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Hu R, Xu J, Wang H, Wang J, Lei K, Zhao X, Zhang H, You K, Liu Z. Impact of preoperative transcatheter arterial chemoembolization (TACE) on postoperative long-term survival in patients with nonsmall hepatocellular carcinoma: a propensity score matching analysis. BMC Cancer 2024; 24:190. [PMID: 38336712 PMCID: PMC10858462 DOI: 10.1186/s12885-024-11978-4] [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: 09/19/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The purpose of this propensity score matching (PSM) analysis was to compare the effects of preoperative transcatheter arterial chemoembolization (TACE) and non-TACE on the long-term survival of patients who undergo radical hepatectomy. METHODS PSM analysis was performed for 387 patients with hepatocellular carcinoma (HCC) (single > 3 cm or multiple) who underwent radical resection of HCC at our centre from January 2011 to June 2018. The patients were allocated to a preoperative TACE group (n = 77) and a non-TACE group (n = 310). The main outcome measures were progression-free survival (PFS) and overall survival (OS) since the treatment date. RESULTS After PSM, 67 patients were included in each of the TACE and non-TACE groups. The median PFS times in the preoperative TACE and non-TACE groups were 24.0 and 11.3 months, respectively (p = 0.0117). The median OS times in the preoperative TACE and non-TACE groups were 41.5 and 29.0 months, respectively (p = 0.0114). Multivariate Cox proportional hazard regression analysis revealed that preoperative TACE (hazard ratio, 1.733; 95% CI, 1.168-2.570) and tumour thrombosis (hazard ratio, 0.323; 95% CI, 0.141-0.742) were independent risk factors significantly associated with OS. CONCLUSIONS Preoperative TACE is related to improving PFS and OS after resection of HCC. Preoperative TACE and tumour thrombus volume were also found to be independent risk factors associated with OS.
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Affiliation(s)
- Run Hu
- The Second Affiliated Hospital of Chongqing Medical University, 74# Linjiang Road, Yuzhong District, Chongqing, 400000, China
| | - Jie Xu
- The Second Affiliated Hospital of Chongqing Medical University, 74# Linjiang Road, Yuzhong District, Chongqing, 400000, China
| | - Hongxiang Wang
- The Second Affiliated Hospital of Chongqing Medical University, 74# Linjiang Road, Yuzhong District, Chongqing, 400000, China
| | - Jiaguo Wang
- The Second Affiliated Hospital of Chongqing Medical University, 74# Linjiang Road, Yuzhong District, Chongqing, 400000, China
| | - Kai Lei
- The Second Affiliated Hospital of Chongqing Medical University, 74# Linjiang Road, Yuzhong District, Chongqing, 400000, China
| | - Xiaoping Zhao
- The Second Affiliated Hospital of Chongqing Medical University, 74# Linjiang Road, Yuzhong District, Chongqing, 400000, China
| | - Huizhi Zhang
- The Second Affiliated Hospital of Chongqing Medical University, 74# Linjiang Road, Yuzhong District, Chongqing, 400000, China
| | - Ke You
- The Second Affiliated Hospital of Chongqing Medical University, 74# Linjiang Road, Yuzhong District, Chongqing, 400000, China
| | - Zuojin Liu
- The Second Affiliated Hospital of Chongqing Medical University, 74# Linjiang Road, Yuzhong District, Chongqing, 400000, China.
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Rai P, Ansari MY, Warfa M, Al-Hamar H, Abinahed J, Barah A, Dakua SP, Balakrishnan S. Efficacy of fusion imaging for immediate post-ablation assessment of malignant liver neoplasms: A systematic review. Cancer Med 2023. [PMID: 37191030 DOI: 10.1002/cam4.6089] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Percutaneous thermal ablation has become the preferred therapeutic treatment option for liver cancers that cannot be resected. Since ablative zone tissue changes over time, it becomes challenging to determine therapy effectiveness over an extended period. Thus, an immediate post-procedural evaluation of the ablation zone is crucial, as it could influence the need for a second-look treatment or follow-up plan. Assessing treatment response immediately after ablation is essential to attain favorable outcomes. This study examines the efficacy of image fusion strategies immediately post-ablation in liver neoplasms to determine therapeutic response. METHODOLOGY A comprehensive systematic search using PRISMA methodology was conducted using EMBASE, MEDLINE (via PUBMED), and Cochrane Library Central Registry electronic databases to identify articles that assessed the immediate post-ablation response in malignant hepatic tumors with fusion imaging (FI) systems. The data were retrieved on relevant clinical characteristics, including population demographics, pre-intervention clinical history, lesion characteristics, and intervention type. For the outcome metrics, variables such as average fusion time, intervention metrics, technical success rate, ablative safety margin, supplementary ablation rate, technical efficacy rate, LTP rates, and reported complications were extracted. RESULTS Twenty-two studies were included for review after fulfilling the study eligibility criteria. FI's immediate technical success rate ranged from 81.3% to 100% in 17/22 studies. In 16/22 studies, the ablative safety margin was assessed immediately after ablation. Supplementary ablation was performed in 9 studies following immediate evaluation by FI. In 15/22 studies, the technical effectiveness rates during the first follow-up varied from 89.3% to 100%. CONCLUSION Based on the studies included, we found that FI can accurately determine the immediate therapeutic response in liver cancer ablation image fusion and could be a feasible intraprocedural tool for determining short-term post-ablation outcomes in unresectable liver neoplasms. There are some technical challenges that limit the widespread adoption of FI techniques. Large-scale randomized trials are warranted to improve on existing protocols. Future research should emphasize improving FI's technological capabilities and clinical applicability to a broader range of tumor types and ablation procedures.
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Affiliation(s)
- Pragati Rai
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohammed Warfa
- Department of Clinical Imaging, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Hammad Al-Hamar
- Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
| | - Julien Abinahed
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ali Barah
- Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
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Du F, Zhang L, Zhang Y, Fan H, Ren L. Efficacy and safety of no-touch radiofrequency ablation for small hepatocellular carcinoma-a systematic review and single-arm meta-analysis. Clin Res Hepatol Gastroenterol 2023; 47:102069. [PMID: 36513251 DOI: 10.1016/j.clinre.2022.102069] [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: 10/08/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to report the efficacy and safety of no-touch radiofrequency ablation (NT-RFA) in the treatment of small hepatocellular carcinoma (HCC). METHODS We systematically searched for eligible studies in PubMed, Embase and Cochrane library until June 1, 2022. Random effect model was applied to synthesize the pooled proportions of local tumor progression-free survival (LTP), recurrence-free survival (RFS) and overall survival (OS) respectively, as well as adverse events, for small HCC treated by NT-RFA. RESULTS Of the 10 included studies, 3 of them reported local tumor recurrence. One reported local tumor recurrence at 19 months (range, 12-24), and 2 studies had no tumor recurrence with 24-months of follow-up. The 1- and 2-year LTP pooled proportions were 99.3% (95%CI, 97.5-100) and 97.8% (95%CI, 94.6-99.6) respectively, and two studies reported a 3-year LTP rate of 96.4% (204/212, 36/37). The 1-yearRFS rates was 91.3% (95%CI, 84.1-98.4), 2-year was 86.4% (95%CI, 75.3-97.5). The 1-, 2- and 3- year OS rates were 92.4% (95%CI, 82.8-92.7), 84.1% (95%CI, 74.7-93.6) and 81.8% (116/181, 33/36) respectively, and only one study reported a 5-year OS rate of 47.0% (85/181). The ablative success rate of the HCC nodules was 96.6% (95%CI, 91.3-99.5) and the proportions of mild and severe adverse events following ablation were 18.3% (95%CI, 8.1-41.6) and 5.0%, respectively. CONCLUSION NT-RFA provides safely very high rate of sustained local control for the treatment of HCC up to 5 cm.
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Affiliation(s)
- Fei Du
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China
| | - Lingkai Zhang
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China; Graduate School of Qinghai University, Xining 810000, China
| | - Yongxuan Zhang
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China; Graduate School of Qinghai University, Xining 810000, China
| | - Haining Fan
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China
| | - Li Ren
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China.
