = 1.662, 95% CI = 1.121-2.465, P = 0.011), and an α-fetoprotein (AFP) level of <200 ug/L (HR = 0.612, 95% CI = 0.386-0.970, P = 0.036) are independent factors affecting the recurrence-free survival of MWA treatment for HCC. CONCLUSION Microwave ablation with parallel acupuncture guided by ultrasound is a safe and effective treatment for single hepatocellular carcinoma in high-risk areas.
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Affiliation(s)
- Sheng Liu
- Department of Interventional Ultrasound, Eastern Hepatobiliary Surgery Hospital, Third Affiliated Hospital of China Naval Medical University, Shanghai, China
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12
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Long Y, Zeng Q, He X, Wu Y, Ye H, Xu J, Chen J, Yuan L, Li H, Li K. Anatomical thermal ablation as an alternative to surgical resection for subcapsular hepatocellular carcinoma. Abdom Radiol (NY) 2024; 49:1144-1153. [PMID: 38289353 DOI: 10.1007/s00261-023-04150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 03/22/2024]
Abstract
PURPOSE To simulate the advantages of anatomical resection, a new strategy of anatomical thermal ablation was proposed. The objective of this study was to evaluate the clinical value of anatomical thermal ablation (ATA) to treat subcapsular hepatocellular carcinoma by comparing it with anatomical resection (AR) and non-anatomical resection (NAR). METHODS This retrospective cohort study enrolled hepatocellular carcinoma patients with subcapsular tumor diameter ≤ 50 mm treated by ATA or surgical resection at our center from October 2015 to December 2018. ATA features ablation of the Glisson capsule, ablation of the liver parenchyma between the tumor and hepatic veins or inferior vena cava and then puncture from the surrounding part to the central part of the tumor. Outcome parameters were compared. RESULTS Seventy-six patients were grouped into ATA group, 95 patients into AR group and 41 patients into NAR group. The 1-, 2-, and 3-year local recurrence rates were 0.0%, 0.0%, 0.0% for ATA group, 0.0%, 1.4%, 1.4% for the AR group and 0.0%, 0.0%, and 0.0% for the NAR group, respectively (P = 0.449). The 1-, 2-, and 3-year progression-free survival rates were 90.6%, 80.9%, and 74.6% for ATA group, 91.5%, 80.2%, and 80.2% for the AR group and 82.9%, 73.8%, and 73.8% for the NAR group, respectively (P = 0.608). The 1-, 2-, and 3-year overall survival rates were 100.0%, 95.2%, and 95.2% for the ATA group, 96.8%, 95.6%, and 95.6% for the AR group and 97.6%, 95.0%, and 95.0% for the NAR group, respectively (P = 0.970). No difference was found in major complication rate among these groups (P = 0.091). CONCLUSION For subcapsular hepatocellular carcinoma, ATA could be an alternative to surgical resection with its comparable treatment effect and safety.
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Affiliation(s)
- Yinglin Long
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Qingjing Zeng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Xuqi He
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Yuxuan Wu
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Huolin Ye
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Jianliang Xu
- Department of Liver Surgery, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, China
| | - Jianning Chen
- Department of Pathology, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, China
| | - Lianxiong Yuan
- Department of Science and Research, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, China
| | - Hua Li
- Department of Liver Surgery, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, China
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China.
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Takada H, Komiyama Y, Osawa L, Muraoka M, Suzuki Y, Sato M, Kobayashi S, Yoshida T, Takano S, Maekawa S, Enomoto N. Usefulness of Body Position Change during Local Ablation Therapies for the High-Risk Location Hepatocellular Carcinoma. Cancers (Basel) 2024; 16:1036. [PMID: 38473393 DOI: 10.3390/cancers16051036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/25/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
Local ablation therapies are important treatment options for early-stage hepatocellular carcinoma (HCC). Various techniques have been used to perform these therapies efficiently and safely. However, few reports have discussed the usefulness of body position change (BPC). This study aimed to investigate the usefulness of BPC during local ablation therapies in patients with HCC. We evaluated 283 HCC nodules that underwent local ablation therapy. These nodules were categorized into high- or low-risk locations on the basis of their proximity to large vessels, adjacent extrahepatic organs, or poor visibility under ultrasound (US) guidance. The technical success rates, procedure time, and prognosis were evaluated. In this study, 176 (62%) nodules were classified in the high-risk location group. The high-risk location group was treated with techniques such as BPC, artificial pleural fluid, artificial ascites, fusion imaging, and contrast-enhanced US more frequently than the low-risk location group. The technical success rates were 96% and 95% for the high- and low-risk location groups, respectively. Within the high-risk location group, those without BPC had a lower success rate than those with BPC (91% vs. 99%, p = 0.015). Notably, BPC emerged as the sole contributing factor to the technical success rate in the high-risk location group (OR = 10, 95% CI 1.2-86, p = 0.034). In contrast, no differences were found in the procedure time, local tumor progression rates, intrahepatic distant recurrence rates, and overall survival between the groups with and without BPC in the high-risk location group. In conclusion, BPC during local ablation therapy in patients with HCC in high-risk locations was safe and efficient. The body position should be adjusted for HCC in high-risk locations to maintain good US visibility and ensure a safe puncture route in patients undergoing local ablation therapies.
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Affiliation(s)
- Hitomi Takada
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Yasuyuki Komiyama
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Leona Osawa
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Masaru Muraoka
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Yuichiro Suzuki
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Mitsuaki Sato
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Shoji Kobayashi
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Takashi Yoshida
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Shinichi Takano
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Shinya Maekawa
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Nobuyuki Enomoto
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
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Ndhlovu E, Zhang BX, Chen XP, Zhu P. Thermal ablation for hepatic tumors in high-risk locations. Clin Res Hepatol Gastroenterol 2024; 48:102300. [PMID: 38367803 DOI: 10.1016/j.clinre.2024.102300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/21/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
Thermal ablative techniques such as radiofrequency and microwave ablation are minimally invasive and cost-effective approaches that are currently being adopted as alternatives to surgical resection for primary and metastatic liver malignancies. However, they are considered to be relatively contraindicated for tumors in high-risk locations due to technical difficulties and a perceived increased risk of perioperative complications. Several techniques, including artificial ascites, non-touch multibipolar ablation, and laparoscopically assisted ablation, can be used to improve the outcomes of ablation for high-risk tumors. This review aims to provide a comprehensive summary of the techniques currently used to improve thermal ablation outcomes for high-risk liver tumors.
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Affiliation(s)
- Elijah Ndhlovu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Bi-Xiang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China.
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15
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Han K, Kim JH, Kim GH, Kim JH, Kim SY, Park SH, Moon S, Kwon JH, Kim GM, Lee SJ, Won HJ, Shin YM. Radiofrequency ablation of subcapsular versus nonsubcapsular hepatocellular carcinomas ≤ 3 cm: analysis of long-term outcomes from two large-volume liver centers. Eur Radiol 2024; 34:1578-1586. [PMID: 37646813 DOI: 10.1007/s00330-023-10165-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To compare the safety and efficacy of RFA for single HCCs ≤ 3 cm in subcapsular versus nonsubcapsular locations using a propensity score matched analysis. MATERIALS AND METHODS This retrospective study included patients with solitary HCCs ≤ 3 cm in size who underwent percutaneous RFA from 2005 to 2015 as initial treatment at two large-volume liver centers. Patients were divided into two groups, consisting of those with subcapsular and nonsubcapsular tumor locations. Complications, local tumor progression (LTP), and overall survival (OS) were compared in these two groups before and after propensity score matching (PSM). RESULTS The study population consisted of 964 patients (712 men [74%]) of mean age 58.3 years. Of these 964 patients, 561 (58%) had nonsubcapsular and 403 (42%) had subcapsular HCCs. PSM generated 402 pairs of patients. Major complication rate was low, but significantly higher in the subcapscular group (p = 0.047). Rates of technical effectiveness in these two groups were 99% and 98%, respectively (p = 0.315). However, during follow-up, cumulative 1-, 3-, 5-, and 10-year LTP and OS rates did significantly differ in both entire and PSM cohorts, resulting in the latter 8%, 15%, 20%, and 26% in the nonsubcapsular group vs. 13%, 24%, 30%, and 31% in the subcapsular group (p = 0.015), and 99%, 91%, 80%, and 59% vs. 98%, 85%, 73%, and 50% in the two groups (p = 0.004), respectively. CONCLUSION Rates of major complications, LTP, and OS differed significantly following first-line RFA treatment of single HCCs ≤ 3 cm in favor of the nonsubcapsular locations. CLINICAL RELEVANCE STATEMENT This large-scale study provides evidence that radiofrequency ablation for small (≤ 3 cm) hepatocellular carcinomas is safer and more effective in nonsubcapsular location than in subcapsular location. KEY POINTS • There exist conflicting outcomes on the effectiveness of RFA for early HCC depending on tumor location. • Rate of local tumor progression was significantly higher in the subcapsular hepatocellular carcinomas. • Overall survival rate was significantly poorer in the subcapsular hepatocellular carcinomas.
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Affiliation(s)
- Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea.
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Ji Hoon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Sungmo Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Hyung Jin Won
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Yong Moon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
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16
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Dai W, Fang S, Mo C, Liu Y, Shen T, Li M, Zhou H, Miao H, Chen M, Tan X, Bao S, Xu X, Chen N. Comparison of laparoscopic radiofrequency ablation with percutaneous radiofrequency ablation in the treatment of chronic hepatitis B-related hepatocellular carcinoma involving specific sites: A retrospective cohort study. Asian J Surg 2024; 47:100-106. [PMID: 37183108 DOI: 10.1016/j.asjsur.2023.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/15/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND This study compared the effectiveness and safety of laparoscopic radiofrequency ablation (LRFA) and percutaneous radiofrequency ablation (PRFA) in the treatment of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) involving specific sites. METHODS This retrospective cohort study included patients with HBV-related HCC involving specific sites treated with LRFA or PRFA between January 2012 and December 2020. The overall survival (OS), disease-free survival (DFS), and complications were compared between the LRFA and PRFA groups. The Cox proportional-hazards regression model was used to determine the factors affecting prognosis. RESULTS This study included 109 patients: 69 in the LRFA group and 40 cases in the PRFA group. No significant differences were found in the 3-year OS rate between the two groups (73.7% vs. 70.0%, P = 0.514), but the LRFA group showed a higher 3-year DFS rate than the PRFA group (58.2% vs. 42.5%, P = 0.018). The RFA method was not associated with OS but was independently associated with DFS (LRPA vs. PRFA, HR = 2.078, P = 0.012). The common complications were ascites, pleural effusion, and fever in the two groups. The occurrence of complications in patients treated with LRFA or PRFA was similar (15.9% vs. 12.5%, P = 0.785). CONCLUSION LRFA was associated with a better DFS in patients with HBV-related HCC involving specific sites. Thus, LRFA might have more advantages in treating liver cancer involving specific sites.
