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Lu CY, Hsiao CY, Peng PJ, Huang SC, Chuang MR, Su HJ, Huang KW. DNA Methylation Biomarkers as Prediction Tools for Therapeutic Response and Prognosis in Intermediate-Stage Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:4465. [PMID: 37760434 PMCID: PMC10527266 DOI: 10.3390/cancers15184465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Alfa-fetoprotein (AFP), as the main serum tumor marker of hepatocellular carcinoma (HCC), is limited in terms of specificity and ability to predict outcomes. This study investigated the clinical utility of DNA methylation biomarkers to predict therapeutic responses and prognosis in intermediate-stage HCC. METHODS This study enrolled 72 patients with intermediate-stage HCC who underwent locoregional therapy (LRT) between 2020 and 2021. The immediate therapeutic response and disease status during a two-year follow-up were recorded. Analysis was performed on 10 selected DNA methylation biomarkers via pyrosequencing analysis of plasma collected before and after LRT. RESULTS Analysis was performed on 53 patients with complete responses and 19 patients with disease progression after LRT. The mean follow-up duration was 2.4 ± 0.6 years. A methylation prediction model for tumor response (MMTR) and a methylation prediction model for early progression (MMEP) were constructed. The area under the curve (AUC) for sensitivity and specificity of MMTR was 0.79 for complete response and 0.759 for overall survival. The corresponding AUCs for sensitivity and specificity of AFP and protein induced by vitamin K absence-II (PIVKA-II) were 0.717 and 0.708, respectively. Note that the MMTR index was the only significant predictor in multivariate analysis. The AUC for sensitivity and specificity of the MMEP in predicting early progression was 0.79. The corresponding AUCs for sensitivity and specificity of AFP and PIVKA-II were 0.758 and 0.714, respectively. Multivariate analysis revealed that platelet count, beyond up-to-7 criteria, and the MMEP index were strongly correlated with early tumor progression. Combining the indexes and serum markers further improved the predictive accuracy (AUC = 0.922). Multivariate analysis revealed the MMEP index was the only independent risk factor for overall survival. DISCUSSION/CONCLUSIONS This study indicates that these methylation markers could potentially outperform current serum markers in terms of accuracy and reliability in assessing treatment response and predicting outcomes. Combining methylation markers and serum markers further improved predictive accuracy, indicating that a multi-marker approach may be more effective in clinical practice. These findings suggest that DNA methylation biomarkers may be a useful tool for managing intermediate-stage HCC patients and guiding personalized treatment, particularly for those who are at high risk for close surveillance or adjuvant treatment after LRT.
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Affiliation(s)
- Chang-Yi Lu
- Phalanx Biotech Group, Hsinchu 300, Taiwan; (C.-Y.L.); (S.-C.H.); (H.-J.S.)
| | - Chih-Yang Hsiao
- Department of Surgery and Hepatitis Research Center, National Taiwan University Hospital, Taipei 100, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Department of Traumatology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Pey-Jey Peng
- Phalanx Biotech Group, Hsinchu 300, Taiwan; (C.-Y.L.); (S.-C.H.); (H.-J.S.)
| | - Shao-Chang Huang
- Phalanx Biotech Group, Hsinchu 300, Taiwan; (C.-Y.L.); (S.-C.H.); (H.-J.S.)
| | - Meng-Rong Chuang
- Phalanx Biotech Group, Hsinchu 300, Taiwan; (C.-Y.L.); (S.-C.H.); (H.-J.S.)
| | - Hung-Ju Su
- Phalanx Biotech Group, Hsinchu 300, Taiwan; (C.-Y.L.); (S.-C.H.); (H.-J.S.)
| | - Kai-Wen Huang
- Department of Surgery and Hepatitis Research Center, National Taiwan University Hospital, Taipei 100, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Center for Functional Image and Interventional Therapy, National Taiwan University, Taipei 100, Taiwan
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Crocetti L, Bozzi E, Scalise P, Bargellini I, Lorenzoni G, Ghinolfi D, Campani D, Balzano E, De Simone P, Cioni R. Locoregional Treatments for Bridging and Downstaging HCC to Liver Transplantation. Cancers (Basel) 2021; 13:5558. [PMID: 34771720 PMCID: PMC8583584 DOI: 10.3390/cancers13215558] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 02/08/2023] Open
Abstract
Liver transplantation (LT) is the first-line treatment for patients diagnosed with unresectable early-stage hepatocellular carcinoma (HCC) in the setting of cirrhosis. It is well known that HCC patients within the Milan criteria (solitary tumour ≤ 5 cm or ≤3 tumours, each <3 cm) could undergo LT with excellent results. However, there is a growing tendency to enlarge inclusion criteria since the Milan criteria are nowadays considered too restrictive and may exclude patients who would benefit from LT. On the other hand, there is a persistent shortage of donor organs. In this scenario, there is consensus about the role of loco-regional therapy (LRT) during the waiting list to select patients who would benefit more from LT, reducing the risk of drop off from the waiting list as well as decreasing tumour dimension to meet acceptable criteria for LT. In this review, current evidence on the safety, efficacy and utility of LRTs as neoadjuvant therapies before LT are summarized.