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Deng Q, He M, Fu C, Feng K, Ma K, Zhang L. Radiofrequency ablation in the treatment of hepatocellular carcinoma. Int J Hyperthermia 2022; 39:1052-1063. [PMID: 35944905 DOI: 10.1080/02656736.2022.2059581] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The purpose of this article is to discuss the use, comparative efficacy, and research progress of radiofrequency ablation (RFA), alone or in combination with other therapies, for the treatment of hepatocellular carcinoma (HCC). METHOD To search and summarize the basic and clinical studies of RFA in recent years. RESULTS RFA is one of the radical treatment methods listed in the guidelines for the diagnosis and treatment of HCC. It has the characteristics of being minimally invasive and safe and can obtain good local tumor control, and it can improve the local immune ability, improve the tumor microenvironment and enhance the efficacy of chemotherapy drugs. It is commonly used for HCC treatment before liver transplantation and combined ALPPS and hepatectomy for HCC. In addition, the technology of RFA is constantly developing. The birth of noninvasive, no-touch RFA technology and equipment and the precise RFA concept have improved the therapeutic effect of RFA. CONCLUSION RFA has good local tumor control ability, is minimally invasive, is safe and has other beneficial characteristics. It plays an increasingly important role in the comprehensive treatment strategy of HCC. Whether RFA alone or combined with other technologies expands the surgical indications of patients with HCC and provides more benefits for HCC patients needs to be determined.
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Affiliation(s)
- Qingsong Deng
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Minglian He
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chunchuan Fu
- Department of Hepatobiliary Surgery, Xuanhan County People's Hospital, Xuanhan, China
| | - Kai Feng
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Kuansheng Ma
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Leida Zhang
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Du H, Tan X, Cheng L, Zhang B, Wang D. Application and Evaluation of a 64-Slice CT Three-Dimensional Fusion Technique in the Determination of the Effective Ablation Margin after Radiofrequency Ablation of Hepatocellular Carcinoma. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6898233. [PMID: 35126633 PMCID: PMC8813220 DOI: 10.1155/2022/6898233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/02/2021] [Accepted: 12/01/2021] [Indexed: 11/24/2022]
Abstract
Due to the low accuracy of traditional three-dimensional fusion technology in radiofrequency ablation of hepatocellular carcinoma, this paper studies the advantages of three-dimensional CT fusion technology over traditional two-dimensional imaging technology in preoperative visualization and radiofrequency ablation path selection of hepatocellular carcinoma. To study the prognostic differences of hepatocellular carcinoma patients with different ablation margins (AM) in the three groups, so as to explore the best AM value, so as to minimize the liver injury caused by radiofrequency ablation. The selected patients underwent CT plain scan and three-phase enhancement at 1, 3, 6, and 12 months after operation and were rechecked every 6 months. For recurrent patients, CT was rechecked every three months. The images were obtained by GE 64-slice spiral CT. The thickness of the reconstruction layer is 1 mm, and the interval is 1 mm. The reconstructed image is imported into 3D fusion software. The three-dimensional images of tumor focus, hepatic artery, portal vein, and hepatic vein were reconstructed by two experienced doctors by superimposing the saved tumor images, merging the vascular images into the display, and measuring the ablation boundary (AM value). The results showed that the recurrence rate in group A was higher than that in group B (P = 0.041), and there was no significant difference between group B and group C (P = 1.000). Compared with traditional two-dimensional imaging, three-dimensional CT fusion technology can display the anatomical structure and three-dimensional spatial relationship of tumors and blood vessels and select the best radiofrequency ablation path, so as to achieve accurate radiofrequency ablation.
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Affiliation(s)
- Haihao Du
- Department of Radiology, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan 450000, China
| | - Xiongmu Tan
- Department of Radiology, Sichuan Cancer Hospital, Chengdu, Sichuan 640041, China
| | - Liuhui Cheng
- Department of Radiology, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan 450000, China
| | - Baopeng Zhang
- Department of Radiology, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan 450000, China
| | - Daoqing Wang
- Department of Radiology, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan 450000, China
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Cheng KC, Ho KM. Pure laparoscopic liver resection versus percutaneous radiofrequency ablation for small hepatocellular carcinoma: a propensity score and multivariate analysis. Transl Cancer Res 2022; 11:43-51. [PMID: 35261883 PMCID: PMC8841462 DOI: 10.21037/tcr-21-1045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND In treatment of hepatocellular carcinoma (HCC), both laparoscopic liver resection (LLR) and radiofrequency ablation (RFA) provided similar short-term advantages. However, there was no robust clinical trial comparing the efficacy of LLR and RFA especially for small HCC. This study aimed to compare the short-term and long-term outcomes of LLR and RFA for patients with small HCC using a propensity score matching analysis to minimize potential selection bias. Factors affecting survival were then identified with multivariate analysis. METHODS All patients underwent RFA or LLR for small HCC [defined as Barcelona Clinic Liver Cancer (BCLC) stage 0 or A, size ≤3 cm, ≤3 nodules on contrast CT scan or MRI with no evidence of macrovascular invasion] from April 2005 to August 2020 were included. Propensity score matching was conducted to match patients in the LLR group and RFA group. Prognostic indicators, i.e., age, gender, tumor size, tumor number, Child's grading, albumin, bilirubin, platelet count, international normalized ratio, alpha-fetoprotein level and presence of cirrhosis on imaging were chosen for propensity score calculation. The demographic data, tumor characteristics, operative data, post-operative outcomes and survival data of the two groups were compared. A multivariate analysis based on Cox regression was used to identify factors associated with survival. RESULTS Median follow-up was 34 months. LLR and RFA had similar overall survival (91.8% vs. 79.2% at 5-year, P=0.060); while the LLR had a significantly better disease-free survival (49.0% vs. 30.3% at 5-year, P=0.002) and local recurrence-free survival (96.0% vs. 63.7% at 5-year, P<0.001) when compared with the RFA. Multivariate analysis showed that treatment received by patient (LLR vs. RFA), prothrombin time and platelet counts were significantly associated with disease-free survival. On the other hand, the only factor associated with local recurrence-free survival was the treatment received by patient. CONCLUSIONS Both RFA and LLR are safe and feasible treatment options for patients with small HCC. LLR should be considered for patients with preserved liver function with a better disease-free survival; while RFA offered a comparable overall survival with less surgical trauma and shorter hospital stay.
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Affiliation(s)
| | - Kit-Man Ho
- Department of Surgery, Kwong Wah Hospital, Hong Kong, China
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Yang S, Lin H, Song J. Efficacy and safety of various primary treatment strategies for very early and early hepatocellular carcinoma: a network meta-analysis. Cancer Cell Int 2021; 21:681. [PMID: 34923980 PMCID: PMC8684647 DOI: 10.1186/s12935-021-02365-1] [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: 08/17/2021] [Accepted: 11/25/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Several treatments are available for treatment of early and very early-stage Hepatocellular Carcinoma, also known as small Hepatocellular Carcinoma (SHCC). However, there is no consensus with regards to the efficacies of these methods. We aimed at identifying the most effective initial treatment strategy for SHCC through Bayesian network meta-analyses. METHODS Studies published between January, 2010, and February, 2021 were searched in EMBASE, Cochrane Library, PubMed and Web of science databases, and conference proceedings for trials. The included studies reported the survival outcomes of very early and early Hepatocellular Carcinoma patients subjected to radiofrequency ablation (RFA), microwave ablation (MWA), surgical resection (SR), transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), minimally invasive liver surgery (MIS), stereotactic body radiotherapy (SBRT) and cryoablation (CA). Then, data were extracted from studies that met the inclusion criteria. Patient survival data were retrieved from the published Kaplan-Meier curves and pooled. A Bayesian random-effects model was used to combine direct and indirect evidence. RESULTS A total of 2058 articles were retrieved and screened, from which 45 studies assessing the efficacies of 8 different treatments in 11,364 patients were selected. The included studies had high methodological quality. Recurrence free survival* (progression/recurrence/relapse/disease/tumor-free survival were combined and redefined as RFS*) and overall survival (OS) outcomes were highest in MIS-treated patients (HR 0·57, 95% confidence intervals [CI] 0·38-0·85; HR 0.48,95% CI 0.36-0.64, respectively), followed by SR-treated patients (HR 0.60, 95% CI 0.50-0.74; HR 0.62, 95% CI 0.55-0.72, respectively). TACE was highly efficacious (58.9%) at decreasing the rates of major complications. Similar findings were obtained through sensitivity analysis, and in most of the prognostic subgroups. CONCLUSIONS MIS and SR exhibited the highest clinical efficacies, however, they were associated with higher rates of complications. Ablation is effective in small tumors, whereas SBRT is a relatively promising treatment option for SHCC. More well-designed, large-scale randomized controlled trials should be performed to validate our findings.