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Affiliation(s)
- Wei Dai
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Shuo Fang
- Department of Oncology, The Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Cong Mo
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yuxin Liu
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Tingyun Shen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Mingyi Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Honglian Zhou
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Huilai Miao
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Ming Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xiaoyu Tan
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Shiting Bao
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xiaohong Xu
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
| | - Nianping Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
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Falk KL, Laeseke PF, Kisting MA, Zlevor AM, Knott EA, Smolock AR, Bradley C, Vlaisavljevich E, Lee FT, Ziemlewicz TJ. Clinical translation of abdominal histotripsy: a review of preclinical studies in large animal models. Int J Hyperthermia 2023; 40:2272065. [PMID: 37875279 PMCID: PMC10629829 DOI: 10.1080/02656736.2023.2272065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
Histotripsy is an emerging noninvasive, non-thermal, and non-ionizing focused ultrasound (US) therapy that can be used to destroy targeted tissue. Histotripsy has evolved from early laboratory prototypes to clinical systems which have been comprehensively evaluated in the preclinical environment to ensure safe translation to human use. This review summarizes the observations and results from preclinical histotripsy studies in the liver, kidney, and pancreas. Key findings from these studies include the ability to make a clinically relevant treatment zone in each organ with maintained collagenous architecture, potentially allowing treatments in areas not currently amenable to thermal ablation. Treatments across organ capsules have proven safe, including in anticoagulated models which may expand patients eligible for treatment or eliminate the risk associated with taking patients off anti-coagulation. Treatment zones are well-defined with imaging and rapidly resorb, which may allow improved evaluation of treatment zones for residual or recurrent tumor. Understanding the effects of histotripsy in animal models will help inform physicians adopting histotripsy for human clinical use.
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Affiliation(s)
- Katrina L Falk
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Paul F Laeseke
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Meridith A Kisting
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Annie M Zlevor
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Emily A Knott
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Amanda R Smolock
- Department of Radiology, Division of Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Charles Bradley
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Fred T Lee
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
- Department of Urology, University of Wisconsin, Madison, Wisconsin, USA
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18
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Hatanaka T, Saito N, Tamura Y, Ito K, Yoshinaga T, Naganuma A, Kakizaki S, Uraoka T. Initial experience of microwave ablation for hepatocellular carcinoma using Mimapro™. KANZO 2023; 64:322-325. [DOI: 10.2957/kanzo.64.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
- Takeshi Hatanaka
- Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital
| | - Naoto Saito
- Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital
| | - Yuki Tamura
- Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital
| | - Kenta Ito
- Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital
| | - Teruo Yoshinaga
- Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital
| | - Atsushi Naganuma
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center
| | - Satoru Kakizaki
- Department of Clinical Research, National Hospital Organization Takasaki General Medical Center
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
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19
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Musick JR, Philips P, Scoggins CR, Egger ME, McMasters KM, Martin RC. Laparoscopic microwave ablation versus percutaneous microwave ablation of hepatic malignancies: Efficacy and recurrence-free survival outcomes in patients. Surgery 2023; 173:598-602. [PMID: 36270823 DOI: 10.1016/j.surg.2022.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hepatic thermal ablation has been found to be effective and equivalent to resection in certain liver histologies. Of the 16,000 annual liver ablations performed in the United States, only 13% (2,080 ablations) are performed laparoscopically. The laparoscopic technique remains underused even with the benefits of improved staging and better access to tumors. The purpose of this study is to compare laparoscopic microwave ablation versus percutaneous microwave ablation in terms of efficacy and recurrence-free survival outcomes in patients with hepatic malignancies. METHODS A comparative analysis was performed on 275 patients (289 ablation procedures) who underwent laparoscopic microwave ablation or percutaneous microwave ablation between February 2011 and May 2021. Ablation success was confirmed postprocedure and recurrence was monitored at follow-up via contrast-enhanced computed tomography/magnetic resonance imaging and/or computed tomography/positron emission tomography. RESULTS The groups were similar for sex, age, body mass index, location of tumor, size of tumor, and number of tumors. Ablation success was 100% in both groups. Local recurrence was significant (5%: laparoscopic microwave ablation vs 22%: percutaneous microwave ablation, P = .002) and same-lobe recurrence (21%: laparoscopic microwave ablation vs 24%: percutaneous microwave ablation) was lower in the laparoscopic microwave ablation group. Median recurrence-free survival was 15.8 months for the laparoscopic microwave ablation group and 5.6 months for the percutaneous microwave ablation group (P = .0002). Overall, 90-day complications were lower in the laparoscopic microwave ablation group (11%) compared with the percutaneous microwave ablation group (21%) (P = .11). CONCLUSION Laparoscopic surgical ablation is a critical surgical skill that must be taught in fellowship. Laparoscopic microwave ablation leads to better tumor specific outcomes and oncologic outcomes demonstrating clinical efficacy in the treatment of hepatic malignancies compared with percutaneous microwave ablation.
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Affiliation(s)
- Joslin R Musick
- Division of Surgical Oncology, Department of Surgery, The Hiram C. Polk, Jr., MD, University of Louisville School of Medicine, KY
| | - Prejesh Philips
- Division of Surgical Oncology, Department of Surgery, The Hiram C. Polk, Jr., MD, University of Louisville School of Medicine, KY
| | - Charles R Scoggins
- Division of Surgical Oncology, Department of Surgery, The Hiram C. Polk, Jr., MD, University of Louisville School of Medicine, KY
| | - Michael E Egger
- Division of Surgical Oncology, Department of Surgery, The Hiram C. Polk, Jr., MD, University of Louisville School of Medicine, KY
| | - Kelly M McMasters
- Division of Surgical Oncology, Department of Surgery, The Hiram C. Polk, Jr., MD, University of Louisville School of Medicine, KY
| | - Robert Cg Martin
- Division of Surgical Oncology, Department of Surgery, The Hiram C. Polk, Jr., MD, University of Louisville School of Medicine, KY.
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20
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Chen Z, Fu X, Qiu Z, Mu M, Jiang W, Wang G, Zhong Z, Qi H, Gao F. CT-guided 125I brachytherapy for hepatocellular carcinoma in high-risk locations after transarterial chemoembolization combined with microwave ablation: a propensity score-matched study. Radiol Oncol 2023; 57:127-139. [PMID: 36942903 PMCID: PMC10039481 DOI: 10.2478/raon-2023-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/30/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the safety and efficacy of 125I brachytherapy combined with transarterial chemoembolization (TACE) and microwave ablation (MWA) for unresectable hepatocellular carcinoma (HCC) in high-risk locations. PATIENTS AND METHODS After 1:2 propensity score matching (PSM), this retrospectively study analyzed 49 patients who underwent TACE +MWA+125I brachytherapy (group A) and 98 patients who only received TACE +MWA (group B). The evaluated outcomes were progression-free survival (PFS), overall survival (OS), and treatment complications. Cox proportional hazards regression analysis survival was used to compare the two groups. RESULTS The patients in group A showed a longer PFS than group B (7.9 vs. 3.3 months, P = 0.007). No significant differences were observed in median OS between the two groups (P = 0.928). The objective response rate (ORR), disease control rate of tumors in high-risk locations, and the ORR of intrahepatic tumors were 67.3%, 93.9%, and 51.0%, respectively, in group A, and 38.8%, 79.6% and 29.6%, respectively, in group B (P < 0.001, P = 0.025 and P = 0.011, respectively). TACE-MWA-125I (HR = 0.479, P < 0.001) was a significant favorable prognostic factor that affected PFS. The present of portal vein tumor thrombosis was an independent prognostic factor for PFS (HR = 1.625, P = 0.040). The Barcelona clinic liver cancer (BCLC) stage (BCLC C vs. B) was an independent factor affecting OS (HR = 1.941, P = 0.038). The incidence of complications was similar between the two groups, except that the incidence of abdominal pain was reduced in the group A (P = 0.007). CONCLUSIONS TACE-MWA-125I resulted in longer PFS and better tumor control than did TACE-MWA in patients with unresectable hepatocellular carcinoma in high-risk locations.
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Affiliation(s)
- Zixiong Chen
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xiaobo Fu
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Zhenkang Qiu
- Interventional Medical Center, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Maoyuan Mu
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Weiwei Jiang
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Guisong Wang
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Zhihui Zhong
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Han Qi
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Fei Gao
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
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21
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Retrospective Evaluation and Significance of Neutrophil-to-Lymphocyte Ratio Prior to and 1 month Following Microwave Ablation of Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2023; 46:49-59. [PMID: 36180599 DOI: 10.1007/s00270-022-03288-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 09/19/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Neutrophil-to-lymphocyte ratio (NLR) recently demonstrated predictive value for hepatocellular carcinoma (HCC) recurrence after thermal ablation. Microwave ablation (MWA) has been shown to induce changes in the immune landscape after HCC treatment. This study aims at identifying predictors of local tumor progression (LTP) and post-treatment NLR kinetics after MWA. MATERIALS AND METHODS Data from 108 consecutive patients who underwent percutaneous MWA of 119 HCCs with a 2450 Hz/100 W generator in two institutions from October 2014 to September 2021 were retrospectively reviewed. Forty-five HCCs (42 patients) met inclusion criteria for analysis (technique efficacy, pre- and post-treatment NLR availability, follow-up > 6 months, absence of complications). NLR was analyzed prior to therapy and at 1-month follow-up; difference between the two time points was defined as ΔNLR1stFU. RESULTS After a median follow-up of 25 months, LTP occurred in 18 HCCs (40%) and 18 patients (42.9%). Multivariate competing risk regression comprising ΔNLR1stFU > 0, cirrhosis etiology and subcapsular location showed that the only independent predictor of LTP was ΔNLR1stFU > 0, on both a per-patient (HR = 2.7, p = 0.049) and per-tumor (HR = 2.8, p = 0.047) analysis. ΔNLR1stFU > 0 occurred in 24/42 patients (57.1%). In this subgroup, higher rates of female patients (p = 0.026), higher mean baseline NLR (p < 0.0001) and lower mean energy/size (p = 0.006) were observed. Upon ROC curve analysis, energy/size < 1414 J/mm predicted ΔNLR1stFU > 0 with 76% sensitivity and 70% specificity (AUC = 0.74). CONCLUSION NLR increase after ablation was the only independent predictor of LTP, supporting the role of balance between systemic inflammation and immunity in recurrence after MWA. Ablation energy/tumor size predicted NLR increase, reinforcing the concept of immune ablation. LEVEL OF EVIDENCE III.