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Affiliation(s)
- Laura Crocetti
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (E.B.); (P.S.); (I.B.); (G.L.); (R.C.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (D.C.); (P.D.S.)
| | - Elena Bozzi
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (E.B.); (P.S.); (I.B.); (G.L.); (R.C.)
| | - Paola Scalise
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (E.B.); (P.S.); (I.B.); (G.L.); (R.C.)
| | - Irene Bargellini
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (E.B.); (P.S.); (I.B.); (G.L.); (R.C.)
| | - Giulia Lorenzoni
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (E.B.); (P.S.); (I.B.); (G.L.); (R.C.)
| | - Davide Ghinolfi
- Division of Hepatobiliary Surgery and Liver Transplantation, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (D.G.); (E.B.)
| | - Daniela Campani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (D.C.); (P.D.S.)
- Division of Pathology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Emanuele Balzano
- Division of Hepatobiliary Surgery and Liver Transplantation, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (D.G.); (E.B.)
| | - Paolo De Simone
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (D.C.); (P.D.S.)
- Division of Hepatobiliary Surgery and Liver Transplantation, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (D.G.); (E.B.)
| | - Roberto Cioni
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (E.B.); (P.S.); (I.B.); (G.L.); (R.C.)
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Faiella E, Santucci D, Bernetti C, Schena E, Pacella G, Zobel BB, Grasso RF. Combined trans-arterial embolisation and microwave ablation for the treatment of large unresectable hepatic metastases (>3 cm in maximal diameter). Int J Hyperthermia 2021; 37:1395-1403. [PMID: 33342310 DOI: 10.1080/02656736.2020.1849823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of a two-step single-session procedure, combining transarterial embolization (TAE) and percutaneous microwave ablation (MWA), in the treatment of > 3 cm unresectable liver metastases. We also compared the final volume obtained by the two techniques (VE-T) and the expected ablation volume of the stand-alone MWA (VT). METHODS From January 2015 to December 2017, 22 consecutive patients, with a total of 24 unresectable hepatic metastases >3 cm in diameter underwent a two-step single-session combined treatment of TAE and MWA. Follow-up computed tomography scans were performed at 1-, 3-, 6-, 12, and 24 months post-procedure. VE-T as final ablation volume induced by the combined treatment (TAE-MWA), VN as initial nodule volume, VT as expected ablation volume of MWA treatment alone were evaluated and compared. RESULTS Tumor dimensions ranged from 32 to 73 mm. Technical success was achieved in all treated tumors with no local tumor recurrence. Final ablation volumes ranged from 50 to 450 cm3 and the short-axis diameter of the ablation zone ranged from 12 to 48 mm. The mean ΔV increment in the final ablation volume with respect to the stand-alone MWA was 196% (ranging from 25 cm3 - 210 cm3) (p < 0.05). The VE-T mean was four times the VN mean, while the VT mean was about twice the VN mean. No recurrence and only one case of post-embolization bleeding were observed. CONCLUSIONS This study demonstrated the safety and efficacy of a combined two-step single-session TAE-MWA treatment of unresectable hepatic metastases > 3 cm in diameter.