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Affiliation(s)
- Sha Yang
- Department of Surgery, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China
- National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
- Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, People's Republic of China
- Children S Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Huapeng Lin
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianning Song
- Department of General Surgery, Guiqian International General Hospital, 1 Dongfeng Dadao, Wudang District, Guiyang, Guizhou, 550018, People's Republic of China.
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Advances in locoregional therapy for hepatocellular carcinoma combined with immunotherapy and targeted therapy. J Interv Med 2021; 4:105-113. [PMID: 34805958 PMCID: PMC8562181 DOI: 10.1016/j.jimed.2021.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022] Open
Abstract
Locoregional therapies (LRTs) of hepatocellular carcinoma (HCC) represented by ablation and TACE has become the main means for the clinical treatment of unresectable HCC. Among these, TACE is used throughout the stage Ib to IIIb of HCC treatment. In recent years, immunotherapy led by immune checkpoint inhibitors has become a hot direction in clinical research. At the same time, targeted drugs such as Sorafenib and Apatinib have played an important role in the treatment and complementary therapy of advanced HCC, and their clinical application has been quite mature. HCC is the sixth most common malignant tumor in the world. When it comes to its treatment, different therapies have different indications, and their individual efficacies are not satisfactory, which makes the exploration of the use of combination therapy in HCC treatment become a new trend. In this paper, the status of the three therapies and the progress of their combined application are briefly reviewed.
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Rai P, Dakua S, Abinahed J, Balakrishnan S. Feasibility and Efficacy of Fusion Imaging Systems for Immediate Post Ablation Assessment of Liver Neoplasms: Protocol for a Rapid Systematic Review. Int J Surg Protoc 2021; 25:209-215. [PMID: 34611571 PMCID: PMC8447974 DOI: 10.29337/ijsp.162] [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: 08/08/2021] [Accepted: 09/02/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Percutaneous thermal ablation is widely adopted as a curative treatment approach for unresectable liver neoplasms. Accurate immediate assessment of therapeutic response post-ablation is critical to achieve favourable outcomes. The conventional technique of side-by-side comparison of pre- and post-ablation scans is challenging and hence there is a need for improved methods, which will accurately evaluate the immediate post-therapeutic response. Objectives and Significance: This review summarizes the findings of studies investigating the feasibility and efficacy of the fusion imaging systems in the immediate post-operative assessment of the therapeutic response to thermal ablation in liver neoplasms. The findings could potentially empower the clinicians with updated knowledge of the state-of-the-art in the assessment of treatment response for unresectable liver neoplasms. Methods and Analysis: A rapid review will be performed on publicly available major electronic databases to identify articles reporting the feasibility and efficacy of the fusion imaging systems in the immediate assessment of the therapeutic response to thermal ablation in liver neoplasms. The risk of bias and quality of articles will be assessed using the Cochrane risk of bias tool 2.0 and Newcastle Ottawa tool. Ethics and Dissemination: Being a review, we do not anticipate the need for any approval from the Institutional Review Board. The outcomes of this study will be published in a peer-reviewed journal. Highlights Evaluation of the therapeutic response in liver neoplasms immediately post-ablation is critical to achieve favourable patient outcomes. We will examine the feasibility and technical efficacy of different fusion imaging systems in assessing the immediate treatment response post-ablation. The findings are expected to guide the clinicians with updated knowledge on the state-of-the-art when assessing the immediate treatment response for unresectable liver neoplasms.
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Affiliation(s)
- Pragati Rai
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Sarada Dakua
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Julien Abinahed
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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Ogiso S, Seo S, Eso Y, Yoh T, Kawai T, Okumura S, Ishii T, Fukumitsu K, Taura K, Seno H, Uemoto S. Laparoscopic liver resection versus percutaneous radiofrequency ablation for small hepatocellular carcinoma. HPB (Oxford) 2021; 23:533-537. [PMID: 32912835 DOI: 10.1016/j.hpb.2020.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) and radiofrequency ablation (RFA) play central roles to treat early-stage hepatocellular carcinoma (HCC, ≤3 cm, 1-3 nodules, and no macrovascular involvement), although data are lacking regarding whether LLR or RFA is preferable. This study aimed to compare outcomes of both treatments for small HCCs. METHODS Treatment outcomes of small HCCs were compared between all the minor LLRs performed between 2005 and 2016 and RFAs performed between 2011 and 2016 at Kyoto University. RESULTS A total of 85 and 136 patients underwent LLR and RFA, respectively. Patients that underwent LLR had higher incidence of blood transfusions, complications, and longer hospital stay. Overall and disease-specific survival rates were similar between LLR and RFA; however, recurrence-free (49.2% vs. 22.1% at 3-year) and local recurrence-free survival rates (94.9% vs. 63.6% at 3-year) were higher after LLR. Multivariate analyses identified that multiple nodules and 65-year-old and above are predictors of disease-specific survival, and that RFA is a predictor of recurrence and local recurrence. CONCLUSION RFA is less invasive, although both LLR and RFA are safe and effective. LLR provides better local control with superior recurrence-free and local-recurrence free survival. These results help optimize treatment selection based on patient-specific factors.
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Affiliation(s)
- Satoshi Ogiso
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Yuji Eso
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoaki Yoh
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Kawai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinya Okumura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takamichi Ishii
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Fukumitsu
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kojiro Taura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Xuan D, Wen W, Xu D, Jin T. Survival comparison between radiofrequency ablation and surgical resection for patients with small hepatocellular carcinoma: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24585. [PMID: 33607788 PMCID: PMC7899892 DOI: 10.1097/md.0000000000024585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/17/2020] [Accepted: 01/13/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate and compare the long-term therapeutic efficacy of radiofrequency ablation (RFA) versus that of surgical resection in small hepatocellular carcinoma (HCC). METHODS Relevant articles in English from PubMed, EMBASE, and the Cochrane Library were retrieved. Pooled hazard ratios (HRs) were calculated to assess the prognostic value of RFA compared with that of surgical resection. RESULTS A total of 19 studies involving 15,071 patients were included. The combined HRs (95% confidence interval [CI]) of RFA for recurrence/relapse-free survival (RFS) and overall survival (OS) were 1.55 (95% CI = 1.29-1.86, I2 = 72.5%) and 1.61 (95% CI = 1.29-2.01, I2 = 60.4%), respectively, compared with surgical resection. In subgroup analyses according to study design, both RFS and OS of the prospective subgroups showed statistical significance, and no statistical heterogeneity existed between studies. CONCLUSION Our clinical data suggest that surgical resection offers better long-term oncologic outcomes than RFA.