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22
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Zhu W, Zhong Z, Yan H, Guo H, Xiao M, He X, Gao F, Zhang F. Clinical efficacy of CT-guided 125I brachytherapy in patients with local residual or recurrent hepatocellular carcinoma after thermal ablation. Insights Imaging 2022; 13:185. [PMID: 36471084 PMCID: PMC9723008 DOI: 10.1186/s13244-022-01327-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Treatment methods of local residual or recurrent hepatocellular carcinoma (HCC) after thermal ablation are limited. Therefore, our study aimed to explore the efficacy and prognostic factors of 125I brachytherapy for local residual or recurrent lesion after thermal ablation. METHODS A total of 114 patients with 212 local residual or recurrent HCC tumors after thermal ablation underwent 125I brachytherapy. Local progression-free survival (LPFS) and prognostic factors were analyzed by Kaplan-Meier curves and the Cox model. RESULTS After a 6-month follow-up, the percentage of patients who achieved complete response (CR), partial response (PR), and stable disease (SD) was 57%, 13.2%, and 5.2%, respectively. The 1-, 2-, and 3-year LPFS rates were 58.7%, 50.0%, and 41.2%, respectively. Portal vein tumor thrombus (PVTT) (p = 0.03), the number of intrahepatic tumors (p = 0.01), and AFP level (p = 0.02) were independent risk factors for local tumor progression (LTP). The median LPFS in patients without PVTT (22 months) was much longer compared to those with PVTT (10 months). The median LPFS in patients with less than three intrahepatic lesions improved from 17 to 24 months. The median LPFS was only 5 months in the high AFP group, but was prolonged with a decrease in AFP level (24 months). No severe complications were recorded. All complications were controllable and treatable. CONCLUSIONS CT-guided 125I brachytherapy was a safe and effective treatment for patients with local residual or recurrent HCC after thermal ablation to improve local control rate.
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Affiliation(s)
- Wenliang Zhu
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Zhihui Zhong
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Huzheng Yan
- grid.12981.330000 0001 2360 039XDepartment of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630 People’s Republic of China
| | - Huanqing Guo
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Meigui Xiao
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Xu He
- grid.452930.90000 0004 1757 8087ZhuHai Interventional Medical Center, ZhuHai People’s Hospital (ZhuHai Hospital Affiliated With Jinan University), Jinan University, ZhuHai, 519000 Guangdong People’s Republic of China
| | - Fei Gao
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Fujun Zhang
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
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23
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Fujita N, Kanogawa N, Makishima H, Ogasawara S, Maruta S, Iino Y, Shiko Y, Kanzaki H, Koroki K, Kobayashi K, Kiyono S, Nakamura M, Kondo T, Nakamoto S, Chiba T, Wakatsuki M, Itobayashi E, Obu M, Koma Y, Azemoto R, Kawasaki Y, Kato J, Tsuji H, Kato N. Carbon-ion radiotherapy versus radiofrequency ablation as initial treatment for early-stage hepatocellular carcinoma. Hepatol Res 2022; 52:1060-1071. [PMID: 35951438 DOI: 10.1111/hepr.13827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 12/24/2022]
Abstract
AIM Carbon-ion radiotherapy (C-ion RT) has shown potential as a curative treatment for patients with hepatocellular carcinoma (HCC). However, no reports have compared the effectiveness of C-ion RT and radiofrequency ablation (RFA). This study aimed to compare clinical outcomes between C-ion RT and RFA for patients with early-stage HCC. METHODS Medical records of consecutive patients with HCC (single lesion ≤5 cm or two to three lesions ≤3 cm) who received either C-ion RT or RFA as initial treatment were retrospectively reviewed. Propensity score matching (PSM) was used to adjust for clinical factors between both groups. RESULTS A total of 560 patients were included, among whom 69 and 491 received C-ion RT and RFA, respectively. After PSM (C-ion RT, 54 patients; RFA, 95 patients), both groups were well balanced. Carbon-ion radiotherapy had significantly lower cumulative intrasubsegmental recurrence rate after PSM compared to RFA (p = 0.004) (2-year, 12.6% vs. 31.7%; 5-year, 15.5% vs. 49.6%, respectively). However, no significant difference in cumulative local recurrence rate, stage progression-free survival, or overall survival (OS) was observed between both groups. In the RFA group, 6 of 491 patients (1.2%) showed grade 3 adverse events, whereas no grade 3 or higher adverse events were observed in the C-ion RT group. CONCLUSION Carbon-ion radiotherapy provided a lower cumulative intrasubsegmental recurrence rate, but a comparable cumulative local recurrence rate, stage progression-free survival, and OS compared to RFA. Thus, C-ion RT appears to be one of the effective treatment options for early-stage HCC when RFA is deemed not indicated.
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Affiliation(s)
- Naoto Fujita
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hirokazu Makishima
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan.,Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Translational Research and Development Center, Chiba University Hospital, Chiba, Japan
| | - Susumu Maruta
- Department of Gastroenterology, Asahi General Hospital, Asahi, Japan
| | - Yotaro Iino
- Department of Gastroenterology, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hiroaki Kanzaki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keisuke Koroki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazufumi Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Translational Research and Development Center, Chiba University Hospital, Chiba, Japan
| | - Soichiro Kiyono
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masato Nakamura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Kondo
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shingo Nakamoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaru Wakatsuki
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan
| | - Ei Itobayashi
- Department of Gastroenterology, Asahi General Hospital, Asahi, Japan
| | - Masamichi Obu
- Department of Gastroenterology, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Yoshihiro Koma
- Department of Gastroenterology, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Ryosaku Azemoto
- Department of Gastroenterology, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Tsuji
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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24
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Ozen M, Raissi D. Current perspectives on microwave ablation of liver lesions in difficult locations. J Clin Imaging Sci 2022; 12:61. [PMID: 36601606 PMCID: PMC9805601 DOI: 10.25259/jcis_126_2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
Abstract
Microwave ablation (MWA) is becoming the standard of care in treating liver lesions smaller than 3 cm benefiting from a plethora of radiofrequency ablation (RFA) data in the literature. Some of the advantages of MWA compared to RFA are as follows: Faster ablations, more reproducible and predictable heating, better thermal conductivity in different liver tissue environments, and less susceptibility to heat-sink effect. Despite its many advantages, there are still concerns regarding MWA use in high-risk locations such as near portal veins, near the bile ducts, and near the heart. Some centers have historically considered these tumor locations as a contraindication to percutaneous thermal ablation. In this review, we summarize the current data on the safety of MWA of liver tumors in challenging locations. We also discuss several technical tips with examples provided.
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Affiliation(s)
- Merve Ozen
- Department of Radiology, University of Kentucky College of Medicine, Lexington, United States
| | - Driss Raissi
- Department of Radiology, Medicine, Surgery, and Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, United States
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25
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Gozzo C, Hermida M, Herrero A, Panaro F, Cassinotto C, Mohamad AM, Assenat E, Guillot C, Allimant C, Schembri V, Basile A, Dharancy S, Ursic‐Bedoya J, Guiu B. Non-transplantable recurrence after percutaneous thermal ablation of ≤3-cm HCC: Predictors and implications for treatment allocation. Hepatol Commun 2022; 6:2975-2987. [PMID: 35932178 PMCID: PMC9512464 DOI: 10.1002/hep4.2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/27/2022] [Accepted: 07/02/2022] [Indexed: 12/02/2022] Open
Abstract
Percutaneous thermal ablation (PTA), resection, and liver transplantation are the standard curative options for hepatocellular carcinoma (HCC). Liver transplantation yields the best long-term outcomes but is limited by graft shortage. Thus, patients with ≤3-cm HCC are primarily treated by PTA even though recurrence is frequent and may occur outside transplant criteria. Data on non-transplantable recurrence (NTR) following PTA are lacking, however. We therefore investigated the incidence and predictors of NTR among 213 potentially transplantable patients (cirrhosis, 93%; Child-Pugh A, 98.6%; alcohol-related disease, 62%) with ≤3-cm HCC(s) treated by PTA, to stratify them according to their NTR risk and to improve treatment allocation. During follow-up (median: 41.2 months), NTR occurred in 18.3% (alpha-fetoprotein [AFP] model) and 23% (Milan) patients. NTR prediction with competing-risk analysis and internal validation revealed AFP > 100 ng/ml (subdistribution hazard ratio: 7.28; p < 0.001) and prior HCC (subdistribution hazard ratio: 3.77; p = 0.002) as independent predictors (Harrell's C: 0.76). Based on this model using the AFP score (equally predictive within Milan criteria), patients were stratified into three NTR risk categories: HCC-naïve with AFP < 100 ng/ml (low risk, n = 108 of 213), non-HCC naïve with AFP < 100 ng/ml (intermediate risk, n = 92 of 213), AFP ≥ 100 ng/ml (high risk, n = 13 of 213), among whom 9.3% (3.7% [Milan]), 22.8% (25% [Milan]), and 61.5% (38/5% [Milan]) presented NTR (p < 0.001). Median recurrence-free survival was 4.6, 14.5, and 43.4 months, respectively, in high-risk, intermediate-risk, and low-risk categories (p < 0.001). Median overall survival, which was 19.1 months in high-risk patients, was not reached otherwise (p < 0.001). Conclusion: Overall, PTA of ≤3-cm HCC incurs a low NTR risk. Simple and noninvasive predictors (HCC naivety, AFP) accurately stratified patients' risk of NTR, and should help to improve treatment allocation. Patients with AFP ≥ 100 ng/ml have a high risk of NTR, poor recurrence-free survival, and overall survival. Further studies evaluating preemptive transplantation or adjuvant/neoadjuvant strategies are highly needed in this small patient subset.
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Affiliation(s)
- Cecilia Gozzo
- Department of RadiologySt‐Eloi University HospitalMontpellierFrance
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”University of CataniaCataniaItaly
| | - Margaux Hermida
- Department of RadiologySt‐Eloi University HospitalMontpellierFrance
| | - Astrid Herrero
- Department of Liver SurgerySt‐Eloi University HospitalMontpellierFrance
| | - Fabrizio Panaro
- Division of HBP Surgery & Transplantation, Department of SurgeryMontpellier University HospitalMontpellierFrance
| | | | | | - Eric Assenat
- Department of OncologySt‐Eloi University HospitalMontpellierFrance
- Department of HepatologySt‐Eloi University HospitalMontpellierFrance
| | - Chloé Guillot
- Department of RadiologySt‐Eloi University HospitalMontpellierFrance
| | - Carole Allimant
- Department of RadiologySt‐Eloi University HospitalMontpellierFrance
| | | | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”University of CataniaCataniaItaly
| | | | - José Ursic‐Bedoya
- Department of Liver SurgerySt‐Eloi University HospitalMontpellierFrance
| | - Boris Guiu
- Department of RadiologySt‐Eloi University HospitalMontpellierFrance
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Tay BWR, Huang DQ, Mark M, Thong NW, Guan Huei L, Gee LS, Cheng LH, Mei LY, Thurairajah P, Chen LJ, Ng CH, Lim WH, Tan DJH, Maureen DC, Alfred KWC, Ganpathi IS, Seng TP, Young DY. Comparable Outcomes in Early Hepatocellular Carcinomas Treated with Trans-Arterial Chemoembolization and Radiofrequency Ablation. Biomedicines 2022; 10:2361. [PMID: 36289623 PMCID: PMC9598932 DOI: 10.3390/biomedicines10102361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022] Open
Abstract
The guidelines recommend radiofrequency ablation (RFA) for early hepatocellular carcinomas that are less than 3 cm and trans-arterial chemoembolization (TACE) for intermediate-stage tumors. Real-world patient and tumor factors commonly limit strict adherence to the guidelines. We aimed to compare the clinical outcomes for TACE and RFA in early HCC. All consecutive patients from 2010 to 2014 that were treated with locoregional therapy at our institution were enrolled. The decision for TACE or RFA was based on tumor location, stage and technical accessibility for ablation. A subgroup analysis was performed for patients with tumors less than 3 cm. A total of 168 patients underwent TACE while 56 patients underwent RFA. Patients treated with TACE and RFA had 1- and 5-year survival rates of 84.7% and 39.8% versus 91.5% and 51.5%, respectively (p = 0.28). In tumors less than 3 cm, there was no significant difference in overall survival (p = 0.69), time to progression (p = 0.55), or number of treatment sessions required (p = 0.12). Radiofrequency ablation had a significantly higher chance of a complete response (p = 0.004). In conclusion, TACE may be selectively considered for early-stage hepatocellular carcinoma in patients unsuitable for other modalities.