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Affiliation(s)
- Eliodoro Faiella
- Department of Radiology, Campus Bio-Medico University, Rome, Italy
| | | | | | - Emiliano Schena
- Center for Integrated Research, University Campus Bio-Medico di Roma, Rome, Italy
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Kuo MJ, Mo LR, Chen CL. Factors predicting long-term outcomes of early-stage hepatocellular carcinoma after primary curative treatment: the role of surgical or nonsurgical methods. BMC Cancer 2021; 21:250. [PMID: 33685409 PMCID: PMC7941925 DOI: 10.1186/s12885-021-07948-9] [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: 11/29/2020] [Accepted: 02/15/2021] [Indexed: 02/06/2023] Open
Abstract
Background We quantified the elusive effects of putative factors on the clinical course of early hepatocellular carcinoma (HCC) after primary surgical or nonsurgical curative treatment. Methods Patients with newly diagnosed early HCC who received surgical resection (SR) or percutaneous radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) from January 2003 to December 2016 were enrolled. The cumulative overall survival (OS) and disease-free survival (DFS) rates were compared. A polytomous logistic regression was used to estimate factors for early and late recurrence. Independent predictors of OS were identified using Cox proportional hazard regression. Results One hundred twenty-five patients underwent SR, and 176 patients underwent RFA, of whom 72 were treated with TACE followed by RFA. Neither match analysis based on propensity score nor multiple adjustment regression yielded a significant difference in DFS and OS between the two groups. Multivariate analysis showed high AFP (> 20 ng/mL), and multinodularity significantly increased risk of early recurrence (< 1 year). In contrast, hepatitis B virus, hepatitis C virus and multinodularity were significantly associated with late recurrence (> 1 year). Multivariate Cox regression with recurrent events as time-varying covariates identified older age (HR = 1.55, 95% CI:1.01–2.36), clinically significant portal hypertension (CSPH) (HR = 1.97, 95% CI:1.26–3.08), early recurrence (HR = 6.62, 95% CI:3.79–11.6) and late recurrence (HR = 3.75, 95% CI:1.99–7.08) as independent risk factors of mortality. A simple risk score showed fair calibration and discrimination in early HCC patients after primary curative treatment. In the Barcelona Clinic Liver Cancer (BCLC) stage A subgroup, SR significantly improved DFS compared to RFA with or without TACE. Conclusion Host and tumor factors rather than the initial treatment modalities determine the outcomes of early HCC after primary curative treatment. Statistical models based on recurrence types can predict early HCC prognosis but further external validation is necessary. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07948-9.
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Affiliation(s)
- Ming-Jeng Kuo
- Department of Hepatogastroenterology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan 701, Taiwan. No. 670, Chon-De Road, Tainan, 701, Taiwan.
| | - Lein-Ray Mo
- Department of Hepatogastroenterology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan 701, Taiwan. No. 670, Chon-De Road, Tainan, 701, Taiwan
| | - Chi-Ling Chen
- Graduate Institute of Clinical Medicine, College of Medicine, and Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, 7 Chung-Shan South Road, Taipei, 100, Taiwan.
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Shah KY, Gaba RC. Combined Transarterial Chemoembolization and Percutaneous Radiofrequency Ablation: More Promising Evidence of Effectiveness in Treating Solitary, Medium-Sized Hepatocellular Carcinoma. J Vasc Interv Radiol 2019; 30:1545-1548. [PMID: 31547921 DOI: 10.1016/j.jvir.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/06/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ketan Y Shah
- Department of Radiology, University of Illinois Health, 1740 West Taylor Street, MC 931, Chicago, IL, 60612
| | - Ron C Gaba
- Department of Radiology, University of Illinois Health, 1740 West Taylor Street, MC 931, Chicago, IL, 60612.
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Srinivasa RN, Chick JFB, Gemmete JJ, Majdalany BS, Hage A, Jo A, Srinivasa RN. Prone transradial catheterization for combined single-session endovascular and percutaneous interventions: approach, technical success, safety, and outcomes in 15 patients. ACTA ACUST UNITED AC 2019; 24:276-282. [PMID: 30211681 DOI: 10.5152/dir.2018.18050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to report approach, safety, technical success, and clinical outcomes of prone trans- radial access (PTRA) and demonstrate feasibility for procedures requiring simultaneous arterial intervention and prone percutaneous access. METHODS Fifteen patients underwent PTRA, seven females (47%) and eight males (53%), mean age of 55 years (range, 19-78 years). All patients underwent PTRA for combined transarterial and posterior-approach percutaneous interventions. Variables included sheath size (French, F), type of anesthesia, arterial intervention technical success, posterior-approach percutaneous intervention technical success, estimated blood loss (mL), fluoroscopy and procedure time, complications, and follow-up. RESULTS Mean sheath size was 4 F (range, 4-6 F; SD = 0.5). Arterial interventions included transarterial embolization of renal (n=6), hepatic (n=2), and pelvic vessels (n=2), diagnostic arteriography (n=4), and embolization of an arteriovenous malformation (n=1). Posterior-approach intervention technical success was 100% (15/15). PTRA technical success was 100% (15/15). Posterior-approach percutaneous interventions included retroperitoneal (n=5) and pelvic (n=1) mass biopsies, nephrostomy tube placement (n=2), cryoablation of pelvic (n=2) and renal (n=1) masses, sclerotherapy of arteriovenous malformations (n=2), foreign body removal from the renal collecting system (n=2), ablation of a renal tumor (n=1), intracavitary injection of pulmonary mycetoma (n=1), and ablation and cementoplasty of a vertebral body tumor (n=1). The biopsies were diagnostic (6/6). There were no minor or major access-site complications. CONCLUSION PTRA is a safe and feasible method for performing combined arterial and posterior approach percutaneous interventions without the need for repositioning.