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Affiliation(s)
- Dongchun Xuan
- Department of Nuclear Medicine, Yanbian University hospital
- Center of Morphological Experiment, Medical College of Yanbian University
| | - Weibo Wen
- Department of Nuclear Medicine, Yanbian University hospital
- Center of Morphological Experiment, Medical College of Yanbian University
| | - Dongyuan Xu
- Center of Morphological Experiment, Medical College of Yanbian University
| | - Toufeng Jin
- Department of General surgery, Yanbian University hospital, Yanji, Jilin Province, China
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12
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Jin S, Tan S, Peng W, Jiang Y, Luo C. Radiofrequency ablation versus laparoscopic hepatectomy for treatment of hepatocellular carcinoma: a systematic review and meta-analysis. World J Surg Oncol 2020; 18:199. [PMID: 32787883 PMCID: PMC7425008 DOI: 10.1186/s12957-020-01966-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/23/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Several randomized controlled trials (RCTs) compared the effects of laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC), but the results have remained inconsistent. Hence, a meta-analysis and a systematic review of these treatment modalities are necessary to evaluate their efficacy and safety for HCC treatment. METHODS From the inception of this meta-analysis and review until August 31, 2019, we searched Medline, PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, and China Biomedical Literature Database for RCTs involving LH and RFA treatments of patients with HCC. The studies were screened and the data from these articles were extracted independently by two authors. Summary odd ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated for each outcome with a fixed- or random-effect model. The outcomes for effectiveness evaluations included duration of surgery, estimated bleeding volume, incidence of blood transfusion during surgery, duration of hospital stay, and the outcome for safety included the incidence of cancer recurrence. RESULTS Seven RCTs with a total of 615 patients were identified, 312 and 303 of which underwent RFA and LH treatments, respectively. The duration of surgery (MD = -99.04; 95% CI: -131.26--66.82), estimated bleeding volume (MD = -241.97; 95% CI: -386.93--97.02), incidence of blood transfusion during surgery (OR = 0.08; 95% CI: 0.02-0.37), and duration of hospital stay (MD = -3.4; 95% CI: -5.22--1.57) in RFA treatment were significantly lower than those of LH treatment. However, the incidence of cancer recurrence was significantly higher for RFA treatment compared with LH treatment (OR = 2.68; 95% CI: 1.72-4.18). CONCLUSIONS LH treatment is preferred over RFA treatment with a better radical effect, but RFA treatment is more beneficial with smaller trauma, development of less complications, and shorter operating time when compared with HCC treatment.
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Affiliation(s)
- Shan Jin
- Department of oncology, People’s Hospital of Guizhou province, Guiyang City, China
| | - Shisheng Tan
- Department of oncology, People’s Hospital of Guizhou province, Guiyang City, China
| | - Wen Peng
- Department of oncology, People’s Hospital of Guizhou province, Guiyang City, China
| | - Ying Jiang
- Department of oncology, People’s Hospital of Guizhou province, Guiyang City, China
| | - Chunshan Luo
- Department of orthopedic, Guizhou Orthopedic Hospital, No. 184, Zhongshan East Road, Nanming District, Guiyang City, 550000 Guizhou Province China
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13
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Satiya J, Schwartz I, Tabibian JH, Kumar V, Girotra M. Ablative therapies for hepatic and biliary tumors: endohepatology coming of age. Transl Gastroenterol Hepatol 2020; 5:15. [PMID: 32258519 PMCID: PMC7063520 DOI: 10.21037/tgh.2019.10.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
Ablative therapies refer to minimally invasive procedures performed to destroy abnormal tissue that may arise with many conditions, and can be achieved clinically using chemical, thermal, and other techniques. In this review article, we explore the different ablative therapies used in the management of hepatic and biliary malignancies, namely hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), with a particular focus on radiofrequency ablation (RFA) and photodynamic therapy (PDT) techniques.
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Affiliation(s)
- Jinendra Satiya
- Internal Medicine, University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, West Palm Beach, FL, USA
| | - Ingrid Schwartz
- Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - James H. Tabibian
- Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Vivek Kumar
- Gastroenterology and Hepatology, UPMC Susquehanna, Williamsport, PA, USA
| | - Mohit Girotra
- Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL, USA
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14
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Dendy MS, Ludwig JM, Stein SM, Kim HS. Locoregional Therapy, Immunotherapy and the Combination in Hepatocellular Carcinoma: Future Directions. Liver Cancer 2019; 8:326-340. [PMID: 31768343 PMCID: PMC6873025 DOI: 10.1159/000494843] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/23/2018] [Indexed: 02/04/2023] Open
Abstract
Image-guided locoregional therapies (LRTs) have long been a vital part of treatment regimens for hepatocellular carcinoma (HCC). Ablation, chemoembolization, and radioembolization are examples of commonly used treatment techniques for HCC. This review describes the various methods utilized to treat HCC in the field of interventional oncology and also focuses on new and novel treatment concepts being developed in the field including the use of novel immunotherapy agents and combination therapy of LRTs with immunotherapy.
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Affiliation(s)
- Meaghan S. Dendy
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Johannes M. Ludwig
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA,Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stacey M. Stein
- Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA,Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hyun S. Kim
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA,Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA,Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA,*Hyun S. Kim, MD, Yale Cancer Center, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT 06510 (USA), E-Mail
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15
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Yamashita YI, Imai K, Kaida T, Yamao T, Tsukamoto M, Nakagawa S, Okabe H, Chikamoto A, Ishiko T, Yoshizumi T, Ikeda T, Maehara Y, Baba H. Multimodal radiofrequency ablation versus laparoscopic hepatic resection for the treatment of primary hepatocellular carcinoma within Milan criteria in severely cirrhotic patients: long-term favorable outcomes over 10 years. Surg Endosc 2019; 33:46-51. [PMID: 29872945 DOI: 10.1007/s00464-018-6264-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/31/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Less invasiveness is an important consideration for the treatment of hepatocellular carcinoma (HCC) especially in patients with severe cirrhosis. METHODS Between April 2000 and September 2016, 100 patients with liver damage B underwent multimodal radiofrequency ablation (RFA; n = 62) or laparoscopic hepatic resection (Lap-HR; n = 38) for primary HCC as defined by the Milan criteria. We compared the operative outcomes and patients' survival between the two groups. RESULTS The RFA group showed worse liver functions as indicated by indocyanine green retention rate (32.9 vs. 22.4%; p < 0.0001) and serum albumin value (3.3 vs. 3.6 g/dl; p = 0.0029). As expected, RFA was less invasive, as indicated by the differences in operation time (166 vs. 288 min.; p < 0.0001) and blood loss (8 vs. 377 g; p < 0.0001). There was no significant difference in the morbidity rate between the two groups; however, the duration of hospital stay of the RFA group was significantly shorter (7 vs. 11 days; p = 0.0002). There were no significant between-group differences regarding overall or disease-free survival. CONCLUSION Multimodal RFA for HCC in patients with severe cirrhosis is associated with less invasiveness and shorter hospital stays, with no compromise in the patients' survival. In patients with severe cirrhosis, it may be time to consider changing the standard treatment for primary HCC within the Milan criteria to multimodal RFA.
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Affiliation(s)
- Yo-Ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takayoshi Kaida
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takanobu Yamao
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masayo Tsukamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shigeki Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hirohisa Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Akira Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takatoshi Ishiko
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tetsuo Ikeda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
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Zhu GQ, Sun M, Liao WT, Yu WH, Zhou SL, Zhou ZJ, Shi YH, Fan J, Zhou J, Qiu LX, Dai Z. Comparative efficacy and safety between ablative therapies or surgery for small hepatocellular carcinoma: a network meta-analysis. Expert Rev Gastroenterol Hepatol 2018; 12:935-945. [PMID: 30025486 DOI: 10.1080/17474124.2018.1503531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Major treatments for small hepatocellular carcinoma (SHCC) include percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI), radiofrequency ablation (RFA), or surgical resection (SR). We aimed to compare these therapies concerning with effectiveness and safety. METHODS Cochrane Library, PubMed, and Embase were searched for randomized controlled studies (RCTs) from inception to 30 April 2017. Odds ratios (OR) for proportion dead (PD), local recurrence (LR) and adverse events (AEs). RESULTS Fourteen RCTs were identified. Compared with SR, PEI (OR 2.79, CrI 1.25, 6.45, p < 0.01) provided a significantly increased risk of PD. Similarly, PEI (OR 4.29, CrI 1.18, 18.35, p < 0.01) yielded more LR than SR. Also, SR significantly conferred more AEs than RFA (OR 0.10; CrI 0.02, 0.35, p < 0.01), PEI (OR 0.06; CrI 0.01, 0.31, p < 0.01). Besides, RFA conferred the highest efficacy for survival, time to recurrence, and new development of HCC. CONCLUSIONS SR was superior to PEI. Although SR achieved highest cumulative ranking probabilities in clinical efficacy, it obtained a low benefit-to-risk ratio for patients. RFA was superior to the other ablative therapies. For tumor sizes > 2 cm or ≤ 2 cm in diameter, SR conferred non-significant effects compared with other therapies for SHCC.