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Affiliation(s)
- Benjamin Wei Rong Tay
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Daniel Q. Huang
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Muthiah Mark
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Neo Wee Thong
- Department of Diagnostic Imaging, National University Health System, Singapore 119228, Singapore
| | - Lee Guan Huei
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Lim Seng Gee
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Low How Cheng
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Lee Yin Mei
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Prem Thurairajah
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Lim Jia Chen
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Cheng Han Ng
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Wen Hui Lim
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Darren Jun Hao Tan
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Da Costa Maureen
- Division of Hepatobiliary Surgery, National University Health System, Singapore 119228, Singapore
| | - Kow Wei Chieh Alfred
- Division of Hepatobiliary Surgery, National University Health System, Singapore 119228, Singapore
| | - Iyer Shridar Ganpathi
- Division of Hepatobiliary Surgery, National University Health System, Singapore 119228, Singapore
| | - Tan Poh Seng
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Dan Yock Young
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
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Lee J, Park SB, Byun S, Kim HI. Impact of ultrasonographic blind spots for early-stage hepatocellular carcinoma during surveillance. PLoS One 2022; 17:e0274747. [PMID: 36112645 PMCID: PMC9481035 DOI: 10.1371/journal.pone.0274747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Abdominal ultrasonography (US) is the backbone of hepatocellular carcinoma (HCC) surveillance. Although previous studies have evaluated clinical factors related to surveillance failure, none have focused specifically on US blind spots.
Methods
This study included 1,289 patients who underwent 6 months intervals surveillance using US and serum alpha-fetoprotein (AFP) and were eventually diagnosed with single-nodular HCC. Patients were divided into US-detected group (n = 1,062) and US-missed group (HCC detected only by AFP ≥ 20ng/mL; n = 227). Blind spots consisted of four locations: hepatic dome, caudate lobe or around the inferior vena cava, <1 cm beneath the ribs, and the surface of the left lateral segment. Both groups were compared by HCC location, proportional distribution, treatment method, and overall survival.
Results
A higher proportion of HCCs were located within blind spots in the US-missed group than in the US-detected group (64.3% vs. 44.6%, P < 0.001). HCC ≥ 2 cm detected in blind spots was higher than in non-blind areas (60.3% vs. 47.1%, P = 0.001). Blind spot HCCs were more treated with surgery, whereas those located in a non-blind area were more treated with local ablation. Patients with an HCC located within a blind spot in the US-detected group had better overall survival than the same in the US-missed group (P = 0.008).
Conclusions
Using the current surveillance test, blind spots affected the initially detected HCC tumor size, applicability of the treatment modality, and overall survival. Physicians should pay attention to US blind spots when performing US-based HCC surveillance.
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Affiliation(s)
- Junghwan Lee
- Department of Gastroenterology, Asan Medical Center, Seoul, South Korea
| | - Su Bee Park
- Department of Gastroenterology, Asan Medical Center, Seoul, South Korea
| | - Soyoung Byun
- Department of Gastroenterology, Asan Medical Center, Seoul, South Korea
| | - Ha Il Kim
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
- * E-mail:
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Lu DE, Cheng SW, Lin YS, Tu MW, Lee CH, Chen C, Chen KH. Combination of radiofrequency ablation and percutaneous ethanol injection versus radiofrequency ablation alone for hepatocellular carcinoma: a systematic review and meta-analysis. Ann Hepatol 2022; 27:100729. [PMID: 35700935 DOI: 10.1016/j.aohep.2022.100729] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Radiofrequency ablation and percutaneous ethanol injection are important treatment modalities for hepatocellular carcinoma patients; Whether a combination treatment yields, additional benefit still remains controversial. METHODS A systematic review and meta-analysis was concluded. Randomized controlled trials published before January 1, 2022, from PubMed, EMBASE, Scopus, and CNKI were searched. Studies were excluded when patients received different ablative treatment or had serious liver dysfunction. The risk of bias assessment was evaluated using the Cochrane Collaboration's tool. RESULTS Ten studies, encompassing 854 patients, with histologically proven HCC were finally analyzed. The results demonstrated that patients who received RFA-PEI had slightly improvements in 1-year overall survival (OS) [risk ratio (RR): 1.11; 95% confidence interval (CI): 1.03, 1.19, I2 = 10%], 2-year OS (RR: 1.25; 95% CI: 1.12, 1.40, I2 = 0%), 3-year OS (RR: 1.42; 95% CI: 1.11, 1.83, I2 = 38%), 1-year local recurrence-free (LRF) proportion (RR: 1.2; 95% CI: 1.01, 1.42, I2 = 61%), and complete tumor necrosis (CTN) (RR: 1.32; 95% CI: 1.14, 1.53, I2 = 45%). Nevertheless, common complications, such as fever, were found to be significant (RR: 1.78, 95% CI: 1.13, 2.80). CONCLUSION Despite RFA-PEI appearing to be superior for HCC patients with a compensated liver in terms of OS, current evidence contained moderate to significant heterogeneity, and it was difficult to draw a definite conclusion regarding the therapeutic management in terms of LRF and CTN.
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Affiliation(s)
- De-En Lu
- Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 11696, Taiwan
| | - Sheng-Wei Cheng
- Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 11696, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 11696, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, 250 Wuxing Street, Xinyi District, Taipei 11031, Taiwan; Division of Gastroenterology, Department of Medicine, Taiwan Adventist Hospital, No.424, Sec. 2, Bade Rd., Songshan District, Taipei City 10556, Taiwan
| | - Yang-Sheng Lin
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, 250 Wuxing Street, Xinyi District, Taipei 11031, Taiwan; Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan
| | - Mei-Wen Tu
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 11696, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 11696, Taiwan
| | - Chia-Hsiang Lee
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 11696, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 11696, Taiwan
| | - Chiehfeng Chen
- Cochrane Taiwan, Taipei Medical University, 250 Wuxing Street, Xinyi District, Taipei 11031, Taiwan; Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 11696, Taiwan; Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 11696, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing Street, Xinyi District, Taipei 11031, Taiwan.
| | - Kee-Hsin Chen
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 11696, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 11696, Taiwan; Cochrane Taiwan, Taipei Medical University, 250 Wuxing Street, Xinyi District, Taipei 11031, Taiwan; Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Xinyi District, Taipei 11031, Taiwan; Evidence-based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan Dist., Taipei 11696, Taiwan.
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Xu Y, Zhang Y, Zheng CZ, Li C, Guo T, Xu Y. Thermal ablation versus hepatic resection for colorectal cancer with synchronous liver metastases: a propensity score matching study. Eur Radiol 2022; 32:6678-6690. [PMID: 35999370 DOI: 10.1007/s00330-022-09080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/09/2022] [Accepted: 08/03/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Several studies have compared the efficacy of hepatic resection (HR) and thermal ablation (TA) for unresectable tumors; however, results remain inconsistent. Most cohorts in previous studies were heterogeneous groups of synchronous colorectal liver metastases (CRLM) and extrahepatic metastases. This retrospective study aimed to compare the therapeutic efficacy between TA and HR in synchronous CRLM without extrahepatic metastases. METHODS Cases with initially synchronous CRLM without extrahepatic metastases between January 2007 and December 2018 were enrolled. Of the 448 cases, 346 received HR and 102 TA. Propensity score matching with a 1:1 ratio was used to improve the comparability between the HR and TA groups. Technical success, complications, disease-free survival (DFS), and overall survival (OS) were compared before and after matching. RESULTS All patients achieved technical success. Major complication rates in the HR and TA groups were, respectively, 36.7% and 8.8% (p < 0.001). Before matching, the 5-year OS and DFS (p = 0.004 and p = 0.020, respectively) were significantly higher in the HR group than in the TA group. After matching, no significant difference in the 5-year OS and DFS was found between the groups (p = 0.770 and p = 0.939, respectively). Local tumor progression rate was significantly higher in the TA group both before (p = 0.027) and after (p = 0.029) matching. CONCLUSIONS For patients with CRC with synchronous CRLM, TA and HR provide comparable OS and DFS. TA is preferable if complete ablation is predicted. KEY POINTS • Thermal ablation and hepatic resection provide comparable overall survival and disease-free survival. • Thermal ablation is a safe and effective treatment for patients with colorectal cancer with synchronous liver metastases and has a lower major complication rate and higher repeatability than hepatic resection. • Thermal ablation is preferable if complete ablation is predicted.
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Affiliation(s)
- Yun Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an road, 270, Shanghai, 200032, People's Republic of China
| | - Yuqin Zhang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an road, 270, Shanghai, 200032, People's Republic of China
| | - Charlie Zhilin Zheng
- Mechanical & Aerospace Engineering, University of California, 7400 Boelter Hall Los Angeles, Los Angeles, CA, 90095, USA
| | - Cong Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an road, 270, Shanghai, 200032, People's Republic of China
| | - Tian'an Guo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an road, 270, Shanghai, 200032, People's Republic of China
| | - Ye Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an road, 270, Shanghai, 200032, People's Republic of China.