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Affiliation(s)
- Rajiv N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology,University of Michigan Health Systems, Ann Arbor, Michigan, USA
| | - Jeffrey Forris Beecham Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan, USA
| | - Joseph J Gemmete
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan, USA
| | - Bill S Majdalany
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan, USA
| | - Anthony Hage
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Alex Jo
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan, USA
| | - Ravi N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan, USA
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Lee BC, Liu KL, Wu CH, Huang KW, Ho CM, Hu RH, Ho MC, Wu YM, Lee PH, Liang PC. Comparison of Radiofrequency Ablation and Transarterial Chemoembolization for Hepatocellular Carcinoma in the Caudate Lobe. Cardiovasc Intervent Radiol 2018; 41:1699-1707. [PMID: 29946941 DOI: 10.1007/s00270-018-1978-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Hepatocellular carcinoma (HCC) in the caudate lobe is technically challenging for both radiofrequency ablation (RFA) and transarterial chemoembolization (TACE). However, each of these modalities has its strengths. This retrospective study compares the effectiveness of RFA and TACE in patients with caudate HCC within the Milan criteria. METHODS This study was approved by institutional review board. Between November 2005 and August 2016, we retrospectively reviewed 74 patients with a single HCC ≤ 5 cm or up to three HCCs ≤ 3 cm without vascular invasion or extrahepatic metastasis who were treated with RFA (n = 43) or TACE (n = 31). The overall survival (OS) and local progression rates were compared after propensity score analysis. RESULTS The mean follow-up period was 2.8 ± 1.9 years. The 1-, 2-, and 3-year survival rates were 97.1, 94.0, and 80.7% for the RFA group and 89.0, 80.8, and 62.0% for the TACE group, respectively. The clinical variables of the RFA and the TACE groups were well balanced by propensity score adjustment, and the RFA group showed better OS (P = .039) and local progression rates (P = .004) than the TACE group. CONCLUSIONS RFA appears to outperform TACE for patients with caudate HCC within the Milan criteria and should be the favored treatment option when surgical resection is not feasible.
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Affiliation(s)
- Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, No. 7 Chung Shan S. Rd., Taipei City, 10002, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Hospital, No. 7 Chung Shan S. Rd., Taipei City, 10002, Taiwan
| | - Chih-Horng Wu
- Department of Medical Imaging, National Taiwan University Hospital, No. 7 Chung Shan S. Rd., Taipei City, 10002, Taiwan
| | - Kai-Wen Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, No. 7 Chung Shan S. Rd., Taipei City, 10002, Taiwan
| | - Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, No. 7 Chung Shan S. Rd., Taipei City, 10002, Taiwan
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, No. 7 Chung Shan S. Rd., Taipei City, 10002, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, No. 7 Chung Shan S. Rd., Taipei City, 10002, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, No. 7 Chung Shan S. Rd., Taipei City, 10002, Taiwan
| | - Po-Huang Lee
- Department of Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, No. 7 Chung Shan S. Rd., Taipei City, 10002, Taiwan.
- Department of Surgery, E-Da Hospital, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung, 824, Taiwan.
| | - Po-Chin Liang
- Department of Medical Imaging, National Taiwan University Hospital, No. 7 Chung Shan S. Rd., Taipei City, 10002, Taiwan.
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Lee H, Yoon CJ, Seong NJ, Jeong SH, Kim JW. Comparison of Combined Therapy Using Conventional Chemoembolization and Radiofrequency Ablation Versus Conventional Chemoembolization for Ultrasound-Invisible Early-Stage Hepatocellular Carcinoma (Barcelona Clinic Liver Cancer Stage 0 or A). Korean J Radiol 2018; 19:1130-1139. [PMID: 30386144 PMCID: PMC6201969 DOI: 10.3348/kjr.2018.19.6.1130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/16/2018] [Indexed: 12/18/2022] Open
Abstract
Objective To compare the therapeutic efficacy between conventional transarterial chemoembolization (cTACE) and combined therapy using cTACE and radiofrequency ablation (RFA) in ultrasound (US)-invisible early stage hepatocellular carcinoma (HCC). Materials and Methods From January 2008 to June 2016, 167 patients with US-invisible early stage HCCs were treated with cTACE alone (cTACE group; n = 85) or cTACE followed by immediate fluoroscopy-guided RFA targeting intratumoral iodized oil retention (combined group; n = 82). Procedure-related complications, local tumor progression (LTP), time to progression (TTP), and overall survival (OS) were compared between the two groups. Multivariate analyses were performed to identify prognostic factors. Results There was no major complication in either group. The cTACE group showed higher 1-, 3-, and 5-year LTP rates than the combined group; i.e., 12.5%, 31.7%, and 37.0%, respectively, in the cTACE group; compared to 7.3%, 16.5%, and 16.5%, respectively, in the combined group; p = 0.013. The median TTP was 18 months in the cTACE group and 24 months in the combined group (p = 0.037). Cumulative 1-, 3-, and 5-year OS rates were 100%, 93.2%, and 87.7%, respectively, in the cTACE group and 100%, 96.6%, and 87.4%, respectively, in the combined group (p = 0.686). Tumor diameter > 20 mm and cTACE monotherapy were independent risk factors for LTP and TTP. Conclusion Combined therapy using cTACE followed by fluoroscopy-guided RFA is a safe and effective treatment in US-invisible early stage HCCs. It provides less LTP and longer TTP than cTACE alone.