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Affiliation(s)
- Gui-Qi Zhu
- a Liver Cancer Institute, Zhongshan Hospital , Fudan University , Shanghai , China.,b State Key Laboratory of Genetic Engineering , Fudan University , Shanghai , China
| | - Min Sun
- c Department of General Surgery, Taihe Hospital , Hubei University of Medicine , Shiyan , China
| | - Wei-Ting Liao
- d Department of Medical Oncology, Cancer Center, West China Hospital , Sichuan University , Chengdu , China
| | - Wei-Hua Yu
- e Department of General Surgery, Sir Run Run Shaw Hospital , Zhejiang University , Hangzhou , China
| | - Shao-Lai Zhou
- a Liver Cancer Institute, Zhongshan Hospital , Fudan University , Shanghai , China.,b State Key Laboratory of Genetic Engineering , Fudan University , Shanghai , China
| | - Zheng-Jun Zhou
- a Liver Cancer Institute, Zhongshan Hospital , Fudan University , Shanghai , China.,b State Key Laboratory of Genetic Engineering , Fudan University , Shanghai , China
| | - Ying-Hong Shi
- a Liver Cancer Institute, Zhongshan Hospital , Fudan University , Shanghai , China.,b State Key Laboratory of Genetic Engineering , Fudan University , Shanghai , China
| | - Jia Fan
- a Liver Cancer Institute, Zhongshan Hospital , Fudan University , Shanghai , China.,b State Key Laboratory of Genetic Engineering , Fudan University , Shanghai , China
| | - Jian Zhou
- a Liver Cancer Institute, Zhongshan Hospital , Fudan University , Shanghai , China.,b State Key Laboratory of Genetic Engineering , Fudan University , Shanghai , China
| | - Li-Xin Qiu
- f Department of Medical Oncology , Fudan University Shanghai Cancer Center , Shanghai , China
| | - Zhi Dai
- a Liver Cancer Institute, Zhongshan Hospital , Fudan University , Shanghai , China.,b State Key Laboratory of Genetic Engineering , Fudan University , Shanghai , China
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17
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Li K, Su Z, Xu E, Huang Q, Zeng Q, Zheng R. Evaluation of the ablation margin of hepatocellular carcinoma using CEUS-CT/MR image fusion in a phantom model and in patients. BMC Cancer 2017; 17:61. [PMID: 28103837 PMCID: PMC5244580 DOI: 10.1186/s12885-017-3061-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/12/2017] [Indexed: 02/06/2023] Open
Abstract
Background To assess the accuracy of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion in evaluating the radiofrequency ablative margin (AM) of hepatocellular carcinoma (HCC) based on a custom-made phantom model and in HCC patients. Methods Twenty-four phantoms were randomly divided into a complete ablation group (n = 6) and an incomplete ablation group (n = 18). After radiofrequency ablation (RFA), the AM was evaluated using ultrasound (US)-CT image fusion, and the results were compared with the AM results that were directly measured in a gross specimen. CEUS-CT/MR image fusion and CT-CT / MR-MR image fusion were used to evaluate the AM in 37 tumors from 33 HCC patients who underwent RFA. Results The sensitivity, specificity, and accuracy of US-CT image fusion for evaluating AM in the phantom model were 93.8, 85.7 and 91.3%, respectively. The maximal thicknesses of the residual AM were 3.5 ± 2.0 mm and 3.2 ± 2.0 mm in the US-CT image fusion and gross specimen, respectively. No significant difference was observed between the US-CT image fusion and direct measurements of the AM of HCC. In the clinical study, the success rate of the AM evaluation was 100% for both CEUS-CT/MR and CT-CT/MR-MR, and the duration was 8.5 ± 2.8 min (range: 4–12 min) and 13.5 ± 4.5 min (range: 8–16 min) for CEUS-CT/MR and CT-CT/MR-MR, respectively. The sensitivity, specificity, and accuracy of CEUS-CT/MR imaging for evaluating the AM were 100.0, 80.0, and 90.0%, respectively. Conclusions A phantom model composed of carrageenan gel and additives was suitable for the evaluation of HCC AM. CEUS-CT/MR image fusion can be used to evaluate HCC AM with high accuracy.
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Affiliation(s)
- Kai Li
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong Province, People's Republic of China
| | - Zhongzhen Su
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong Province, People's Republic of China
| | - Erjiao Xu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong Province, People's Republic of China
| | - Qiannan Huang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong Province, People's Republic of China
| | - Qingjing Zeng
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong Province, People's Republic of China
| | - Rongqin Zheng
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong Province, People's Republic of China.
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Abdelsalam ME, Murthy R, Avritscher R, Mahvash A, Wallace MJ, Kaseb AO, Odisio BC. Minimally invasive image-guided therapies for hepatocellular carcinoma. J Hepatocell Carcinoma 2016; 3:55-61. [PMID: 27785450 PMCID: PMC5067062 DOI: 10.2147/jhc.s92732] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most frequently occurring cancer globally and predominantly develops in the setting of various grades of underlying chronic liver disease, which affects management decisions. Image-guided percutaneous ablative or transarterial therapies have acquired wide acceptance in HCC management as a single treatment modality or combined with other treatment options in patients who are not amenable for surgery. Recently, such treatment modalities have also been used for bridging or downsizing before definitive treatment (ie, surgical resection or liver transplantation). This review focuses on the use of minimally invasive image-guided locoregional therapies for HCC. Additionally, it highlights recent advancements in imaging and catheter technology, embolic materials, chemotherapeutic agents, and delivery techniques; all lead to improved patient outcomes, thereby increasing the interest in these invasive techniques.
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Affiliation(s)
| | | | | | | | | | - Ahmed O Kaseb
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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19
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Qi X, Zhao Y, Li H, Guo X, Han G. Management of hepatocellular carcinoma: an overview of major findings from meta-analyses. Oncotarget 2016; 7:34703-34751. [PMID: 27167195 PMCID: PMC5085185 DOI: 10.18632/oncotarget.9157] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/11/2016] [Indexed: 02/07/2023] Open
Abstract
This paper aims to systematically review the major findings from meta-analyses comparing different treatment options for hepatocellular carcinoma (HCC). A total of 153 relevant papers were searched via the PubMed, EMBASE, and Cochrane library databases. They were classified according to the mainstay treatment modalities (i.e., liver transplantation, surgical resection, radiofrequency ablation, transarterial embolization or chemoembolization, sorafenib, and others). The primary outcome data, such as overall survival, diseases-free survival or recurrence-free survival, progression-free survival, and safety, were summarized. The recommendations and uncertainties regarding the treatment of HCC were also proposed.
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Affiliation(s)
- Xingshun Qi
- Department of Gastroenterology and Meta-analysis Study Interest Group, General Hospital of Shenyang Military Area, Shenyang, 110840 China
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032 China
| | - Yan Zhao
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032 China
- Department of Gastroenterology, First Affiliated Hospital of the Medical College, Xi'an Jiaotong University, Xi'an, 710000 China
| | - Hongyu Li
- Department of Gastroenterology and Meta-analysis Study Interest Group, General Hospital of Shenyang Military Area, Shenyang, 110840 China
| | - Xiaozhong Guo
- Department of Gastroenterology and Meta-analysis Study Interest Group, General Hospital of Shenyang Military Area, Shenyang, 110840 China
| | - Guohong Han
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032 China
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20
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Shi Y, Zhai B. A Recent Advance in Image-Guided Locoregional Therapy for Hepatocellular Carcinoma. Gastrointest Tumors 2016; 3:90-102. [PMID: 27904861 DOI: 10.1159/000445888] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/22/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third most common cause of cancer-related deaths. Hepatic resection and liver transplantation are considered to be the preferred treatment for HCC. However, as novel therapeutic options such as image-guided locoregional therapies have emerged and been refined, the manner in which HCC is treated has changed dramatically compared with what it was considered just 2 decades earlier. SUMMARY This study reviews the current results of various image-guided locoregional therapies for treating HCC, especially focusing on thermal ablative and transarterial techniques. KEY MESSAGE Advances in image-guided locoregional therapies, including local ablative therapy and transarterial therapy, have led to a major breakthrough in the management of HCC. Both survival rates and cure rates of patients with HCC have improved markedly since the introduction of these techniques. PRACTICAL IMPLICATIONS Radiofrequency ablation is currently considered as an alternative to surgical resection for patients with early-stage HCC. A newer technique of ablation such as microwave ablation is increasingly being used, especially for large HCC. Transarterial chemoembolization has become a standard care for asymptomatic patients with multinodular tumors in intermediate-stage disease, and transarterial radioembolization has become the method of choice in HCC cases with portal vein thrombosis. Moreover, combination treatment modalities, such as thermal-based ablation combined with transarterial chemoembolization or 125I seed implant brachytherapy, may further broaden their clinical indications for HCC. Moreover, use of localized radiation in combination with thermal ablation has been reported to improve tumor control and long-term survival.
