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Floridi C, Cacioppa LM, Rossini N, Macchini M, Bruno A, Agostini A, Consoli V, Inchingolo R, Acquafredda F, Nicolini D, Schiadà L, Svegliati Baroni G, Candelari R. Microwave ablation followed by cTACE in 5-cm HCC lesions: does a single-session approach affect liver function? LA RADIOLOGIA MEDICA 2024; 129:1252-1264. [PMID: 38958915 PMCID: PMC11322225 DOI: 10.1007/s11547-024-01842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Microwave ablation (MWA) and conventional transarterial chemoembolization (cTACE) are locoregional treatments commonly performed in very early, early and intermediate stages of hepatocellular carcinoma (HCC). Despite combined locoregional approaches have shown encouraging results in obtaining complete tumor necrosis, their application in a single session is poorly described. Our aim was to evaluate the safety and efficacy of single-session MWA and cTACE treatment in 5-cm HCCs and its influence on liver function. MATERIALS AND METHODS All 5-cm HCCs treated by MWA and cTACE performed in a single-session in our Interventional Radiology unit between January 2020 and December 2022 were retrospectively recorded and analyzed. Patients with poor or missing pre- and post-treatment imaging were excluded. Technical success, clinical success, and complications rate were examined as primary endpoints. Pre- and post-treatment liver function laboratory parameters were also evaluated. RESULTS A total of 15 lesions (mean lesion diameter, 5.0 ± 1.4 cm) in 15 patients (11 men; mean age, 67.1 ± 8.9 years) were retrospectively evaluated. Technical and clinical success were 100% and 73%, respectively. Four (27%) cases of partial response and no cases of progressive or stable disease were recorded. AST and ALT values have found to be significantly higher in post-treatment laboratory tests. No other significant differences between pre- and post-treatment laboratory values were registered. AST and ALT pre- and post-treatment higher differences (ΔAST and ΔALT) were significantly associated with a lower clinical success rate. CONCLUSION MWA and cTACE single-session approach is safe and effective for 5-cm HCCs, without significant liver function impairment. A post-treatment increase in AST and ALT values may be a predictor for clinical failure.
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Affiliation(s)
- Chiara Floridi
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - Laura Maria Cacioppa
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy.
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy.
| | - Nicolò Rossini
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Marco Macchini
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Alessandra Bruno
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
| | - Andrea Agostini
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - Valeria Consoli
- Division of Interventional Radiology, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" Regional General Hospital, 70021, Acquaviva Delle Fonti, Bari, Italy
| | - Fabrizio Acquafredda
- Interventional Radiology Unit, "F. Miulli" Regional General Hospital, 70021, Acquaviva Delle Fonti, Bari, Italy
| | - Daniele Nicolini
- Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126, Ancona, Italy
| | - Laura Schiadà
- "Transplant and Hepatic Damage" Unit, University Politecnica Delle Marche, 60126, Ancona, Italy
| | | | - Roberto Candelari
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
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Wang S, Geng H, Li Y, Xu Z, Yang K, Yang L, Hui F, Zhang Y. Which is the best TACE agent for patients with different NLR hepatocellular carcinomas? A systematic review and network meta-analysis. Heliyon 2024; 10:e30759. [PMID: 38765170 PMCID: PMC11098848 DOI: 10.1016/j.heliyon.2024.e30759] [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: 10/31/2023] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 05/21/2024] Open
Abstract
Background Transarterial chemoembolization (TACE) is a common treatment for hepatocellular carcinoma (HCC), but the best therapeutic agent for TACE treatment has not been determined. The neutrophil/lymphocyte ratio (NLR) is a systemic immune system marker; however, the ability of the NLR to predict the prognosis of patients with HCC is unknown, and no studies have been conducted to determine the most appropriate TACE regimen for HCC patients with different NLRs. Methods The PubMed, Embase, Web of Science, and CNKI databases were searched through May 28, 2023. Comparisons of overall survival (OS) among cohort studies with different NLRs and different TACE treatment regimens were performed with a random effects model. Findings Thirty-five studies involving 9210 patients were included in this meta-analysis. The results showed that Group 3-4 (NLR<2.5) patients had a significantly longer OS than Group 1-2 (NLR 2.5-5.0). Among the patients, Group 1-3 (NLR 2.0-5.0) patients had the best survival after treatment with adriamycin (lnHR (95 % CI = 0.48 [0.31, 0.75] and lnHR (95 % CI = 0.41 [0.19, 0.91]). Among the Group 4 patients (NLR<2.0), the best outcome was obtained with platinum + adriamycin (lnHR (95 % CI = 0.59 [0.45, 0.78]), followed by adriamycin. A subgroup analysis of TACE combined with other treatments showed that adriamycin combined with sorafenib was the most effective and superior to the other treatment agents. Interpretation The NLR can be used to predict the prognosis of HCC patients treated with TACE; the higher the NLR is, the worse the prognosis. Adriamycin may be the best therapeutic agent for HCC patients treated with TACE.