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Affiliation(s)
- Hyukjoon Lee
- Division of Vascular and Interventional Radiology, Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Chang Jin Yoon
- Division of Vascular and Interventional Radiology, Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Nak Jong Seong
- Division of Vascular and Interventional Radiology, Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Sook-Hyang Jeong
- Division of Internal Medicines, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Jin-Wook Kim
- Division of Internal Medicines, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Prone Transradial Catheterization for Combined Single-Session Transarterial Embolization and Percutaneous Posterior Approach Cryoablation of Solid Neoplasms. Cardiovasc Intervent Radiol 2016; 40:1026-1032. [PMID: 27921153 DOI: 10.1007/s00270-016-1529-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/01/2016] [Indexed: 12/18/2022]
Abstract
Transradial access (TRA) has been associated with improved post-procedure hemostasis and patient satisfaction, and decreased hemorrhagic complications, sedation requirements, recovery times, and procedure-related costs when compared with traditional transfemoral catheterization. Supine TRA has been described for the treatment of myocardial infarctions, aortoiliac and femoropopliteal stenoses, and a variety of neoplasms. This original research describes prone transradial catheterization to facilitate combined single-session transarterial embolization and percutaneous cryoablation of solid neoplasms from a posterior approach without repositioning. Prone TRA access, transarterial embolization, and percutaneous cryoablation were successful in all cases described. Mean procedure time was 210 min (range: 140-250 min). One minor complication, transient bacteremia which responded to antibiotics, was reported. No major complications occurred.
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Best J, Schotten C, Theysohn JM, Wetter A, Müller S, Radünz S, Schulze M, Canbay A, Dechêne A, Gerken G. Novel implications in the treatment of hepatocellular carcinoma. Ann Gastroenterol 2016; 30:23-32. [PMID: 28042235 PMCID: PMC5198244 DOI: 10.20524/aog.2016.0092] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/29/2016] [Indexed: 02/06/2023] Open
Abstract
Worldwide hepatocellular carcinoma remains one of the leading causes of cancer-related death, associated with a poor prognosis due to late diagnosis in the majority of cases. Physicians at care are frequently confronted with patients who are ineligible for curative treatment such as liver resection, transplantation or radiofrequency ablation. Besides established palliative locoregional therapies, such as ablation or chemoembolization, new treatment options, such as microwave ablation, drug-eluting bead transarterial chemoembolization or selective internal radiation therapy, are emerging; however, data from randomized controlled trials are still lacking. In order to achieve optimal tumor control, patients should receive tailored treatment concepts, considering their tumor burden, liver function and performance status, instead of strictly assigning patients to treatment modalities following algorithms that may be partly very restrictive. Palliative locoregional pretreatment might facilitate downstaging to ensure later curative resection or transplantation. In addition, the combined utilization of different locoregional treatment options or systemic co-treatment has been the subject of several trials. In cases where local tumor control cannot be achieved, or in the scenario of extrahepatic spread, sorafenib remains the only approved systemic therapy option. Alternative targeted therapies, such as immune checkpoint inhibitors have shown encouraging preliminary results, while data from phase III studies are pending.