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Affiliation(s)
- Yaoping Shi
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Li K, Su ZZ, Xu EJ, Ju JX, Meng XC, Zheng RQ. Improvement of ablative margins by the intraoperative use of CEUS-CT/MR image fusion in hepatocellular carcinoma. BMC Cancer 2016; 16:277. [PMID: 27090513 PMCID: PMC4836159 DOI: 10.1186/s12885-016-2306-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 04/07/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To assess whether intraoperative use of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion can accurately evaluate ablative margin (AM) and guide supplementary ablation to improve AM after hepatocellular carcinoma (HCC) ablation. METHODS Ninety-eight patients with 126 HCCs designated to undergo thermal ablation treatment were enrolled in this prospective study. CEUS-CT/MR image fusion was performed intraoperatively to evaluate whether 5-mm AM was covered by the ablative area. If possible, supplementary ablation was applied at the site of inadequate AM. The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded. Local tumor progression (LTP) was observed during follow-up. Clinical factors including AM were examined to identify risk factors for LTP. RESULTS The success rate of image fusion was 96.2% (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3-13) min. The CEUS image quality was good in 36.1% (53/147) and medium in 63.9% (94/147) of the cases. By supplementary ablation, 21.8% (12/55) of lesions with inadequate AMs became adequate AMs. During follow-up, there were 5 LTPs in lesions with inadequate AMs and 1 LTP in lesions with adequate AMs. Multivariate analysis showed that AM was the only independent risk factor for LTP (hazard ratio, 9.167; 95% confidence interval, 1.070-78.571; p = 0.043). CONCLUSION CEUS-CT/MR image fusion is feasible for intraoperative use and can serve as an accurate method to evaluate AMs and guide supplementary ablation to lower inadequate AMs.
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Affiliation(s)
- Kai Li
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China
| | - Zhong-Zhen Su
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China
| | - Er-Jiao Xu
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China
| | - Jin-Xiu Ju
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China
| | - Xiao-Chun Meng
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China
| | - Rong-Qin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, , Guangdong Province, PR China.
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Yune Y, Kim S, Song I, Chun K. Comparative analysis of intraoperative radiofrequency ablation versus non-anatomical hepatic resection for small hepatocellular carcinoma: short-term result. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2015; 19:173-80. [PMID: 26693237 PMCID: PMC4683920 DOI: 10.14701/kjhbps.2015.19.4.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/04/2015] [Accepted: 11/08/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUNDS/AIMS To compare the clinical outcomes of intraoperative radiofrequency ablation (RFA) and non-anatomical hepatic resection (NAHR) for small hepatocellular carcinoma (HCC). METHODS From February 2007 to January 2015, clinical outcomes of thirty four patients with HCC receiving RFA or NAHR were compared, retrospectively. RESULTS There was no difference of patient and tumor characteristic between the two groups that received RFA or NAHR. The 1, 2, and 3-year recurrence rates following RFA were 32.2%, 32.2% and 59.3% respectively, and 6.7%, 33.3% and 33.3% following NAHR respectively (p=0.287). The 1, 2 and 3-year overall survival (OS) rates following RFA were 100%, 88.9% and 76.2% respectively, and 100%, 85.6% and 85.6%, respectively, following NAHR (p=0.869). We did not find a definite statistical difference in recurrence rate and OS rate between the two groups. In the multivariate analysis, number of tumor was an independent prognostic factor for recurrence and albumin was an independent prognostic factor for OS. CONCLUSIONS We recommend non-anatomical hepatic resection rather than intraoperative RFA in small sized HCC, due to a higher recurrence rate in intraoperative RFA. Intraoperative RFA was inferior to non-anatomical hepatic resection in terms of recurrence rate. We need to select the optimal treatment considering liver function and possibility of recurrence.
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Affiliation(s)
- Yongwoo Yune
- Department of surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Seokwhan Kim
- Department of surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Insang Song
- Department of surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Kwangsik Chun
- Department of surgery, Chungnam National University Hospital, Daejeon, Korea
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Wang XL, Li K, Su ZZ, Huang ZP, Wang P, Zheng RQ. Assessment of radiofrequency ablation margin by MRI-MRI image fusion in hepatocellular carcinoma. World J Gastroenterol 2015; 21:5345-51. [PMID: 25954109 PMCID: PMC4419076 DOI: 10.3748/wjg.v21.i17.5345] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 12/06/2014] [Accepted: 02/11/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the feasibility and clinical value of magnetic resonance imaging (MRI)-MRI image fusion in assessing the ablative margin (AM) for hepatocellular carcinoma (HCC). METHODS A newly developed ultrasound workstation for MRI-MRI image fusion was used to evaluate the AM of 62 tumors in 52 HCC patients after radiofrequency ablation (RFA). The lesions were divided into two groups: group A, in which the tumor was completely ablated and 5 mm AM was achieved (n = 32); and group B, in which the tumor was completely ablated but 5 mm AM was not achieved (n = 29). To detect local tumor progression (LTP), all patients were followed every two months by contrast-enhanced ultrasound, contrast-enhanced MRI or computed tomography (CT) in the first year after RFA. Then, the follow-up interval was prolonged to every three months after the first year. RESULTS Of the 62 tumors, MRI-MRI image fusion was successful in 61 (98.4%); the remaining case had significant deformation of the liver and massive ascites after RFA. The time required for creating image fusion and AM evaluation was 15.5 ± 5.5 min (range: 8-22 min) and 9.6 ± 3.2 min (range: 6-14 min), respectively. The follow-up period ranged from 1-23 mo (14.2 ± 5.4 mo). In group A, no LTP was detected in 32 lesions, whereas in group B, LTP was detected in 4 of 29 tumors, which occurred at 2, 7, 9, and 15 mo after RFA. The frequency of LTP in group B (13.8%; 4/29) was significantly higher than that in group A (0/32, P = 0.046). All of the LTPs occurred in the area in which the 5 mm AM was not achieved. CONCLUSION The MRI-MRI image fusion using an ultrasound workstation is feasible and useful for evaluating the AM after RFA for HCC.
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Tang H, Tang Y, Hong J, Chen T, Mai C, Jiang P. A measure to assess the ablative margin using 3D-CT image fusion after radiofrequency ablation of hepatocellular carcinoma. HPB (Oxford) 2015; 17:318-25. [PMID: 25346478 PMCID: PMC4368395 DOI: 10.1111/hpb.12352] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/12/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine the feasibility of three-dimensional computed tomography (3D-CT) image fusion in facilitating assessment of the ablative margin (AM) after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). METHODS This study involved 75 patients with solitary HCC who underwent RFA. The AM was evaluated using 3D-CT image fusion. All cases were categorized into two groups based on the extent of the AM: in Group A, sufficient AM was obtained, which was greater than or equal to 5 mm; in Group B, the lesion was also ablated successfully, but a 5 mm AM was not obtained. RESULTS 3D-CT Image Fusion was performed on 36 and 39 patients in Group A and Group B, respectively. The 1, 3, 5 year RFS was 87.6%, 63.2%, 50.6% for Group A, and 77.2%, 51.5%, 35.6% for Group B, respectively (P = 0.042); the corresponding OS was 94.3%, 73.8%, 64.6%, and 86.2%, 60.5%, 47.6%, respectively (P = 0.046). Multivariate analysis showed that the AM (P = 0.048, HR = 2.15, 95% CI 1.01-4.60) and Pre-NLR were independent prognostic factors for PFS. CONCLUSIONS 3D-CT image fusion is a feasible and useful method to evaluate the AM after RFA of HCC.