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Affiliation(s)
- Shuai Wang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, 110016 China
- Bei Fang Hospital of Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenhe District, Shenyang, 110016 China
| | - Hefeng Geng
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, 110016 China
- Bei Fang Hospital of Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenhe District, Shenyang, 110016 China
| | - Yizhen Li
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, 110016 China
- Bei Fang Hospital of Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenhe District, Shenyang, 110016 China
| | - Ziang Xu
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, 110016 China
- Bei Fang Hospital of Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenhe District, Shenyang, 110016 China
| | - Kaisi Yang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, 110016 China
- Bei Fang Hospital of Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenhe District, Shenyang, 110016 China
| | - Ling Yang
- Department of Pharmacy, Shenzhen Children's Hospital, Shenzhen 518000, China
| | - Fuhai Hui
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, 110016 China
| | - Yingshi Zhang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, 110016 China
- Bei Fang Hospital of Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenhe District, Shenyang, 110016 China
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Iezzi R, Posa A, Valente I, Contegiacomo A, Zocco MA, Pompili M, Annicchiarico BE, Ponziani FR, Basso M, Goldberg SN, Giuliante F, Gasbarrini A, Sala E. Hug sign in intraprocedural cone-beam-CT to predict short-term response to combined treatment of hepatocellular carcinoma. LA RADIOLOGIA MEDICA 2024; 129:807-816. [PMID: 38512624 PMCID: PMC11088537 DOI: 10.1007/s11547-024-01805-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Combined treatment of ablation and chemoembolization for hepatocellular carcinoma represents a promising therapy to increase treatment efficacy and improve patient survival. The "hug sign" is a recently introduced radiological sign consisting in deposition of beads/contrast agent during transarterial chemoembolization in the hyperemic area surrounding the post-ablation volume, seen during intraprocedural unenhanced cone-beam CT, that may indicate intraprocedural success. Aim of our retrospective study was to analyze the usefulness of the "hug sign" at the intraprocedural unenhanced cone-beam CT as an early predictor of response to combined treatment, based on the hug sign angle. MATERIALS AND METHODS Between January 2017 and September 2021 all patients with hepatocellular carcinoma which underwent a combined treatment of thermal ablation followed by chemoembolization were enrolled. All treated patients underwent immediate post-procedural unenhanced cone-beam CT to evaluate the deposition of contrast agent, lipiodol or radiopaque beads and to assess the percentage of coverage of the ablated area with the contrast agent (hug sign angle). Patients with missing pre-procedural, intra-procedural and/or post-procedural data/imaging, or with poor-quality post-procedural cone-beam CT images were excluded. RESULTS 128 patients (mean age, 69.3 years ± 1.1 [standard deviation]; 87 men) were evaluated. Our study evidenced that 84.4% (81/85) of patients with a hug sign angle of 360° had no residual tumor at the first 1-/3-months follow-up examination. A hug sign angle of 360° also showed to be an independent protective factor against residual tumor at multivariate analysis. CONCLUSION Unenhanced cone-beam CT performed at the end of a combined treatment with ablation plus chemoembolization can effectively predict an early treatment response on radiological images, when a hug sign angle of 360° was detected.
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Affiliation(s)
- Roberto Iezzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy, and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go A. Gemelli 8, 00168, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
- U.O.C. Radiologia d'Urgenza e Interventistica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy.