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Affiliation(s)
- Jan Best
- Department of Gastroenterology and Hepatology (Jan Best, Clemens Schotten, Ali Canbay, Alexander Dechêne, Guido Gerken)
| | - Clemens Schotten
- Department of Gastroenterology and Hepatology (Jan Best, Clemens Schotten, Ali Canbay, Alexander Dechêne, Guido Gerken)
| | - Jens M Theysohn
- Departments of Diagnostic and Interventional Radiology and Neuroradiology (Jens M. Theysohn, Axel Wetter)
| | - Axel Wetter
- Departments of Diagnostic and Interventional Radiology and Neuroradiology (Jens M. Theysohn, Axel Wetter)
| | | | - Sonia Radünz
- Departments of Transplant and General Surgery (Sonia Radünz, Maren Schulze), University Hospital Essen, Essen, Germany
| | - Maren Schulze
- Departments of Transplant and General Surgery (Sonia Radünz, Maren Schulze), University Hospital Essen, Essen, Germany
| | - Ali Canbay
- Department of Gastroenterology and Hepatology (Jan Best, Clemens Schotten, Ali Canbay, Alexander Dechêne, Guido Gerken)
| | - Alexander Dechêne
- Department of Gastroenterology and Hepatology (Jan Best, Clemens Schotten, Ali Canbay, Alexander Dechêne, Guido Gerken)
| | - Guido Gerken
- Department of Gastroenterology and Hepatology (Jan Best, Clemens Schotten, Ali Canbay, Alexander Dechêne, Guido Gerken)
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Ramaswamy RS, Darcy MD. Arterial Embolization for the Treatment of Renal Masses and Traumatic Renal Injuries. Tech Vasc Interv Radiol 2016; 19:203-10. [DOI: 10.1053/j.tvir.2016.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Zhou ZG, Zheng XR, Zhou Q, Shi M, Zhang YJ, Guo RP, Yuan YF, Chen MS, Lin XJ, Lao XM, Li SP. Impact of oral anti-hepatitis B therapy on the survival of patients with hepatocellular carcinoma initially treated with chemoembolization. CHINESE JOURNAL OF CANCER 2015; 34:205-16. [PMID: 26058595 PMCID: PMC4593372 DOI: 10.1186/s40880-015-0017-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/04/2015] [Indexed: 02/07/2023]
Abstract
Introduction Most hepatocellular carcinomas (HCC) develop in a background of underlying liver disease including chronic hepatitis B. However, the effect of antiviral therapy on the long-term outcome of patients with hepatitis B virus (HBV)-related HCC treated with chemoembolization is unclear. This study aimed to evaluate the survival benefits of anti-HBV therapy after chemoembolization for patients with HBV-related HCC. Methods A total of 224 HCC patients who successfully underwent chemoembolization were identified, and their survival and other relevant clinical data were reviewed. Kaplan-Meier and Cox regression analyses were performed to validate possible effects of antiviral treatment on overall survival (OS). Results The median survival time (MST) was 15.9 (95% confidence interval [CI], 9.5–27.7) months in the antiviral group and 9.6 (95% CI, 7.8–13.7) months in the non-antiviral group (log-rank test, P = 0.044). Cox multivariate analysis revealed that antiviral treatment was a prognostic factor for OS (P = 0.008). Additionally, a further analysis was based on the stratification of the TNM tumor stages. In the subgroup of early stages, MST was significantly longer in the antiviral-treatment group than in the non-antiviral group (61.8 months [95% CI, 34.8 months to beyond the follow-up period] versus 26.2 [95% CI, 14.5–37.7] months, P = 0.012). Multivariate analysis identified antiviral treatment as a prognostic factor for OS in the early-stage subgroup (P = 0.006). However, in the subgroup of advanced stages, MST of the antiviral-treated group was comparable to that of the non-antiviral group (8.4 [95% CI, 5.2–13.5] months versus 7.4 [95% CI, 5.9–9.3] months, P = 0.219). Multivariate analysis did not indicate that antiviral treatment was a significant prognostic factor in this subgroup. Conclusion Antiviral treatment is associated with prolonged OS time after chemoembolization for HCC, especially in patients with early-stage tumors.
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Affiliation(s)
- Zhong-Guo Zhou
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, Peoples Republic of China.
| | - Xing-Rong Zheng
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510630, Peoples Republic of China.
| | - Qian Zhou
- Epidemiology Research Unit, Translational Medicine Research Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510080, Peoples Republic of China.
| | - Ming Shi
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, Peoples Republic of China.
| | - Yao-Jun Zhang
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, Peoples Republic of China.
| | - Rong-Ping Guo
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, Peoples Republic of China.
| | - Yun-Fei Yuan
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, Peoples Republic of China.
| | - Min-Shan Chen
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, Peoples Republic of China.
| | - Xiao-Jun Lin
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, Peoples Republic of China.
| | - Xiang-Ming Lao
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, Peoples Republic of China.
| | - Sheng-Ping Li
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, Peoples Republic of China.
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Ganne-Carrié N, Nault JC, Ziol M, N'Kontchou G, Nahon P, Grando V, Bourcier V, Barge S, Beaugrand M, Trinchet JC, Seror O. Predicting recurrence following radiofrequency percutaneous ablation for hepatocellular carcinoma. Hepat Oncol 2014; 1:395-408. [PMID: 30190975 PMCID: PMC6095149 DOI: 10.2217/hep.14.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Within 5 years after percutaneous ablation of hepatocellular carcinoma, roughly 70% of patients experience tumor recurrence. Relapses beyond curative options affected patients' survival. Ablation shares with resection common predictive factors of recurrence as size of the tumor, multinodularity and presence of vascular invasion. High serum α-fetoprotein level and markers of severity of underlying liver disease have also been found to be associated with recurrence and even survival. However, predictive values for recurrence of technical factors, histopathological and molecular tumors' features have been rarely studied. Few comparative studies have shown that ablation techniques impact recurrence rates. Moreover, although ablation does not allow analysis of the whole tumor, some reports suggest that biopsies allow histopathological and even molecular testing of the risk of recurrence.