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Affiliation(s)
- Hui Tang
- Department of Hepatobiliary Oncology, Cancer Center of Guangzhou Medical UniversityGuangzhou, China
| | - Yunqiang Tang
- Department of Hepatobiliary Oncology, Cancer Center of Guangzhou Medical UniversityGuangzhou, China,Correspondence, Yunqiang Tang, Department of Hepatobiliary Oncology, Cancer Center of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou 510095, Guangdong, China. Tel.: + 86 2066673655. Fax: + 86 2083489984. E-mail:
| | - Jian Hong
- Department of Hepatobiliary Oncology, Cancer Center of Guangzhou Medical UniversityGuangzhou, China
| | - Tiejun Chen
- Department of Hepatobiliary Oncology, Cancer Center of Guangzhou Medical UniversityGuangzhou, China
| | - Cong Mai
- Department of Hepatobiliary Oncology, Cancer Center of Guangzhou Medical UniversityGuangzhou, China
| | - Peng Jiang
- Department of Hepatobiliary Oncology, Cancer Center of Guangzhou Medical UniversityGuangzhou, China
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Willatt J, Hannawa KK, Ruma JA, Frankel TL, Owen D, Barman PM. Image-guided therapies in the treatment of hepatocellular carcinoma: A multidisciplinary perspective. World J Hepatol 2015; 7:235-244. [PMID: 25729478 PMCID: PMC4342605 DOI: 10.4254/wjh.v7.i2.235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/26/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
A multidisciplinary approach to the treatment of patients with unresectable hepatocellular carcinoma (HCC) has led to improvements in screening, detection, and treatments. Interventional techniques include thermal ablation, transarterial chemoembolization, and radioembolization whilst stereotactic body radiation therapy also uses imaging to target the radiation. Both survival rates and cure rates have improved markedly since the introduction of these techniques. This review article describes the image guided techniques used for the treatment of HCC.
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Sapisochin G, Sevilla EFD, Echeverri J, Charco R. Management of “very early” hepatocellular carcinoma on cirrhotic patients. World J Hepatol 2014; 6:766-775. [PMID: 25429314 PMCID: PMC4243150 DOI: 10.4254/wjh.v6.i11.766] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/29/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
Due to the advances in screening of cirrhotic patients, hepatocellular carcinoma (HCC) is being diagnosed in earlier stages. For this reason the number of patients diagnosed of very early HCC (single tumors ≤ 2 cm) is continuously increasing. Once a patient has been diagnosed with this condition, treatment strategies include liver resection, local therapies or liver transplantation. The decision on which therapy should the patient undergo depends on the general patients performance status and liver disease. Anyway, even in patients with similar conditions, the best treatment offer is debatable. In this review we analyze the state of the art on the management of very early HCC on cirrhotic patients to address the best treatment strategy for this patient population.
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Feng K, Ma KS. Value of radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Gastroenterol 2014; 20:5987-98. [PMID: 24876721 PMCID: PMC4033438 DOI: 10.3748/wjg.v20.i20.5987] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 02/21/2014] [Accepted: 04/01/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a malignant disease that substantially affects public health worldwide. It is especially prevalent in east Asia and sub-Saharan Africa, where the main etiology is the endemic status of chronic hepatitis B. Effective treatments with curative intent for early HCC include liver transplantation, liver resection (LR), and radiofrequency ablation (RFA). RFA has become the most widely used local thermal ablation method in recent years because of its technical ease, safety, satisfactory local tumor control, and minimally invasive nature. This technique has also emerged as an important treatment strategy for HCC in recent years. RFA, liver transplantation, and hepatectomy can be complementary to one another in the treatment of HCC, and the outcome benefits have been demonstrated by numerous clinical studies. As a pretransplantation bridge therapy, RFA extends the average waiting time without increasing the risk of dropout or death. In contrast to LR, RFA causes almost no intra-abdominal adhesion, thus producing favorable conditions for subsequent liver transplantation. Many studies have demonstrated mutual interactions between RFA and hepatectomy, effectively expanding the operative indications for patients with HCC and enhancing the efficacy of these approaches. However, treated tumor tissue remains within the body after RFA, and residual tumors or satellite nodules can limit the effectiveness of this treatment. Therefore, future research should focus on this issue.
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Wang Y, Luo Q, Li Y, Deng S, Li X, Wei S. A systematic assessment of the quality of systematic reviews/meta-analyses in radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma. J Evid Based Med 2014; 7:103-20. [PMID: 25155767 DOI: 10.1111/jebm.12100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/01/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The systematic reviews (SRs) of radiofrequency ablation (RFA) versus hepatic resection (HR) for early hepatocellular carcinoma (HCC) are increasing with varies qualities. The aim of this study is to evaluate quality and their impacts on outcomes of these studies. METHODS We searched six databases and five official websites to find the SRs of RFA versus HR for early HCC. The Overview Quality Assessment Questionnaire (OQAQ), the Cochrane Collaboration's tool, and modified MINORS score were applied to assess their quality for SRs, randomized (RCTs) and nonrandomized controlled trials (NRCTs), respectively. RESULTS Nineteen SRs were included. The results showed that the overall quality was poor, with a mean OQAQ score of 3.3 and 95%CI 2.6 to 4.1, only five (26.3%) SRs were good quality, six (31.6%) misused the statistical models, and three of them changed outcome direction after modification. Five SRs taken retrospective studies as RCT. In addition, a total of 39 primary studies referenced by these 19 SRs were included. The results showed that 3 RCTs were leveled grade B, and 35 NRCTs were of moderate quality, with an estimated mean MINORS score of 15.0 and 95%CI 14.6 to 15.4. CONCLUSIONS The overall quality of SRs comparing the effects between RFA and HR for early HCC was poor. There was high heterogeneity and low evidence level. Physicians should take caution when applying the results from these studies to their clinical practice.
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Affiliation(s)
- Yingqiang Wang
- The Chinese Evidence-based Medicine Center/The Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu 610041, China; Department of Medical Administration, 363 Hospital, Chengdu 610041, China
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Jiang K, Zhang W, Su M, Liu Y, Zhao X, Wang J, Yao M, Ogbonna J, Dong J, Huang Z. Laparoscopic radiofrequency ablation of solitary small hepatocellular carcinoma in the caudate lobe. Eur J Surg Oncol 2013; 39:1236-42. [DOI: 10.1016/j.ejso.2013.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 08/01/2013] [Accepted: 08/05/2013] [Indexed: 01/25/2023] Open
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Imai K, Beppu T, Chikamoto A, Doi K, Okabe H, Hayashi H, Nitta H, Ishiko T, Takamori H, Baba H. Comparison between hepatic resection and radiofrequency ablation as first-line treatment for solitary small-sized hepatocellular carcinoma of 3 cm or less. Hepatol Res 2013; 43:853-64. [PMID: 23281579 DOI: 10.1111/hepr.12035] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/26/2012] [Accepted: 11/27/2012] [Indexed: 12/13/2022]
Abstract
AIM It is a matter of debate whether hepatic resection (HR) or radiofrequency ablation (RFA) should be preferred for the treatment of patients with hepatocellular carcinoma (HCC). The aim of this study is to compare the long-term outcome between HR and RFA in patients with solitary small-sized HCC. METHODS One hundred and eighty-three patients with solitary HCC of 3 cm or less who underwent either HR (n = 101) or RFA (n = 82) as a first-line treatment were enrolled in this study. Their cumulative disease-free and overall survival and prognostic factors were compared. RESULTS The disease-free and overall survival in the HR group were significantly better than those in the RFA group for HCC of 3 cm or less; the 5-year disease-free and overall survival rates were 46.8% versus 23.9% and 87.5% versus 59.4% (P = 0.0008, =0.0002), respectively. In the subgroup analysis, the disease-free and overall survival in the HR group were significantly better than those in the RFA group for HCC of more than 2 cm (P < 0.0001, <0.0001, respectively), whereas there were no significant differences between the two groups for HCC of 2 cm or less. In patients treated with RFA, a tumor size of more than 2 cm was the only independent prognostic factor for disease-free survival (risk ratio = 1.832, P = 0.039). CONCLUSION HR is proposed as the first-line treatment for patients with solitary small-sized HCC rather than RFA, especially for those with tumors in the range 2-3 cm.
