Clinical Trials Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2015; 21(36): 10418-10426
Published online Sep 28, 2015. doi: 10.3748/wjg.v21.i36.10418
Predictive value of quantitative contrast-enhanced ultrasound in hepatocellular carcinoma recurrence after ablation
Yi Gao, Dong-Yan Zheng, Zheng Cui, Yan Ma, Yuan-Zhi Liu, Wei Zhang
Yi Gao, Zheng Cui, Yan Ma, Department of Ultrasound in Medicine, Tongji University Affiliated East Hospital, Shanghai 200120, China
Dong-Yan Zheng, Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai 200233, China
Yuan-Zhi Liu, Department of first Gastroenterology, Capital Medical University Affiliated Beijing You’an Hospital, Beijing 100069, China
Wei Zhang, Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
Author contributions: Gao Y and Zheng DY contributed equally to this work; Gao Y, Zheng DY and Cui Z designed the research; Gao Y, Zheng DY, Cui Z, Ma Y, Liu YZ and Zhang W performed the research; Ma Y, Liu YZ and Zhang W contributed new reagents/analytic tools; Gao Y, Zheng DY and Cui Z analyzed the data; and Gao Y and Zheng DY wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Department of Ultrasound in Medicine, Tongji University Affiliated East Hospital, Shanghai Institutional Review Board.
Clinical trial registration statement: This study is not registered as a Clinical trial as all the data were gained from an ultrasound system.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that there are no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zheng Cui, BD, Deputy Chief Physician, Department of Ultrasound in Medicine, Tongji University Affiliated East Hospital, No. 150 Jimo Road, Shanghai 200120, China. gaoyisixth@163.com
Telephone: +86-21-38804518
Received: March 15, 2015
Peer-review started: March 15, 2015
First decision: April 13, 2015
Revised: May 28, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: September 28, 2015
Processing time: 197 Days and 1.7 Hours
Abstract

AIM: To investigate the relationship between contrast-enhanced ultrasound (CEUS), basic fibroblast growth factor (bFGF), endothelin-1 (ET-1), and hepatocellular carcinoma (HCC) recurrence after ablation.

METHODS: A total of 51 HCC patients (38 males and 13 females) who received radiofrequency ablation in our hospital from June 2012 to July 2014 were enrolled in this study. The patients were divided into two groups: recurrence group and non-recurrence group. Routine abdominal examination was first performed in the horizontal position. Then the patients underwent CEUS and immunohistochemical staining before receiving radiofrequency ablation. All patients were followed-up every three months for one year. The results of CEUS and serum tumor marker levels were evaluated and combined together to estimate HCC recurrence and metastasis. Patients were divided into two groups: recurrence group and non-recurrence group. Quantitative parameters of CEUS and tumor expression levels of bFGF and ET-1 were compared between the two groups, respectively. Binary logistic regression analysis was used to analyze the relationship between CEUS quantitative parameters, expression levels of ET-1 and bFGF, and HCC recurrence after ablation.

RESULTS: Based on the quantitative parameters of CEUS before patients received radiofrequency ablation, the levels of tumor rise time (tRT), tumor time to peak (tTTP), tumor peak intensity (tPI) and tumor-parenchymal peak intensity (t-pPI) in the recurrence group were significantly lower than those in the non-recurrence group (16.6 ± 6.1 vs 23.2 ± 7.0, P = 0.000; 41.2 ± 10.2 vs 59.6 ± 14.2, P = 0.000; 23.8 ± 6.7 vs 31.4 ± 6.4, P = 0.000; 7.1 ± 3.4 vs 14.6 ± 7.4, P = 0.000; respectively). The expression levels of bFGF in the recurrence group were significantly higher than those in the non-recurrence group (P < 0.05). Levels of tTTP showed a significant inverse correlation with the level of bFGF in tumors (r = -0.312, P = 0.037). The Binary logistic regression analysis results revealed that the levels of tRT, tTTP, tPI and the level of bFGF were associated with HCC recurrence after radiofrequency ablation (P < 0.05).

CONCLUSION: CEUS is a noninvasive and effective method for evaluating the angiogenesis of HCC, and predicting its recurrence and prognosis.

Keywords: Contrast-enhanced ultrasonography; Hepatocellular carcinoma; Radiofrequency ablation

Core tip: This study quantitatively analyzed contrast-enhanced ultrasound (CEUS) images from patients with hepatocellular carcinoma (HCC). The results showed that HCC patients who have low levels of tumor time to peak (tTTP), tumor peak intensity and tumor-parenchymal peak intensity before ablation were more likely to relapse after ablation. Expression levels of basic fibroblast growth factor (bFGF) in the recurrence group were higher than those in the non-recurrence group, and tTTP levels were negatively correlated with bFGF expression levels. This was expected to be a predictable index for HCC recurrence after ablation. The results also revealed that CEUS is a non-invasive and effective method for evaluating HCC angiogenesis, its recurrence and metastasis.