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Thamtorawat S, Patanawanitkul R, Rojwatcharapibarn S, Chaiyasoot W, Tongdee T, Yodying J, Sorotpinya S. Biliary complications and efficacy after ablation of peribiliary tumors using irreversible electroporation (IRE) or radiofrequency ablation (RFA). Int J Hyperthermia 2022; 39:751-757. [PMID: 35649727 DOI: 10.1080/02656736.2022.2079733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the biliary complication rates and efficacy of peribiliary tumor ablation using irreversible electroporation (IRE) or radiofrequency ablation (RFA). MATERIAL AND METHODS This is a retrospective study of 42 consecutive patients with 44 peribiliary tumors (≤5 mm distance between the tumor margin and the primary or secondary bile duct). Data were collected between January 2014 and September 2020 from patients who underwent percutaneous liver ablation using IRE (n = 13) or RFA (n = 31). RESULTS The median length of follow-up was 23.1 months. The mean tumor size was 17.2 ± 5.2 mm in IRE vs. 18.4 ± 7.0 mm in RFA (p= .56). Complete tumor ablation was achieved in 100% with a significantly larger ablation zone in the IRE group (3.8 ± 0.3 cm vs. 2.6 ± 0.6 cm, p<.001). Significant biliary complications occurred in one patient (7.7%) of the IRE group and in five patients (16.1%) of the RFA group. Significant risk factors for biliary complications included the RFA procedure (HR 9.71, p=.032) and proximity of the tumor to the bile duct (HR 0.63, p=.048). The local tumor progression (LTP) rates were 7.7% (IRE) vs. 21.5% (RFA) at 1 year, 23.1% (IRE) vs. 32.7% (RFA) at 2 years and 23.1% (IRE) vs. 44% (RFA) at 3 years, respectively (p=.289). CONCLUSIONS The IRE and RFA procedures are safe and effective to treat peribiliary liver tumors. However, the RFA may have a higher risk of significant bile duct injury than IRE. The shorter distance between the bile duct and the tumor is a strong risk factor for biliary complications.
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Affiliation(s)
- Somrach Thamtorawat
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rujira Patanawanitkul
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Satit Rojwatcharapibarn
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Walailak Chaiyasoot
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Trongtum Tongdee
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jirawadee Yodying
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sukrit Sorotpinya
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Lee J, Jin YJ, Shin SK, Kwon JH, Kim SG, Suh YJ, Jeong Y, Yu JH, Lee JW, Kwon OS, Nahm SW, Kim YS. Surgery versus radiofrequency ablation in patients with Child- Pugh class-A/single small (≤3 cm) hepatocellular carcinoma. Clin Mol Hepatol 2022; 28:207-218. [PMID: 34814239 PMCID: PMC9013608 DOI: 10.3350/cmh.2021.0294] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/AIMS We compared the post-treatment overall survival (OS) and recurrence-free survival (RFS) between patients with Child-Turcotte-Pugh (CTP) class-A and single small (≤3 cm) hepatocellular carcinoma (HCC) treated by surgical resection (SR) and radiofrequency ablation (RFA). METHODS We retrospectively analyzed 391 HCC patients with CTP class-A who underwent SR (n=232) or RFA (n=159) as first-line therapy for single small (≤3 cm) HCC. Survival was compared according to the tumor size (≤2 cm/2-3 cm) and the presence of cirrhosis. Inverse probability of treatment weighting (IPW) method was used to estimate the average causal effect of treatment. RESULTS The median follow-up period was 64.8 months (interquartile range, 0.1-162.6). After IPW, the estimated OS was similar in the SR and RFA groups (P=0.215), and even in patients with HCC of ≤2 cm (P=0.816) and without cirrhosis (P=0.195). The estimated RFS was better in the SR group than in the RFA groups (P=0.005), also in patients without cirrhosis (P<0.001), but not in those with HCC of ≤2 cm (P=0.234). The weighted Cox proportional hazards model with IPW provided adjusted hazard ratios (95% confidence interval) for OS, and the RFS after RFA versus SR were 0.698 (0.396-1.232) (P=0.215) and 1.698 (1.777-2.448) (P=0.005), respectively. CONCLUSION SR was similar for OS compared to RFA, but was better for RFS in patients with CTP class-A and single small (≤3 cm) HCC. The RFS was determined by the presence or absence of cirrhosis. Hence, SR rather than RFA should be considered in patients without cirrhosis to prolong the RFS, although there is no OS difference.
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Affiliation(s)
- Jungnam Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Young-Joo Jin
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jung Hyun Kwon
- Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary’s Hospital, Incheon, Korea,Corresponding author : Jung Hyun Kwon Division of Hepatology, Department of Internal Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea Tel: +82-32-280-5886, Fax: +82-32-280-5023 E-mail:
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Korea,Sang Gyune Kim Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: +82-32-621-5094, Fax: +82-32-621-5080 E-mail:
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University School of Medicine, Incheon, Korea
| | - Yujin Jeong
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Jung Hwan Yu
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jin-Woo Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Oh Sang Kwon
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Soon Woo Nahm
- Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary’s Hospital, Incheon, Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Korea
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Kim MS, Hong HP, Kang KA. Radiofrequency ablation of subcapsular lesions with internally cooled perfusion electrode: ex vivo study. MINIM INVASIV THER 2022; 31:216-222. [DOI: 10.1080/13645706.2020.1783686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung A Kang
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Identification of MAD2L1 as a Potential Biomarker in Hepatocellular Carcinoma via Comprehensive Bioinformatics Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9868022. [PMID: 35132379 PMCID: PMC8817109 DOI: 10.1155/2022/9868022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/19/2021] [Accepted: 01/15/2022] [Indexed: 11/17/2022]
Abstract
Background Hepatocellular carcinoma (HCC) is widely acknowledged as a malignant tumor with rapid progression, high recurrence rate, and poor prognosis. At present, there is a paucity of reliable biomarkers at the clinical level to guide the management of HCC and improve patient outcomes. Our research is aimed at assessing the prognostic value of MAD2L1 in HCC. Methods Four datasets, GSE121248, GSE101685, GSE85598, and GSE62232, were selected from the GEO database to analyze differentially expressed genes (DEGs) between HCC and normal liver tissues. After functional analysis, we constructed a protein-protein interaction network (PPI) for DEGs and identified core genes in this network with high connectivity with other genes. We assessed the relationship between core genes and the pathogenesis and prognosis of HCC. Finally, we explored the gene regulatory signaling mechanisms involved in HCC pathogenesis. Results 145 DEGs were screened from the intersection of the four GEO datasets. MAD2L1 was associated with most genes according to the PPI network and was selected as a candidate gene for further study. Survival analysis suggested that high MAD2L1 expression in HCC correlated with a worse prognosis. In addition, real-time quantitative PCR (RT-qPCR), western blot (WB), and immunohistochemistry (IHC) findings suggested that the expression of MAD2L1 was abnormally increased in HCC tissues and cells compared to paraneoplastic tissues and normal hepatocytes. Conclusion We found that high MAD2L1 expression in HCC was significantly associated with overall patient survival and clinical features. We also explored the potential biological properties of this gene.
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Yao J, Liu B, Wang X, Yu J, Cheng Z, Han Z, Liu F, Zheng R, Cheng W, Wei Q, Yu S, Li K, Chen P, Luo Y, Yu X, Liang P. Long-term efficacy of microwave ablation in the treatment of subcapsular hepatocellular carcinomas of ≤3 cm in diameter: a multicenter, propensity score-matched study. Int J Hyperthermia 2022; 39:209-216. [PMID: 35067144 DOI: 10.1080/02656736.2021.2023228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Jundong Yao
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Binbin Liu
- Henan University of Science and Technology School of Nursing, Luoyang, China
| | - Xiaohui Wang
- Department of Ultrasound Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Yu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qiang Wei
- Department of Ultrasound, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Songyuan Yu
- Department of Ultrasound, Wuhan University of science and technology, Tianyou Hospital, Wuhan, China
| | - Kai Li
- Chinese PLA Medical School, Beijing, China
| | - Peng Chen
- Chinese PLA Medical School, Beijing, China
| | - Yanchun Luo
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
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Yu J, Kim DH, Lee J, Shin YM, Kim JH, Yoon SM, Jung J, Kim JC, Yu CS, Lim SB, Park IJ, Kim TW, Hong YS, Kim SY, Kim JE, Park JH, Kim SY. Radiofrequency Ablation versus Stereotactic Body Radiation Therapy in the Treatment of Colorectal Cancer Liver Metastases. Cancer Res Treat 2021; 54:850-859. [PMID: 34645129 PMCID: PMC9296936 DOI: 10.4143/crt.2021.674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/12/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to compare the treatment outcomes of radiofrequency ablation (RFA) and stereotactic body radiation therapy (SBRT) for colorectal cancer liver metastases (CRLM) and to determine the favorable treatment modality according to tumor characteristics. Materials and Methods We retrospectively analyzed the records of 222 colorectal cancer patients with 330 CRLM who underwent RFA (268 tumors in 178 patients) or SBRT (62 tumors in 44 patients) between 2007 and 2014. Kaplan-Meier method and Cox models were used by adjusting with inverse probability of treatment weighting (IPTW). Results The median follow-up duration was 30.5 months. The median tumor size was significantly smaller in the RFA group than in the SBRT group (1.5 cm vs 2.3 cm, p < 0.001). In IPTW-adjusted analysis, difference in treatment modality was not associated with significant differences in 1-year and 3-year recurrence-free survival (35% vs. 43%, 22% vs. 23%; p=0.198), overall survival (96% vs. 91%, 58% vs. 56%; p=0.508), and freedom from local progression (FFLP; 90% vs. 72%, 78% vs. 60%; p=0.106). Significant interaction effect between the treatment modality and tumor size was observed for FFLP (p=0.001). In IPTW-adjusted subgroup analysis of patients with tumor size > 2 cm, the SBRT group had a higher FFLP compared with the RFA group (hazard ratio, 0.153; p < 0.001). Conclusion SBRT and RFA showed similar local control in the treatment of patients with CRLM. Tumor size was an independent prognostic factor for local control and SBRT may be preferred for larger tumors.
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Affiliation(s)
- Jesang Yu
- Department of Radiation Oncology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Dong Hwan Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jungbok Lee
- Department of Clinical Epidemiology & Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Moon Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Hoon Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Min Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinhong Jung
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Cheon Kim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Sik Yu
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok-Byung Lim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Young Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Hong Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Wu CH, Liang PC, Su TH, Lin MC, Chang YH, Shih TTF, Kao JH. Iodized oil computed tomography versus ultrasound-guided radiofrequency ablation for early hepatocellular carcinoma. Hepatol Int 2021; 15:1247-1257. [PMID: 34338971 DOI: 10.1007/s12072-021-10236-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Radiofrequency ablation (RFA) is the standard of care for early stage hepatocellular carcinoma (HCC). However, the clinical outcomes of iodized oil computed tomography (IoCT) versus ultrasound (US)-guided RFA for HCC remain unclear. METHODS We retrospectively analyzed consecutive treatment-naïve patients who received curative RFA for HCC within Milan criteria from January 2016 to December 2018. Patients who underwent either IoCT-guided RFA (IoCT group) or US-guided RFA (US group) were included. Various clinical factors, including tumor location, were adjusted with a 1:1 propensity score matching. Subsequently, the cumulative incidence rates for recurrence and hazard ratios for survival were calculated. RESULTS We included 184 (37.9%) and 301 (62.1%) patients who received IoCT- and US-guided RFA, respectively. Before propensity score matching, IoCT guidance was significantly associated with multiple tumors, higher body mass index, lower albumin level, and tumors located at S8. After matching, the 1-, 2-, and 3-year local tumor progression rates of the IoCT group were significantly lower than those of the US group (4.4%, 6.9%, and 7.5% vs. 14.4%, 16.3%, and 16.3%, respectively, at p = 0.002, 0.009, and 0.016, respectively). In univariate analyses and multivariate analyses that adjusted for clinical and tumor location-related parameters, the IoCT group had better recurrence-free survival (hazard ratio = 0.581, 95% confidence interval 0.375-0.899) than those with US guidance but not overall survival. CONCLUSION IoCT-guided RFA had a lower local tumor progression rate and better recurrence-free survival than did US-guided RFA for HCC within the Milan criteria. CT-guide RFA is a safe and effective alternative to US-guided with similar overall survival. IoCT-guided RFA might have a better local tumor control than US-guided. IoCT-guided RFA may be more suitable for male patients, aged < 70 years, a single tumor measuring 2-5 cm, and a tumor located at the subdiaphragmatic/subcardiac region.