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Affiliation(s)
- Kastunori Imai
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
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Kim YS, Lim HK, Rhim H, Lee MW, Choi D, Lee WJ, Paik SW, Koh KC, Lee JH, Choi MS, Gwak GY, Yoo BC. Ten-year outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: analysis of prognostic factors. J Hepatol 2013; 58:89-97. [PMID: 23023009 DOI: 10.1016/j.jhep.2012.09.020] [Citation(s) in RCA: 294] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 09/07/2012] [Accepted: 09/13/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The aim was to assess 10-year outcomes of radiofrequency ablation as a first-line therapy of early-stage hepatocellular carcinoma with an analysis of prognostic factors. METHODS From April 1999 to April 2011, 1305 patients (male:female=993:312; mean age, 58.4 years) with 1502 early-stage hepatocellular carcinomas (mean size, 2.2 cm) were treated with percutaneous radiofrequency ablation as a first-line option. Follow-up period ranged from 0.4 to 146.6 months (median, 33.4 months). We assessed the 10-year follow-up results of recurrences and survival with the analyses of prognostic factors. RESULTS Recurrences occurred in 795 patients (1-17 times), which were managed with various therapeutic modalities. The cumulative local tumor progression rates were 27.0% and 36.9% at 5 and 10 years, respectively, for which the only significant risk factor was large tumor size (B=0.584, p=0.001). Cumulative intrahepatic distant and extrahepatic recurrence rates were 73.1% and 88.5%, and 19.1% and 38.2% at 5 and 10 years, respectively. Corresponding overall survival rates were 59.7% and 32.3%, respectively. Poor survival was associated with old age (B=0.043, p=0.010), Child-Pugh class B (B=-1.054, p<0.001), absence of antiviral therapy during follow-up (B=-0.699, p=0.034), and presence of extrahepatic recurrence (B=0.971, p=0.007). CONCLUSIONS Ten-year survival outcomes after percutaneous radiofrequency ablation as a first-line therapy of hepatocellular carcinoma were excellent despite frequent tumor recurrences. Overall survival was influenced by age, Child-Pugh class, antiviral therapy, or extrahepatic recurrence.
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Affiliation(s)
- Young-sun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Feng K, Yan J, Li X, Xia F, Ma K, Wang S, Bie P, Dong J. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol 2012; 57:794-802. [PMID: 22634125 DOI: 10.1016/j.jhep.2012.05.007] [Citation(s) in RCA: 591] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 05/07/2012] [Accepted: 05/11/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The aim of this study was to compare the efficacy of radiofrequency ablation (RFA) with surgical resection (RES) in the treatment of small hepatocellular carcinoma (HCC). METHODS A total of 168 patients with small HCC with nodular diameters of less than 4 cm and up to two nodules were randomly divided into RES (n=84) and RFA groups (n=84). Outcomes were carefully monitored and evaluated during the 3-year follow-up period. RESULTS The 1-, 2-, and 3-year survival rates for the RES and RFA groups were 96.0%, 87.6%, 74.8% and 93.1%, 83.1%, 67.2%, respectively. The corresponding recurrence-free survival rates for the two groups were 90.6%, 76.7%, 61.1% and 86.2%, 66.6%, 49.6%, respectively. There were no statistically significant differences between the two groups in overall survival rate (p=0.342) or recurrence-free survival rate (p=0.122). Multivariate analysis demonstrated that the independent risk factors associated with survival were multiple occurrences of tumors at different hepatic locations (relative risk of 2.696; 95% CI: 1.189-6.117; p=0.018) and preoperative indocyanine green retention rate at 15 min (ICG-15) (relative risk of 3.853; 95% CI: 1.647-9.015; p=0.002). CONCLUSIONS In patients with small hepatocellular carcinomas, percutaneous RFA may provide therapeutic effects similar to those of RES. However, percutaneous RFA is more likely to be incomplete for the treatment of small HCCs located at specific sites of the liver, and open or laparoscopic surgery may be the better choice.
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Affiliation(s)
- Kai Feng
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
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Laparoscopic Anatomic Monosegmentectomy of Hepatocellular Carcinoma of the Right Hepatic Lobe. Surg Laparosc Endosc Percutan Tech 2012; 22:e259-62. [DOI: 10.1097/sle.0b013e31825cacb3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Karabulut K, Aucejo F, Akyildiz HY, Siperstein A, Berber E. Resection and radiofrequency ablation in the treatment of hepatocellular carcinoma: a single-center experience. Surg Endosc 2011; 26:990-7. [PMID: 22038164 DOI: 10.1007/s00464-011-1983-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 09/27/2011] [Indexed: 01/15/2023]
Abstract
BACKGROUND We have been utilizing both resection and laparoscopic radiofrequency ablation (RFA) to treat hepatocellular carcinoma (HCC). The aim of this study is to describe patient characteristics and outcome for each treatment modality from a single institution. METHODS Medical records of HCC patients who underwent resection (n = 92) or laparoscopic (RFA) (n = 92) between 1997 and 2010 were reviewed. Univariate Kaplan-Meier and multivariate Cox proportional-hazards model were used to analyze survival. RESULTS Patients with normal liver function and larger tumors were resected, and those with liver dysfunction, portal hypertension, and multiple tumors were ablated. Tumor size was larger in the Resection group, whereas number of tumors was higher in the RFA group. Child class and Barcelona Clinic Liver Cancer (BCLC) staging were more advanced in the RFA group. Hospital stay was longer, and morbidity and mortality higher in the Resection versus the RFA group. There was no difference in disease-free survival, but the 5-year actual survival was significantly higher (40% versus 21%) in the Resection group. On univariate analysis, number of tumors, tumor size, platelet count, BCLC stage, Child class, and type of surgery were predictors of overall survival. On multivariate analysis, Child class and number of tumors were independent predictors of overall survival. CONCLUSIONS To our knowledge, this is the largest North American series reporting on RFA and resection for HCC from a single institution. Herein, we describe the perioperative and oncologic outcomes to be expected when these modalities are used in a certain treatment algorithm.
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Affiliation(s)
- Koray Karabulut
- Department of General Surgery, Liver Tumor Ablation Program, Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH 44195, USA
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Percutaneous Radiofrequency Ablation for Treatment of Hepatocellular Carcinoma in the Caudate Lobe. AJR Am J Roentgenol 2011; 197:W571-5. [DOI: 10.2214/ajr.11.6893] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Laparoscopy or not: a meta-analysis of the surgical effects of laparoscopic versus open appendicectomy. Surg Laparosc Endosc Percutan Tech 2011; 20:362-70. [PMID: 21150411 DOI: 10.1097/sle.0b013e3182006f40] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Both open appendicectomy and laparoscopic appendicectomy have their own advantages and disadvantages. The purpose of our meta-analysis is to compare the surgical effects of laparoscopic versus open appendicectomy. In our study, Medline, Embase, and the Cochrane Library were searched. Only prospective randomized controlled trials that compared the 2 methods of operation were included. Evaluation indexes in our study involved are operating time, complications, hospital stay, time to return to normal activities, time to return to normal diet, and the overall cost. Results showed that operating time of laparoscopic appendicectomy was significantly longer [weighted mean difference (WMD) 7.60; 95% confidence interval (CI) 6.03-9.17 min; P<0.00001]. Time of hospital stay (WMD -0.82; 95% CI: -0.93 to -0.70 d), time to return to normal activities (WMD -6.85; 95% CI: -7.62 to -6.09 d), and diet (WMD -0.61; 95% CI: -0.86 to -0.36 d) were significantly decreased in the laparoscopic appendicectomy group (all P<0.00001). There is no convincing difference in complications (odds ratio 0.99; 95% CI: 0.80-1.22; P=0.92) and death rates (odds ratio 0.97; 95% CI: 0.29-3.25; P=0.96). In conclusion, laparoscopic appendicectomy may have advantages over open appendicectomy in hospital stay and postoperative recovery.
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