| | - Alessandro Posa
- Department of Diagnostic Imaging, Oncologic Radiotherapy, and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go A. Gemelli 8, 00168, Rome, Italy
- U.O.C. Radiologia d'Urgenza e Interventistica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Iacopo Valente
- Department of Diagnostic Imaging, Oncologic Radiotherapy, and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go A. Gemelli 8, 00168, Rome, Italy
| | - Andrea Contegiacomo
- Department of Diagnostic Imaging, Oncologic Radiotherapy, and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go A. Gemelli 8, 00168, Rome, Italy
- U.O.C. Radiologia d'Urgenza e Interventistica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Maria Assunta Zocco
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maurizio Pompili
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Francesca Romana Ponziani
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michele Basso
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Shraga Nahum Goldberg
- Division of Image-Guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Felice Giuliante
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Evis Sala
- Department of Diagnostic Imaging, Oncologic Radiotherapy, and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go A. Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Özen Ö, Boyvat F, Zeydanlı T, Kesim Ç, Karakaya E, Haberal M. Transarterial Chemoembolization Combined with Simultaneous Thermal Ablation for Solitary Hepatocellular Carcinomas in Regions with a High Risk of Recurrence. EXP CLIN TRANSPLANT 2023; 21:512-519. [PMID: 37455470 DOI: 10.6002/ect.2023.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVES We evaluated the safety and efficacy of transarterial chemoembolization combined with percutaneous thermal ablation (radiofrequency or microwave ablation) in the treatment of solitary hepatocellular carcinoma tumors ranging from 2 to 4.5 cm at subdiaphragmatic, subcapsular, or perivascular locations. MATERIALS AND METHODS Fifteen patients (12 men, mean [range] age of 66.6 ± 10.88 [34-75] y) who received transarterial chemoembolization combined with simultaneous percutaneous radiofrequency ablation (n = 5) or microwave ablation (n = 10) for hepatocellular carcinoma in regions with high risk of recurrence (subdiaphragmatic, subcapsular, or perivascular) between 2012 and 2018 were evaluated. We retrospectively investigated tumor diameter and localization, success rate, safety, local efficacy (imaging at month 1 after treatment), local tumor response (3 months posttreatment), local tumor progression, intrahepatic distant recurrence, overall survival and complications. RESULTS Tumor diameter ranged from 20 to 45 mm (mean 31.7 ± 7.37 mm). Hepatocellular carcinoma diameter was 2 to 3 cm in 7 patients and 3.1 to 4.5 cm in 8 patients. The technical success rate was 100%, with no life-threatening complications. At enhanced imaging at 1-month follow-up, the complete necrosis rate was 100%; at 3 months, 100% of patients had a complete response. During a mean follow-up of 26 ± 13.6 months, 7 patients (46.7%) had tumor progression. Three patients (20%) had local tumor response, and 4 patients (26.7 %) experienced distant recurrences in the untreated liver. The mean local tumor progression and mean intrahepatic distance recurrence times were 11 months and 29.5 months, respectively. Overall survival rates were 100% at 1 year, 73% at 3 years, and 47% at 5 years. CONCLUSIONS Transarterial chemoembolization combined with simultaneous percutaneous thermal ablation is safe, feasible, and effective in enhancing the local control rate for solitary hepatocellular carcinoma ranging from 2 to 4.5 cm in regions with high risk of recurrence.
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Affiliation(s)
- Özgür Özen
- From the Ankara Hospital, Department of Radiology, Baskent University, Ankara, Turkey
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Combined transarterial iodized oil injection and computed tomography-guided thermal ablation for hepatocellular carcinoma: utility of the iodized oil retention pattern. Abdom Radiol (NY) 2022; 47:431-442. [PMID: 34642785 PMCID: PMC8776722 DOI: 10.1007/s00261-021-03305-3] [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: 08/05/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/21/2022]
Abstract
Purpose To investigate whether the iodized oil (Lipiodol, Guerbet Group, Villepinte, France) retention pattern influences the treatment efficacy of combined transarterial Lipiodol injection (TLI) and thermal ablation in patients with hepatocellular carcinoma (HCC). Methods Data of 198 patients (280 HCC lesions), who underwent TLI plus computed tomography (CT)-guided thermal ablation at three separate medical institutions between June 2014 and September 2020, were reviewed and analyzed. The Lipiodol retention pattern was classified as complete or incomplete based on non-enhanced CT at the time of ablation. The primary outcome was local recurrence-free survival (LRFS) for lesions; the secondary outcome was overall survival (OS) for patients. Propensity score matching (PSM) was performed using a caliper width of 0.1 between the two groups. Differences in LRFS and OS between the two groups were compared using the log-rank test. Results A total of 133 lesions exhibited a complete Lipiodol retention pattern, while 147 exhibited an incomplete pattern. After PSM analysis of baseline characteristics of the lesions, 121 pairs of lesions were matched. LRFS was significantly longer for lesions exhibiting complete retention than for those exhibiting incomplete retention (P = 0.030). After PSM analysis of patient baseline characteristics, 74 pairs of patients were matched. There was no significant difference in OS between the two groups (P = 0.456). Conclusion Lipiodol retention patterns may influence the treatment efficacy of combined TLI and thermal ablation for HCC lesions. However, a survival benefit for the Lipiodol retention pattern among HCC patients was not observed and needs further confirmation.