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Affiliation(s)
- Chih-Horng Wu
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Road, Taipei, 10002, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Chin Liang
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Tung-Hung Su
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Chi Lin
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Yu-Hsuan Chang
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Road, Taipei, 10002, Taiwan.
| | - Jia-Horng Kao
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
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Han X, Ni JY, Li SL, Deng HX, Liang HM, Xu YY, Huang ZM, Zhang TQ, Huang JH. Radiofrequency versus microwave ablation for hepatocellular carcinoma within the Milan criteria in challenging locations: a retrospective controlled study. Abdom Radiol (NY) 2021; 46:3758-3771. [PMID: 34032898 DOI: 10.1007/s00261-021-03105-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to compare the safety and efficacy of radiofrequency ablation (RFA) with microwave ablation (MWA) for hepatocellular carcinoma (HCC) within the Milan criteria in challenging locations. METHODS This study retrospectively investigated 201 consecutive patients with Milan criteria HCCs who underwent RFA (RFA group, n = 150) or MWA (MWA group, n = 51) between January 2012 and December 2016. Overall survival (OS), recurrence-free survival (RFS), local tumor control, and treatment-related complications were compared between the two groups. Prognostic factors were analyzed using the Cox proportional hazard regression model. RESULTS Median follow-up duration was 36.7 months (range: 6.2-64.0 months). Cumulative 1-, 3-, and 5-year OS rates were 97.9%, 92.3%, and 80.6% in the MWA group and 96.4%, 87.4%, and 78.2% in the RFA group, respectively, (P = 0.450). Cumulative RFS rates at 1, 3, and 5 years were 93.2%, 74.4%, and 63.7% in the MWA group and 80.3%, 57.3%, and 49.6% in the RFA group, respectively, (P = 0.097). Multivariate analyses showed that variable categories "patient age above 65 years" (P = 0.004) and "more than one tumor" (P = 0.004) were associated with overall mortality, and "patient age above 65 years" (P = 0.048) and "tumor size greater than 3 cm" (P = 0.009) were associated with inferior RFS. The incidences of major complications were not significantly different between the two groups (3.3% vs 3.9%, P = 0.843). CONCLUSIONS RFA and MWA were associated with comparable safety and efficacy for HCC within the Milan criteria in challenging locations. Further study in a large, multi-center patient cohort is necessary to validate the results.
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Affiliation(s)
- Xue Han
- Department of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Jia-Yan Ni
- Department of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
- Department of Interventional Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
| | - Shao-Long Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Han-Xia Deng
- Department of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Hui-Ming Liang
- School of Medicine, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Ying-Ying Xu
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Zhi-Mei Huang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Tian-Qi Zhang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Jin-Hua Huang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China.
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Hu H, Chi JC, Liu R, Zhai B. Microwave ablation for peribiliary hepatocellular carcinoma: propensity score analyses of long-term outcomes. Int J Hyperthermia 2021; 38:191-201. [PMID: 33682598 DOI: 10.1080/02656736.2019.1706766] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To compare the long-term outcomes of MWA as the first-line treatment for HCC in peribiliary versus non-peribiliary locations using propensity score matching analysis. METHODS The study participants were recruited between April 2012 and October 2016. In total, 236 patients with HCC <5 cm who underwent ultrasonography-guided percutaneous MWA as the first-line treatment were enrolled. The patients were grouped into two according to tumor location: peribiliary (n = 74) and non-peribiliary (n = 162). The progression-free survival (PFS) and overall survival (OS) rates were compared before and after propensity score matching. Subgroup analyses were conducted for the peribiliary group according to the biliary grading. RESULTS Propensity score matching yielded 63 matched pairs of patients. In the two matched groups, cumulative PFS rates were 29.0% and 14.0% in the peribiliary group, and 51.0% and 31.0% in the non-peribiliary group at 3 and 5 years, respectively. Corresponding OS rates were 51.0% and 49.0% in the peribiliary group, and 77.0% and 70.0% in the non-peribiliary group at 3 and 5 years, respectively. In addition, there were significant differences in major complication rates between the two groups (25.7% vs 8.0%; p < .001). In contrast to peribiliary HCCs adjacent to the second-degree branches of intrahepatic bile duct (67.1 ± 5.2 months), subgroup analysis indicated that the mean OS was significantly lower in peribiliary HCCs adjacent to the first-degree branches (51.2 ± 7.5 months) (p = .015). CONCLUSION The application of MWA for peribiliary HCC leads to a higher rate of complications and worse long-term tumor control than for non-peribiliary HCC.KEY POINTSThe application of MWA for peribiliary HCC leads to a higher rate of complications than for non-peribiliary HCC.The application of MWA for peribiliary HCC leads to worse long-term tumor control than for non-peribiliary HCC. Abbreviations: Hepatocellular carcinoma (HCC); microwave ablation (MWA); α-fetoprotein (α-FP); local tumor progression (LTP); intrahepatic distal recurrence (IDR); progression-free survival (PFS); overall survival (OS).
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Affiliation(s)
- Hao Hu
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jia Chang Chi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Liu
- Department of Interventional Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Fan H, Wang X, Qu J, Lu W, Pang Z, Shao T, Xia J, Wang H, Li G, Zhang Y, Sun J, Yang X. Periprocedural risk factors for incomplete radiofrequency ablation of liver metastases from colorectal cancer: a single-center retrospective analysis. Int J Hyperthermia 2021; 38:985-994. [PMID: 34167430 DOI: 10.1080/02656736.2021.1942564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To explore independent risk factors for incomplete radiofrequency ablation (iRFA) of colorectal cancer liver metastases (CRLM) and evaluate adverse outcomes following iRFA. MATERIALS AND METHODS Magnetic resonance imaging data of CRLM patients who received percutaneous RFA were randomized into training (70%) and validation set 1 (30%) data sets. An independent validation set 2 was derived from computed tomography scans. Uni- and multivariate analyses identified independent risk factors for iRFA. Area under the curve (AUC) values were used to evaluate the predictive model performance. Risk points were assigned to independent predictors, and iRFA was predicted according to the total risk score. Kaplan-Meier curves were used to assess new intrahepatic metastases (NIHM), unablated tumor progression, and overall survival (OS). RESULTS Multivariate regression determined as independent iRFA risk factors perivascular tumor location, subcapsular tumor location, tumor size ≥20 mm, and minimal ablative margin ≤5 mm. The AUC values of the model in the training set, validation set 1, and validation set 2 were 0.867, 0.772, and 0.820, respectively. The respective AUC values of the total risk score were 0.864, 0.768, and 0.817. During the 6-year follow-up, the cumulative OS was significantly shorter in the iRFA than in the complete RFA group, and NIHM (hazard ratio [HR] = 2.79; 95% confidence interval [CI]: 1.725, 4.513) and unablated tumor progression (HR = 3.473; 95% CI: 1.506, 8.007) were more severe. CONCLUSIONS Perivascular tumor location, subcapsular tumor location, tumor size ≥20 mm, and minimal ablative margin ≤5 mm were independent risk factors for iRFA. iRFA may be a potential predictor of NIHM, unablated tumor progression, and OS.
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Affiliation(s)
- Hongjie Fan
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoyan Wang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jiali Qu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wei Lu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhenzhu Pang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tingting Shao
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingya Xia
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Huiyang Wang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Guangyao Li
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yanhua Zhang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jihong Sun
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoming Yang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Department of Radiology, Image-Guided Bio-Molecular Intervention Research, University of Washington School of Medicine, Seattle, WA, USA
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Zhou Y, Yang Y, Zhou B, Wang Z, Zhu R, Chen X, Ouyang J, Li Q, Zhou J. Challenges Facing Percutaneous Ablation in the Treatment of Hepatocellular Carcinoma: Extension of Ablation Criteria. J Hepatocell Carcinoma 2021; 8:625-644. [PMID: 34189133 PMCID: PMC8232857 DOI: 10.2147/jhc.s298709] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
As an emerging minimally invasive treatment method, percutaneous ablation is more and more widely used in the treatment of liver tumors. It has been recommended by guidelines for diagnosis and treatment of hepatocellular carcinoma (HCC) as a curative treatment alongside surgical resection and liver transplantation. In recent years, with the continuous advancement and innovation of percutaneous ablation technologies, their clinical efficacy and safety have been significantly improved, which has led to the expanded application of percutaneous ablation in the treatment of HCC—more and more patients who were previously considered unsuitable for ablation therapies are now being treated with percutaneous ablation. Obviously, percutaneous ablation can reduce the risk of treatment changes from curative strategies to palliative strategies. Based on clinical practice experience, this review enumerates the advantages and disadvantages of different ablative modalities and summarizes the existing combinations of ablation techniques, thus will help clinicians choose the most appropriate ablative modality for each patient and will provide scientific guidance for improving prognosis and making evidence-based treatment decisions. In addition, we point out the challenges and future prospects of the ablation therapies, thereby providing direction for future research.