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Affiliation(s)
- Nathalie Ganne-Carrié
- APHP, Hôpitaux Universitaires Paris – Seine-Saint Denis, Site Jean Verdier, Pôle d'Activités Cancérologiques Spécialisées, Service d'Hépatologie, F-93143 Bondy, France
- Université Paris 13, Sorbonne Paris Cité, UFR SMBH, F-93000 Bobigny, France
- Inserm, UMR-1162, Génomique fonctionnelle des tumeurs solides, 27 rue Juliette Dodu, F-75010 Paris, France
| | - Jean-Charles Nault
- APHP, Hôpitaux Universitaires Paris – Seine-Saint Denis, Site Jean Verdier, Pôle d'Activités Cancérologiques Spécialisées, Service d'Hépatologie, F-93143 Bondy, France
- Université Paris 13, Sorbonne Paris Cité, UFR SMBH, F-93000 Bobigny, France
- Inserm, UMR-1162, Génomique fonctionnelle des tumeurs solides, 27 rue Juliette Dodu, F-75010 Paris, France
| | - Marianne Ziol
- Université Paris 13, Sorbonne Paris Cité, UFR SMBH, F-93000 Bobigny, France
- Inserm, UMR-1162, Génomique fonctionnelle des tumeurs solides, 27 rue Juliette Dodu, F-75010 Paris, France
- APHP, Hôpitaux Universitaires Paris – Seine-Saint Denis, Site Jean Verdier, Centre de Ressources Biologiques, F-93143 Bondy, France
- APHP, Hôpitaux Universitaires Paris – Seine-Saint Denis, Site Jean Verdier, Laboratoire d'Anatomie Pathologique, F-93143 Bondy, France
| | - Gisèle N'Kontchou
- APHP, Hôpitaux Universitaires Paris – Seine-Saint Denis, Site Jean Verdier, Pôle d'Activités Cancérologiques Spécialisées, Service d'Hépatologie, F-93143 Bondy, France
| | - Pierre Nahon
- APHP, Hôpitaux Universitaires Paris – Seine-Saint Denis, Site Jean Verdier, Pôle d'Activités Cancérologiques Spécialisées, Service d'Hépatologie, F-93143 Bondy, France
- Université Paris 13, Sorbonne Paris Cité, UFR SMBH, F-93000 Bobigny, France
- Inserm, UMR-1162, Génomique fonctionnelle des tumeurs solides, 27 rue Juliette Dodu, F-75010 Paris, France
| | - Véronique Grando
- APHP, Hôpitaux Universitaires Paris – Seine-Saint Denis, Site Jean Verdier, Pôle d'Activités Cancérologiques Spécialisées, Service d'Hépatologie, F-93143 Bondy, France
| | - Valérie Bourcier
- APHP, Hôpitaux Universitaires Paris – Seine-Saint Denis, Site Jean Verdier, Pôle d'Activités Cancérologiques Spécialisées, Service d'Hépatologie, F-93143 Bondy, France
| | - Sandrine Barge
- APHP, Hôpitaux Universitaires Paris – Seine-Saint Denis, Site Jean Verdier, Pôle d'Activités Cancérologiques Spécialisées, Service d'Hépatologie, F-93143 Bondy, France
- Université Paris 13, Sorbonne Paris Cité, UFR SMBH, F-93000 Bobigny, France
| | - Michel Beaugrand
- APHP, Hôpitaux Universitaires Paris – Seine-Saint Denis, Site Jean Verdier, Pôle d'Activités Cancérologiques Spécialisées, Service d'Hépatologie, F-93143 Bondy, France
- Université Paris 13, Sorbonne Paris Cité, UFR SMBH, F-93000 Bobigny, France
| | - Jean-Claude Trinchet
- APHP, Hôpitaux Universitaires Paris – Seine-Saint Denis, Site Jean Verdier, Pôle d'Activités Cancérologiques Spécialisées, Service d'Hépatologie, F-93143 Bondy, France
- Université Paris 13, Sorbonne Paris Cité, UFR SMBH, F-93000 Bobigny, France
- Inserm, UMR-1162, Génomique fonctionnelle des tumeurs solides, 27 rue Juliette Dodu, F-75010 Paris, France
- APHP, Hôpitaux Universitaires Paris – Seine-Saint Denis, Site Jean Verdier, Centre de Ressources Biologiques, F-93143 Bondy, France
| | - Olivier Seror
- Université Paris 13, Sorbonne Paris Cité, UFR SMBH, F-93000 Bobigny, France
- Inserm, UMR-1162, Génomique fonctionnelle des tumeurs solides, 27 rue Juliette Dodu, F-75010 Paris, France
- APHP, Hôpitaux Universitaires Paris – Seine-Saint Denis, Site Jean Verdier, Département d'imagerie Médicale, 93143 Bondy, France
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Abstract
Renal arterial embolization (RAE) performed for the treatment of renal masses has been proven to be a safe and effective technique, with several decades of experience. RAE is well tolerated with few complications, particularly if the time interval from embolization to surgery is reduced to less than 48 hours. Review of the literature suggests that RAE is also extremely effective for palliation of symptoms in the setting of nonoperative advanced stage renal cell carcinoma. In addition, this technique plays a large role in the management of angiomyolipomas that are symptomatic or at risk of spontaneous rupture. To date, RAE has not been evaluated in a randomized controlled setting, which has contributed to its underutilization. All of these potential benefits warrant the need for prospective studies for further validation.