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Yang XY, Deng JB, An TZ, Zhou S, Li JX. Tumor enhancement ratio with unenhanced imaging is an independent prognostic factor for patients with hepatocellular carcinoma after transarterial chemoembolization. J Int Med Res 2021; 49:3000605211058367. [PMID: 34812068 PMCID: PMC8647277 DOI: 10.1177/03000605211058367] [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] [Indexed: 12/03/2022] Open
Abstract
Objective To investigative whether the odds tumor enhancement ratio (OTER) on
cross-sectional imaging is a prognostic factor for hepatocellular carcinoma
after transarterial chemoembolization (TACE). Methods This study involved 126 patients who underwent TACE from May 2015 to March
2019. The signal intensity/Hounsfield units (HU) was measured by placing
regions of interest on the tumor and surrounding liver in unenhanced and
arterial-phase contrast-enhanced cross-sectional images. The OTER was
calculated as follows:
OTER = (HUTUMORart − HUTUMORun)/
(HULIVERart − HULIVERun). Univariate analysis was
performed to determine the factors associated with overall survival (OS).
Variables with a P value of <0.10 were included in the multivariate Cox
regression analysis. Results The median OS was 757 days. Tumors with a peripheral location, small size,
and low OTER had better OS than those with a central location, large size,
and high OTER. OS did not differ according to the extent of tumor
involvement or tumor enhancement pattern. The OTER, tumor location, and size
were included in the multivariate Cox regression analysis. A low OTER was
the predictor of better OS. Conclusion A high OTER is a risk factor for poor OS in patients undergoing TACE. This
should be taken into consideration before the procedure.
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Affiliation(s)
- Xi-Yuan Yang
- Department of Interventional Radiology, the Affiliated Baiyun Hospital of Guizhou Medical University, Guiyang, China
| | - Jiang-Bei Deng
- Department of Interventional Radiology, Changsha Central Hospital, University of South China, Changsha, China
| | - Tian-Zhi An
- Department of Interventional Radiology, 74720The Affiliated Hospital of Guizhou Medical University, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shi Zhou
- Department of Interventional Radiology, 74720The Affiliated Hospital of Guizhou Medical University, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jun-Xiang Li
- Department of Interventional Radiology, Guizhou Medical University Affiliated Cancer Hospital, Guiyang, China
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Li HZ, Tan J, Tang T, An TZ, Li JX, Xiao YD. Chemoembolization Plus Microwave Ablation vs Chemoembolization Alone in Unresectable Hepatocellular Carcinoma Beyond the Milan Criteria: A Propensity Scoring Matching Study. J Hepatocell Carcinoma 2021; 8:1311-1322. [PMID: 34754838 PMCID: PMC8570378 DOI: 10.2147/jhc.s338456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/23/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose Transarterial chemoembolization (TACE) is recommended in patients with unresectable HCC beyond the Milan criteria (MC). However, the long-term efficacy of TACE remains unsatisfactory. Percutaneous microwave ablation (MWA) is a curative therapy for early-stage HCC that provides better local tumor control than TACE; however, MWA is limited for large or multifocal lesions. We aimed to compare treatment efficacy and downstaging rate following combined TACE-MWA and TACE alone in patients with unresectable HCC beyond the MC. Patients and Methods Patients with unresectable HCC beyond the MC who underwent either TACE-MWA (n=91) or TACE alone (n=140) at four medical institutions were included. Potential influencing factors on overall survival (OS) and progression-free survival (PFS) were included in the Cox regression analysis. Propensity-score matching of patients treated with TACE-MWA and TACE alone was performed. Differences in OS and PFS were compared with the Log rank test. Patients who met the University of California, San Francisco criteria were eligible for assessment of the probability of downstaging within the MC. Downstaging rate was compared between the two groups. Results In multivariate analysis, treatment with TACE alone was an independent predictor of poor PFS (P=0.011) and OS (P<0.001). Both PFS (P=0.043) and OS (P=0.002) were significantly higher in patients treated with TACE-MWA than those treated with TACE alone. The downstaging rate was higher in patients treated with TACE-MWA than those treated with TACE alone (P=0.039). Conclusion Compared with TACE alone, TACE-MWA may offer a survival benefit in terms of OS and PFS in HCC patients beyond the MC. Additionally, TACE-MWA may provide higher probability of downstaging within the MC than TACE alone, thereby increasing the possibility of liver transplantation.