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Affiliation(s)
- Yanzhao Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Yi Yang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Bingyan Zhou
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, People's Republic of China
| | - Zhengzheng Wang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Ruili Zhu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Xun Chen
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Jingzhong Ouyang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Qingjun Li
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
| | - Jinxue Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450008, People's Republic of China
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Asai A, Yokohama K, Ohama H, Tsuchimoto Y, Fukunishi S, Higuchi K. Association between Administration of Antithrombotics and Intraperitoneal Hemorrhage in Patients Undergoing Percutaneous Interventions for Liver Diseases. J Clin Med 2021; 10:jcm10112527. [PMID: 34200283 PMCID: PMC8201393 DOI: 10.3390/jcm10112527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/13/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022] Open
Abstract
Currently, percutaneous interventions are essential for diagnosis and treatment of liver diseases. The most frequent complication of percutaneous interventions is intraperitoneal hemorrhage. Recently, the number of patients with liver diseases on antithrombotics has been increasing. This retrospective cohort study aimed to evaluate the risk factors for intraperitoneal hemorrhage in patients after percutaneous interventions for liver diseases. This study included 1025 patients who underwent percutaneous interventions for liver diseases from April 2015 to March 2020. All interventions were performed using an ultrasound-guided approach. The influence of antithrombotic drug administration in patients, who underwent percutaneous interventions according to the guidelines for the American Association for the Study of Liver Disease, was evaluated. Intraperitoneal hemorrhage after percutaneous interventions was detected by computed tomography. Intraperitoneal hemorrhage occurred in nine patients (0.88%); however, these adverse events were not severe. We compared clinical characteristics between the patients with and without intraperitoneal hemorrhage. Although, there was no difference based on the administration of antithrombotics (p = 0.1961), seven of nine patients who showed intraperitoneal hemorrhage received percutaneous treatments (radio frequency ablation or microwave ablation). Therefore, we divided patients who underwent treatments and liver biopsy and then investigated the influence of antithrombotics on the intraperitoneal hemorrhage. After propensity score matching in each patient group, the administration of antithrombotics was not identified as a risk factor for hemorrhage in patients who underwent interventional treatments and patients who underwent liver biopsy. When the antithrombotics were discontinued, according to the guidelines, it may not increase the risk factor for hemorrhage in patients of liver disease who underwent percutaneous interventions.
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You Y, Zhang M, Li K, Zeng Q, Luo L, Long Y, Tan L, He X, Liang P, Xu E, Zheng R. Feasibility of 3D US/CEUS-US/CEUS fusion imaging-based ablation planning in liver tumors: a retrospective study. Abdom Radiol (NY) 2021; 46:2865-2874. [PMID: 33484284 DOI: 10.1007/s00261-020-02909-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE To assess the feasibility of ablation planning based on fusion imaging of three-dimensional ultrasound/contrast-enhanced ultrasound (3D US/CEUS) with real-time US/CEUS for liver tumor thermal ablation. MATERIALS AND METHODS Between January 2017 and December 2018, 85 hepatic tumors from 82 patients who underwent percutaneous ablation were included. First, intraprocedural 3D US/CEUS imaging was performed for ablation planning. Then, fusion imaging of 3D US/CEUS with real-time US/CEUS was used to guide the implementation of the plan, immediately evaluate the technical success and indicate the need for supplemental ablation. In addition, contrast-enhanced CT/MR imaging was performed 1 month after the procedure to evaluate the presence of residual tumors, and follow-up scans were repeated every 3 months. RESULTS The average liver tumor diameter was 28 ± 9 mm (range, 10-55 mm). 3D US/CEUS-based planning was successfully conducted in all 85 tumors with a 100% technical success rate of planning. The immediate evaluation by 3D CEUS/US-CEUS fusion imaging showed a 100% technical success rate of ablation. The 1-month CT/MR scans found a residual tumor in one intrahepatic cholangiocarcinoma patient; the technique efficacy rate was 98.8%. The median follow-up period was 21.5 months (IQR: 4-36 months). During the follow-up period, the local tumor progression rate was 5.9% (5/84), and no major procedure-related complications occurred. CONCLUSIONS Ablation planning based on 3D US/CEUS-US/CEUS fusion imaging is feasible for liver tumors.
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Fan H, Wang X, Qu J, Lu W, Xu S, Wu X, Xia J, Zhang Y, Sun J, Yang X. Comparison of Percutaneous Radiofrequency Ablation for Subcapsular and Non-Subcapsular Colorectal Cancer Liver Metastases. Front Oncol 2021; 11:678490. [PMID: 34055647 PMCID: PMC8160317 DOI: 10.3389/fonc.2021.678490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/27/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of percutaneous radiofrequency ablation (RFA) for subcapsular colorectal cancer liver metastases (CLMs). Materials and Methods With the approval of the Institutional Review Board, the clinical data of CLM patients who underwent percutaneous RFA for the first time from August 2010 to August 2020 were continuously collected. All CLMs were divided into subcapsular and non-capsular groups. Baseline characteristic data, technical effectiveness, minimal ablative margin, complications, local tumor progression (LTP), and overall survival (OS) between the two groups were analyzed using the t-test or chi-square test. A Cox regression model was used to evaluate the prognostic factors of LTP. Results One hundred and ninety-nine patients (124 males; mean age, 60.2 years) with 402 CLMs (221 subcapsular; mean size, 16.0 mm) were enrolled in the study. Technical effectiveness was achieved in 93.5% (376/402) of CLMs, with a major complication rate of 5.5%. Compared with non-subcapsular tumors, the minimal ablative margin achieved in subcapsular CLM was smaller (χ2 = -8.047, P < 0.001). With a median follow-up time of 23 months (range, 3−96 months), 37.1% of the tumors had LTP. The estimated cumulative OS at 1, 3, and 5 years was 96.1%, 66.0%, and 44.2%, respectively. There were no statistically significant differences between the two groups in terms of technical effectiveness (χ2 = 0.484, P = 0.487), major complications (χ2 = 0.082, P = 0.775), local tumor progression-free survival (LTPFS) (χ2 = 0.881, P = 0.348), and OS (χ2 = 2.874, P = 0.090). Minimal ablative margin, tumor size (≥20 mm), and technical effectiveness were predictors of LTP (all P < 0.05). Conclusion RFA is a safe and effective technique for local tumor control of subcapsular CLMs.
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Affiliation(s)
- Hongjie Fan
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoyan Wang
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiali Qu
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Lu
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shufeng Xu
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jingya Xia
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yanhua Zhang
- Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jihong Sun
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoming Yang
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Image-Guided Bio-Molecular Intervention Research, Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
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Lin CC, Lui KW, Chen WT, Hsieh YC, Cheng YT, Teng W, Lin SM. Switching monopolar radiofrequency ablation improves long-term outcomes of medium-sized hepatocellular carcinoma. Eur Radiol 2021; 31:8649-8661. [PMID: 33895858 DOI: 10.1007/s00330-021-07729-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/24/2020] [Accepted: 01/28/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Radiofrequency ablation (RFA) of medium-sized (3-5 cm) hepatocellular carcinoma (HCC) is suboptimal. Switching monopolar RFA (SW-RFA) enlarges the ablative volume to better cover larger tumors. This study aims to compare the long-term outcomes of medium-sized HCC treated by either SW-RFA or single-monopolar RFA (S-RFA). METHODS We retrospectively reviewed 139 cases (147 medium-size HCC) between 2008 and 2014. Under propensity score matching, a total of 43 paired patients with medium-size HCC and balanced clinical variables treated by either SW-RFA or S-RFA were selected for comparison. RESULTS SW-RFA showed a higher rate of achieving an adequate safety margin (p = 0.002). After a mean follow-up period of 40.4 months, SW-RFA produced significantly lower global RFA failure rates (p < 0.001) and better overall survival (p = 0.005) compared to S-RFA. SW-RFA was independently associated with a decreased risk of global RFA failure (hazard ratio [HR]: 0.136, 95% confidence interval [CI]: 0.030-0.607, p = 0.009) and improved overall survival (HR: 0.337, 95% CI: 0.152-0.747, p = 0.007). By last follow-up, the SW-RFA group maintained a superior tumor-free rate (p = 0.010) and fewer progressions to Barcelona Clinic Liver Cancer stage C (p = 0.011). Major complication rates were comparable in both groups (SW-RFA: 2.3% vs. S-RFA: 4.7%, p = 1.000). CONCLUSIONS The switching multi-monopolar ablation technique could be beneficial for patients with medium-sized HCCs given sustained control of larger tumors with better overall survival. KEY POINTS • Switching monopolar ablation could provide a sustained local tumor control and better overall survival than single-monopolar ablation for the medium-sized hepatocellular carcinoma. • Compared to single-monopolar ablation, switching monopolar ablation could create a larger homogeneous coagulation volume by using a shorter total ablation time to achieve a higher rate of adequate safety margin for a medium-sized HCC. • Patients with medium-sized HCC can be maintained at a higher rate of tumor-free status and at a lower risk of progression into BCLC stage C in the follow-up period after ablation by switching monopolar than by single-monopolar ablation.
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Affiliation(s)
- Chen-Chun Lin
- Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan, 333
| | - Kar-Wai Lui
- Department of Medical Imaging & Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Ting Chen
- Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan, 333
| | - Yi-Chung Hsieh
- Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan, 333
| | - Ya-Ting Cheng
- Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan, 333
| | - Wei Teng
- Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan, 333
| | - Shi-Ming Lin
- Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan, 333.
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Xu E, Li K, Long Y, Luo L, Zeng Q, Tan L, He X, Huang Q, Wu Y, Zheng R. Intra-Procedural CT/MR-Ultrasound Fusion Imaging Helps to Improve Outcomes of Thermal Ablation for Hepatocellular Carcinoma: Results in 502 Nodules. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:e9-e19. [PMID: 31671457 DOI: 10.1055/a-1021-1616] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim was to assess the value of intra-procedural CT/MR-ultrasound (CT/MR-US) fusion imaging in the management of thermal ablation for hepatocellular carcinoma (HCC). MATERIALS AND METHODS This retrospective study was approved by the institutional review board. From May 2010 to October 2016, 543 HCC nodules in 440 patients (387 men and 53 women; age range: 25-84 years) that met the Milan Criteria were treated by percutaneous thermal ablation using intra-procedural CT/MR-US fusion imaging. The HCC nodules were divided into subgroups and compared (≤ 3 cm and > 3 cm, or high-risk and low-risk location, or inconspicuous and conspicuous, respectively). Technique efficacy and major complication were calculated. Cumulative local tumor progression (LTP), tumor-free and overall survival rates were estimated with the Kaplan-Meier method. RESULTS CT/MR-US fusion imaging was successfully registered in 419 patients with 502 nodules. The technique efficacy rate of thermal ablation was 99.4 %. The major complication rate was 1.9 %. The cumulative LTP rates were 3.2 %, 5.6 % and 7.2 % at 1, 3, and 5 years, respectively. There were no significant differences for the comparisons of cumulative LTP rates between different subgroups (P = 0.541, 0.314, 0.329). The cumulative tumor-free survival rates were 74.8 %, 54.0 % and 37.5 % at 1, 3, and 5 years, respectively. The cumulative overall survival rates were 97.8 %, 87.1 % and 81.7 % at 1, 3, and 5 years, respectively. CONCLUSION Intra-procedural CT/MR-ultrasound fusion imaging is a useful technique for percutaneous liver thermal ablation. It could help to achieve satisfying survival outcomes for HCC patients who meet the Milan Criteria.