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Affiliation(s)
- David Li
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Bradley B Pua
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
| | - David C Madoff
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
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Sorafenib in combination with transarterial chemoembolization and radiofrequency ablation in the treatment for unresectable hepatocellular carcinoma. Med Oncol 2013; 30:730. [DOI: 10.1007/s12032-013-0730-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 09/12/2013] [Indexed: 12/17/2022]
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16
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Wang ZJ, Wang MQ, Duan F, Song P, Liu FY, Chang ZF, Wang Y, Yan JY, Li K. Transcatheter arterial chemoembolization followed by immediate radiofrequency ablation for large solitary hepatocellular carcinomas. World J Gastroenterol 2013; 19:4192-4199. [PMID: 23864783 PMCID: PMC3710422 DOI: 10.3748/wjg.v19.i26.4192] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/21/2013] [Accepted: 07/05/2013] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the technical safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with immediate radiofrequency ablation (RFA) for large hepatocellular carcinomas (HCC) (maximum diameter ≥ 5 cm). METHODS Individual lesions in 18 patients with HCCs (mean maximum diameter: 7.5 cm; range: 5.1-15.5 cm) were treated by TACE combined with percutaneous RFA between January 2010 and June 2012. All of the patients had previously undergone one to four cycles of TACE treatment. Regular imaging and laboratory tests were performed to evaluate the rate of technical success, technique-related complications, local-regional tumor responses, recurrence-free survival time and survival rate after treatment. RESULTS Technical success was achieved for all 18 visible HCCs. Complete response (CR) was observed in 17 cases, and partial response was observed in 1 case 1 mo after intervention. The CR rate was 94.4%. Local tumors were mainly characterized by coagulative necrosis. During follow-up (2-29 mo), the mean recurrence-free survival time was 16.8 ± 4.0 mo in 17 cases of CR. The estimated overall survival rate at 6, 12, and 18 mo was 100%. No major complications were observed. Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the blood of 17 patients transiently increased on the third day after treatment (ALT 200.4 ± 63.4 U/L vs 24.7 ± 9.3 U/L, P < 0.05; AST 228.1 ± 25.4 U/L vs 32.7 ± 6.8 U/L, P < 0.05). Severe pain occurred in three patients, which was controlled with morphine and fentanyl. CONCLUSION TACE combined with immediate RFA is a safe and effective treatment for large solitary HCCs. Severe pain is a major side effect, but can be controlled by morphine.
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MESH Headings
- Analgesics, Opioid/therapeutic use
- Carcinoma, Hepatocellular/mortality
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/surgery
- Carcinoma, Hepatocellular/therapy
- Catheter Ablation/adverse effects
- Catheter Ablation/mortality
- Chemoembolization, Therapeutic/adverse effects
- Chemoembolization, Therapeutic/mortality
- Chemotherapy, Adjuvant
- Disease-Free Survival
- Humans
- Liver Neoplasms/mortality
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Liver Neoplasms/therapy
- Morphine/therapeutic use
- Neoadjuvant Therapy/adverse effects
- Neoadjuvant Therapy/mortality
- Pain, Postoperative/drug therapy
- Pain, Postoperative/etiology
- Retrospective Studies
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Tumor Burden
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17
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Kudo M. Advances in liver fibrosis imaging and hepatocellular carcinoma: update in 2013. Preface. Oncology 2013; 84 Suppl 1:1-2. [PMID: 23428851 DOI: 10.1159/000345882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Masatoshi Kudo
- Kinki University School of Medicine, Osakasayama, Osaka, Japan.
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