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Affiliation(s)
- Hui-Zhou Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, 410011, People's Republic of China
| | - Jie Tan
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, 410011, People's Republic of China
| | - Tian Tang
- Department of Interventional Radiology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, People's Republic of China
| | - Tian-Zhi An
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550002, People's Republic of China
| | - Jun-Xiang Li
- Department of Interventional Radiology, Guizhou Medical University Affiliated Cancer Hospital, Guiyang, 550004, People's Republic of China
| | - Yu-Dong Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, 410011, People's Republic of China
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Tan J, Tang T, Zhao W, Zhang ZS, Xiao YD. Initial Incomplete Thermal Ablation Is Associated With a High Risk of Tumor Progression in Patients With Hepatocellular Carcinoma. Front Oncol 2021; 11:760173. [PMID: 34733792 PMCID: PMC8558404 DOI: 10.3389/fonc.2021.760173] [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: 08/17/2021] [Accepted: 10/01/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose To investigate whether incomplete thermal ablation is associated with a high risk of tumor progression in patients with hepatocellular carcinoma (HCC), and to compare the efficacy of repeated thermal ablation and transarterial chemoembolization (TACE) for residual tumor after incomplete ablation. Methods This retrospective study included 284 patients with unresectable HCC who underwent thermal ablation from June 2014 to September 2020. The response of the initially attempted ablation was classified into complete (n=236) and incomplete (n=48). The progression-free survival (PFS) and overall survival (OS) were compared between patients with complete and incomplete responses, before and after a one-to-one propensity score-matching (PSM), and between patients in whom repeated ablation or TACE was performed after a first attempt incomplete ablation. Results After PSM of the 284 patients, 46 pairs of patients were matched. The PFS was significantly higher in the complete response group than in the incomplete response group (P<0.001). No difference in OS was noted between two groups (P=0.181). After a first attempt incomplete ablation, 29 and 19 patients underwent repeated ablation and TACE, respectively. There were no significant differences in PFS (P=0.424) and OS (P=0.178) between patients who underwent repeated ablation and TACE. In multivariate Cox regression analysis, incomplete response (P<0.001) and Child-Pugh class B (P=0.017) were independent risk factors for tumor progression, while higher AFP level (P=0.011) and Child-Pugh class B (P=0.026) were independent risk factors for poor OS. Conclusion Although patients with incomplete ablation are associated with tumor progression compared with those with complete ablation, their OS is not affected by incomplete ablation. When patients present with residual tumors, TACE may be an alternative if repeated ablation is infeasible.
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Affiliation(s)
- Jie Tan
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Tian Tang
- Department of Interventional Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Wei Zhao
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zi-Shu Zhang
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yu-Dong Xiao
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, China
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Zou ZM, An TZ, Li JX, Zhang ZS, Xiao YD, Liu J. Predicting early refractoriness of transarterial chemoembolization in patients with hepatocellular carcinoma using a random forest algorithm: A pilot study. J Cancer 2021; 12:7079-7087. [PMID: 34729109 PMCID: PMC8558659 DOI: 10.7150/jca.63370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/03/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose: To develop and validate a random forest (RF) based predictive model of early refractoriness to transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC). Methods: A total of 227 patients with unresectable HCC who initially treated with TACE from three independent institutions were retrospectively included. Following a random split, 158 patients (70%) were assigned to a training cohort and the remaining 69 patients (30%) were assigned to a validation cohort. The process of variables selection was based on the importance variable scores generated by RF algorithm. A RF predictive model incorporating the selected variables was developed, and five-fold cross-validation was performed. The discrimination and calibration of the RF model were measured by a receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow test. Results: The potential variables selected by RF algorithm for developing predictive model of early TACE refractoriness included patients' age, number of tumors, tumor distribution, platelet count (PLT), and neutrophil-to-lymphocyte ratio (NLR). The results showed that the RF predictive model had good discrimination ability, with an area under curve (AUC) of 0.863 in the training cohort and 0.767 in the validation cohort, respectively. In Hosmer-Lemeshow test, the RF model had a satisfactory calibration with P values of 0.538 and 0.068 in training cohort and validation cohort, respectively. Conclusion: The RF algorithm-based model has a good predictive performance in the prediction of early TACE refractoriness, which may easily be deployed in clinical routine and help to determine the optimal patient of care.