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Affiliation(s)
- Erjiao Xu
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Kai Li
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yinglin Long
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Liping Luo
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qingjing Zeng
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lei Tan
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xuqi He
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qiannan Huang
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuxuan Wu
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Centonze L, Di Sandro S, Lauterio A, De Carlis R, Frassoni S, Rampoldi A, Tuscano B, Bagnardi V, Vanzulli A, De Carlis L. Surgical Resection vs. Percutaneous Ablation for Single Hepatocellular Carcinoma: Exploring the Impact of Li-RADS Classification on Oncological Outcomes. Cancers (Basel) 2021; 13:1671. [PMID: 33916311 PMCID: PMC8038048 DOI: 10.3390/cancers13071671] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/25/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Single hepatocellular carcinoma (HCC) benefits from surgical resection (SR) or US-guided percutaneous ablation (PA), although the best approach is still debated. We evaluated the impact of Li-RADS classification on the oncological outcomes of SR vs. PA as single HCC first-line treatment. Methods: We retrospectively and blindly classified treatment-naïve single HCC that underwent SR or PA between 2010 and 2016 according to Li-RADS protocol. Overall survival (OS), recurrence free survival (RFS) and local recurrence after SR and PA were compared for each Li-RADS subclass before and after propensity-score matching (PS-M). Results: Considering the general population, SR showed better 5-year OS (68.3% vs. 52.2%; p = 0.049) and RFS (42.5% vs. 29.8%; p = 0.002), with lower incidence of local recurrence (8.2% vs. 44.4%; p < 0.001), despite a significantly higher frequency of clinically-relevant complications (12.8% vs. 1.9%; p = 0.002) and a higher Comprehensive Complication Index (12.1 vs. 2.2; p < 0.001). Focusing on different Li-RADS subclasses, we highlighted better 5-year OS (67.1% vs. 46.2%; p = 0.035), RFS (45.0% vs. 27.0% RFS; p < 0.001) and lower incidence of local recurrence (9.7% vs. 48.6%; p < 0.001) after SR for Li-RADS-5 HCCs, while these outcomes did not differ for Li-RADS-3/4 subclasses; such results were confirmed after PS-M. Conclusions: Our analysis suggests a potential prognostic role of Li-RADS classification, supporting SR over PA especially for Li-RADS-5 single HCC.
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Affiliation(s)
- Leonardo Centonze
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (S.D.S.); (A.L.); (R.D.C.); (L.D.C.)
| | - Stefano Di Sandro
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (S.D.S.); (A.L.); (R.D.C.); (L.D.C.)
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (S.D.S.); (A.L.); (R.D.C.); (L.D.C.)
| | - Riccardo De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (S.D.S.); (A.L.); (R.D.C.); (L.D.C.)
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Antonio Rampoldi
- Department of Diagnostic and Interventional Radiology, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (A.R.); (B.T.); (A.V.)
| | - Bruno Tuscano
- Department of Diagnostic and Interventional Radiology, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (A.R.); (B.T.); (A.V.)
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Angelo Vanzulli
- Department of Diagnostic and Interventional Radiology, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (A.R.); (B.T.); (A.V.)
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (S.D.S.); (A.L.); (R.D.C.); (L.D.C.)
- School of Medicine and Surgery, University of Milan-Bicocca, 20126 Milan, Italy
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Feng Y, Wang L, Lv H, Shi T, Xu C, Zheng H, Qi J, Zhao X, Li J, Gao Y, Qin C, Zhu Q. Microwave ablation versus radiofrequency ablation for perivascular hepatocellular carcinoma: a propensity score analysis. HPB (Oxford) 2021; 23:512-519. [PMID: 32839089 DOI: 10.1016/j.hpb.2020.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND To compare the efficacy and safety of microwave ablation (MWA) and radiofrequency ablation (RFA) as first-line treatments for perivascular HCC. METHODS This multicentre study enrolled 170 patients with perivascular HCC who underwent MWA or RFA. The ablation response, progression-free survival (PFS), overall survival (OS), and complications between the treatment groups for the total and propensity score-matched (PSM) cohorts were compared. RESULTS The disease control rates for MWA and RFA were similar in total (94% vs. 91%, p = 0.492) and PSM (93% vs. 93%, p = 1.00) cohorts. The PFS rates at 1, 3, and 5 years were 71%, 55% and 52% in MWA group and 61%, 33% and 28% in RFA group (p = 0.017). The OS rates were comparable between two groups in total (p = 0.249) and PSM cohorts (p = 0.345). In subgroup analyses, the PFS of patients with periportal HCC (45 vs. 36 months, p = 0.048) and a single HCC nodule (51 vs. 42 months, p = 0.014) were significantly better in MWA group than RFA. Major complications were more frequent in the MWA group than in RFA (27% vs. 7%, p < 0.001). CONCLUSION Compared with RFA, MWA provides better control of tumour progression especially in periportal HCC or single-nodule perivascular HCC patients.
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Affiliation(s)
- Yuemin Feng
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Le Wang
- Department of Geriatrics, Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Huanran Lv
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Tongtong Shi
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Chenghui Xu
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Hang Zheng
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Jianni Qi
- Department of Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Xinya Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Jie Li
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Yanjing Gao
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Chengyong Qin
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China.
| | - Qiang Zhu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China.
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Kuroda H, Nagasawa T, Fujiwara Y, Sato H, Abe T, Kooka Y, Endo K, Oikawa T, Sawara K, Takikawa Y. Comparing the Safety and Efficacy of Microwave Ablation Using Thermosphere TM Technology versus Radiofrequency Ablation for Hepatocellular Carcinoma: A Propensity Score-Matched Analysis. Cancers (Basel) 2021; 13:cancers13061295. [PMID: 33803926 PMCID: PMC7998443 DOI: 10.3390/cancers13061295] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Microwave ablation using ThermosphereTM technology is a novel locoregional treatment for hepatocellular carcinoma. This study compared the safety and efficacy outcomes of this microwave ablation strategy versus radiofrequency ablation using propensity score-matched analysis. Microwave ablation led to a high rate of curative ablation (94.7%) and a low rate of local recurrence (3.3%), with an overall survival rate of 99.3% at 1 year (recurrence-free survival: 81.1%) and 88.4% at 2 years (recurrence-free survival: 60.5%). There were no significant differences in survival outcomes after microwave and radiofrequency ablation. However, microwave ablation required significantly fewer insertions (1.22 ± 0.49 vs. 1.59 ± 0.94; p < 0.0001). Based on the similar survival outcomes, we recommend microwave ablation using ThermosphereTM technology for hepatocellular carcinoma with a diameter of >2 cm because of the lower number of insertions. Abstract There is limited information regarding the oncological benefits of microwave ablation using ThermosphereTM technology for hepatocellular carcinoma. This study compared the overall survival and recurrence-free survival outcomes among patients with hepatocellular carcinoma after microwave ablation using ThermosphereTM technology and after radiofrequency ablation. Between December 2017 and August 2020, 410 patients with hepatocellular carcinoma (a single lesion that was ≤5 cm or ≤3 lesions that were ≤3 cm) underwent ablation at our institution. Propensity score matching identified 150 matched pairs of patients with well-balanced characteristics. The microwave ablation and radiofrequency ablation groups had similar overall survival rates at 1 year (99.3% vs. 98.2%) and at 2 years (88.4% vs. 87.5%) (p = 0.728), as well as similar recurrence-free survival rates at 1 year (81.1% vs. 76.2%) and at 2 years (60.5% vs. 62.1%) (p = 0.492). However, the microwave ablation group had a significantly lower mean number of total insertions (1.22 ± 0.49 vs. 1.59 ± 0.94; p < 0.0001). This retrospective study revealed no significant differences in the overall survival and recurrence-free survival outcomes after microwave ablation or radiofrequency ablation. However, we recommend microwave ablation for hepatocellular carcinoma tumors with a diameter of >2 cm based on the lower number of insertions.
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Feasibility, safety and accuracy of a CT-guided robotic assistance for percutaneous needle placement in a swine liver model. Sci Rep 2021; 11:5218. [PMID: 33664412 PMCID: PMC7933138 DOI: 10.1038/s41598-021-84878-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/18/2021] [Indexed: 01/05/2023] Open
Abstract
Evaluate the feasibility, safety and accuracy of a CT-guided robotic assistance for percutaneous needle placement in the liver. Sixty-six fiducials were surgically inserted into the liver of ten swine and used as targets for needle insertions. All CT-scan acquisitions and robotically-assisted needle insertions were coordinated with breath motion using respiratory monitoring. Skin entry and target points were defined on planning CT-scan. Then, robotically-assisted insertions of 17G needles were performed either by experienced interventional radiologists or by a novice. Post-needle insertion CT-scans were acquired to assess accuracy (3D deviation, ie. distance from needle tip to predefined target) and safety. All needle insertions (43/43; median trajectory length = 83 mm (interquartile range [IQR] 72–105 mm) could be performed in one (n = 36) or two (n = 7) attempts (100% feasibility). Blinded evaluation showed an accuracy of 3.5 ± 1.3 mm. Accuracy did not differ between novice and experienced operators (3.7 ± 1.3 versus 3.4 ± 1.2 mm, P = 0.44). Neither trajectory angulation nor trajectory length significantly impacted accuracy. No complications were encountered. Needle insertion using the robotic device was shown feasible, safe and accurate in a swine liver model. Accuracy was influenced neither by the trajectory length nor by trajectory angulations nor by operator’s experience. A prospective human clinical trial is recruiting.
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Rim CH, Lee HY, Kim JS, Kim H. Radiofrequency ablation and stereotactic body radiotherapy for hepatocellular carcinoma: should they clash or reconcile? Int J Radiat Biol 2020; 97:111-119. [PMID: 33253598 DOI: 10.1080/09553002.2021.1857453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Until a few decades ago, surgical resection was the only valid option for treating hepatocellular carcinoma (HCC). However, various locoregional modalities including arterial-directed therapy, radiofrequency ablation (RFA), and radiotherapy have been recently shown to be effective. RFA is now established as a standard treatment for small localized HCCs, showing oncological results comparable to those of surgical resection in randomized studies. Stereotactic body radiotherapy (SBRT) is a modern radiotherapeutic modality that targets tumors with precision and delivers high radiation doses over a short period of time; it has particularly attracted clinical interest after its therapeutic efficacy was found to be similar to that of surgery in early-stage lung cancer. Given its potent disease control capability, SBRT has also been applied to early HCCs and demonstrated promising results in recent studies. It has also been noted for its suitability to treat tumors located in anatomical locations where RFA would be challenging. However, since its effectiveness has not been compared to that of RFA in randomized studies of patients eligible for RFA, the use of SBRT has been debated. This review was conducted to guide physicians from all fields involved in the treatment of early HCC. The therapeutic characteristics and indications of both SBRT and RFA are described, and recent comparative studies between the two modalities are discussed. In addition, we examined the factors that should be considered when selecting the appropriate treatments, and offer our recommendations.
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Affiliation(s)
- Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital, Gyeonggido, Korea
| | - Hye Yoon Lee
- Department of General Surgery, Korea University Ansan Hospital, Gyeonggido, Korea
| | - Jung Sun Kim
- Department of Medical Oncology, Korea University Ansan Hospital, Gyeonggido, Korea
| | - Hakyoung Kim
- Department of Radiation Oncology, Korea University Guro Hospital, Seoul, Korea
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