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Chen S, Qi H, Tan H, Cao F, Xie L, Huang T, Wu Y, Wen C, Wang Y, Shen L, Fan W. Long-Term Analysis of Recurrence Beyond Milan Criteria Following Ablation of Solitary Early-Stage Hepatocellular Carcinoma ≤3 cm in Potentially Transplantable Patients: A Over 10-Year Survival Study. J Hepatocell Carcinoma 2025; 12:205-218. [PMID: 39925626 PMCID: PMC11804238 DOI: 10.2147/jhc.s505979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 01/27/2025] [Indexed: 02/11/2025] Open
Abstract
Background Salvage liver transplantation is promising for hepatocellular carcinoma(HCC) recurrence post-ablation but is significantly affected by recurrence beyond Milan Criteria (RBM). Materials and Methods A retrospective cohort study of potentially transplantable HCC patients undergoing ablation between 2007 and 2017 assessed median time to recurrence beyond Milan Criteria(TRBM) via Kaplan-Meier curves and predictive capacity of recurrence and RBM for overall survival(OS) via Receiver Operating Characteristic Curves, and identified independent risk factors for TRBM and RBM via Cox and binary logistic regression models. Results We enrolled 191 potentially transplantable patients with early-stage HBV-related HCC ≤3 cm who underwent ablation. During a median follow-up of 7.64 years, HCC recurrence occurred in 126 patients(65.9%), with RBM 86 patients(45.0%). The median TRBM was 10.54 years. Cumulative survival rates without RBM at 3, 5, 8, 10, and 13 years were 77.3%, 65.9%, 56.5%, 51.0%, and 37.6%, respectively. Multivariable analysis identified older age, C-reactive protein(CRP)≥1.81 mg/L, and platelet(PLT)≤80×109/L as independent risk factors for TRBM. Also, cirrhosis, CRP≥1.81 mg/L and PLT≤80×109/L were identified as independent risk factors of the occurrence of RBM. Elevated Platelet-CRP Score(PCS), integrating CRP and PLT, correlated significantly with an increased incidence of RBM and a more aggressive phenotype, characterized by vascular invasion or metastatic dissemination (P<0.05). Notably, RBM was a superior predictive indicator for OS compared to recurrence (P<0.05). Conclusion When using ablation as a bridge to liver transplantation for solitary HBV-related early HCC (≤3 cm), it is crucial first to identify key preoperative features, including high CRP, low PLT, cirrhosis, and older age.
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Affiliation(s)
- Shuanggang Chen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Han Qi
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Hongtong Tan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Fei Cao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Lin Xie
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Tao Huang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Ying Wu
- Department of Interventional Therapy, Shenzhen second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, People’s Republic of China
| | - Chunyong Wen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Yujia Wang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Lujun Shen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
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Lindner C, San Martín R, Concha A, Clemo D, Valenzuela J. Imaging-based prediction of hepatocellular carcinoma recurrence after microwave ablation as bridge therapy: A glimpse into the future. World J Transplant 2024; 14:98653. [PMID: 39697452 PMCID: PMC11438946 DOI: 10.5500/wjt.v14.i4.98653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/16/2024] [Accepted: 08/08/2024] [Indexed: 09/20/2024] Open
Abstract
Liver transplantation (LT) remains the treatment of choice for early-stage hepatocellular carcinoma (HCC) and offers the best long-term oncological outcomes. However, the increasing waiting list for LT has led to a significant dropout rate as patients experience tumor progression beyond the Milan criteria. Currently, locoregional therapies, such as microwave ablation (MWA), have emerged as promising bridge treatments for patients awaiting LT. These therapies have shown promising results in preventing tumor progression, thus reducing the dropout rate of LT candidates. Despite the efficacy of MWA in treating HCC, tumoral recurrence after ablation remains a major challenge and significantly impacts the prognosis of HCC patients. Therefore, accurately diagnosing tumoral recurrence post-ablation is crucial. Recent studies have developed novel imaging features based on magnetic resonance imaging of HCC, which could provide essential information for predicting early tumoral recurrence after MWA. These advancements could address this unresolved challenge, improving the clinical outcomes of patients on the LT waiting list. This article explored the current landscape of MWA as a bridge therapy for HCC within the Milan criteria, highlighting the emerging role of novel imaging-based features aimed at improving the prediction of tumor recurrence after MWA.
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Affiliation(s)
- Cristian Lindner
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Chile
- Department of Radiology, Hospital Regional Guillermo Grant Benavente, Concepción 4030000, Biobío, Chile
| | - Rodrigo San Martín
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Chile
- Department of Radiology, Hospital Regional Guillermo Grant Benavente, Concepción 4030000, Biobío, Chile
| | - Andrés Concha
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Chile
- Department of Radiology, Hospital Regional Guillermo Grant Benavente, Concepción 4030000, Biobío, Chile
| | - David Clemo
- Department of Radiology, Hospital Regional Guillermo Grant Benavente, Concepción 4030000, Biobío, Chile
| | - Jorge Valenzuela
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Chile
- Department of Radiology, Hospital Regional Guillermo Grant Benavente, Concepción 4030000, Biobío, Chile
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Dong LN, Wang S, Dong G, Kong D, Liang P. MRI non-rigid registration with tumor contraction correction for ablative margin assessment after microwave ablation of hepatocellular carcinomas. Phys Med Biol 2024; 69:055004. [PMID: 38271728 DOI: 10.1088/1361-6560/ad22a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/25/2024] [Indexed: 01/27/2024]
Abstract
Objective. This study aims to develop and assess a tumor contraction model, enhancing the precision of ablative margin (AM) evaluation after microwave ablation (MWA) treatment for hepatocellular carcinomas (HCCs).Approach. We utilize a probabilistic method called the coherent point drift algorithm to align pre-and post-ablation MRI images. Subsequently, a nonlinear regression method quantifies local tumor contraction induced by MWA, utilizing data from 47 HCC with viable ablated tumors in post-ablation MRI. After automatic non-rigid registration, correction for tumor contraction involves contracting the 3D contour of the warped tumor towards its center in all orientations.Main results. We evaluate the performance of our proposed method on 30 HCC patients who underwent MWA. The Dice similarity coefficient between the post-ablation liver and the warped pre-ablation livers is found to be 0.95 ± 0.01, with a mean corresponding distance between the corresponding landmarks measured at 3.25 ± 0.62 mm. Additionally, we conduct a comparative analysis of clinical outcomes assessed through MRI over a 3 month follow-up period, noting that the AM, as evaluated by our proposed method, accurately detects residual tumor after MWA.Significance. Our proposed method showcases a high level of accuracy in MRI liver registration and AM assessment following ablation treatment. It introduces a potentially approach for predicting incomplete ablations and gauging treatment success.
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Affiliation(s)
- Li-Nan Dong
- School of Computer Science and Technology, Dalian University of Technology, Dalian, 116086, People's Republic of China
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Shouchao Wang
- School of Mathematical Sciences, Zhejiang University, Hangzhou, 310007, People's Republic of China
| | - Guoping Dong
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
- Chinese PLA Medical School, Beijing 100853, People's Republic of China
| | - Dexing Kong
- School of Mathematical Sciences, Zhejiang University, Hangzhou, 310007, People's Republic of China
| | - Ping Liang
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
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