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Affiliation(s)
- Zhi-Min Zou
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, 410011, China.,Department of Radiology, Hunan Children's Hospital, Changsha, 410007, China
| | - Tian-Zhi An
- Department of Interventional Radiology, the Affiliated Hospital of Guizhou Medical University, Guiyang, 550002, China
| | - Jun-Xiang Li
- Department of Interventional Radiology, Guizhou Medical University Affiliated Cancer Hospital, Guiyang, 550004, China
| | - Zi-Shu Zhang
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Yu-Dong Xiao
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, 410011, China.,Clinical Research Center for Medical Imaging in Hunan Province, Changsha, 410011, China.,Department of Radiology Quality Control Center, Changsha, 410011, China
| | - Jun Liu
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, 410011, China.,Clinical Research Center for Medical Imaging in Hunan Province, Changsha, 410011, China.,Department of Radiology Quality Control Center, Changsha, 410011, China
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10
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Zang C, Zhao Y, Qin L, Liu G, Sun J, Li K, Zhao Y, Sheng S, Zhang H, He N, Zhao P, Wang Q, Li X, Peng Y, Dong T, Zhang Y. Distinct tumour antigen-specific T-cell immune response profiles at different hepatocellular carcinoma stages. BMC Cancer 2021; 21:1007. [PMID: 34496797 PMCID: PMC8428121 DOI: 10.1186/s12885-021-08720-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cancer-testis antigens (CTAs) and tumour-associated antigens (TAAs) are frequently expressed in hepatocellular carcinoma (HCC); however, the role of tumour-antigen-specific T cell immunity in HCC progression is poorly defined. We characterized CTA- and TAA-specific T cell responses in different HCC stages and investigated their alterations during HCC progression. METHODS Fifty-eight HCC patients, 15 liver cirrhosis patients, 15 chronic hepatitis B patients and 10 heathy controls were enrolled in total. IFN-γ ELSPOT using CTAs, including MAGE-A1, MAGE-A3, NY-ESO-1, and SSX2, and two TAAs, SALL4 and AFP, was performed to characterize the T-cell immune response in the enrolled individuals. The functional phenotype of T cells and the responsive T cell populations were analyzed using short-term T-cell culture. RESULTS T cell responses against CTAs and TAAs were specific to HCC. In early-stage HCC patients, the SALL4-specific response was the strongest, followed by MAGE-A3, NY-ESO-1, MAGE-A1 and SSX2. One-year recurrence-free survival after transcatheter arterial chemoembolization plus radiofrequency ablation treatment suggested the protective role of CTA-specific responses. The four CTA- and SALL4-specific T cell responses decreased with the progression of HCC, while the AFP-specific T cell response increased. A higher proportion of CD4+ T cells specific to CTA/SALL4 was observed than AFP-specific T cell responses. CONCLUSIONS The IFN-γ ELISPOT assay characterized distinct profiles of tumour-antigen-specific T cell responses in HCC patients. CTA- and SALL4-specific T cell responses may be important for controlling HCC in the early stage, whereas AFP-specific T cell responses might be a signature of malignant tumour status in the advanced stage. The application of immunotherapy at an early stage of HCC development should be considered.
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Affiliation(s)
- Chaoran Zang
- Biomedical Information Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China
- Interventional Therapy Center of Liver Disease, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Yan Zhao
- Clinical Laboratory Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Ling Qin
- Biomedical Information Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Guihai Liu
- Biomedical Information Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, Oxford University, Oxford, UK
- CAMS Oxford Institute, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Jianping Sun
- Biomedical Information Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Kang Li
- Biomedical Information Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Yanan Zhao
- Department of Radiology and Research Institute of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Shoupeng Sheng
- Interventional Therapy Center of Liver Disease, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Honghai Zhang
- Interventional Therapy Center of Liver Disease, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Ning He
- Interventional Therapy Center of Liver Disease, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Peng Zhao
- Interventional Therapy Center of Liver Disease, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Qi Wang
- Biomedical Information Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China
- Interventional Therapy Center of Liver Disease, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Xi Li
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, Oxford University, Oxford, UK
- CAMS Oxford Institute, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Yanchun Peng
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, Oxford University, Oxford, UK
- CAMS Oxford Institute, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Tao Dong
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, Oxford University, Oxford, UK.
- CAMS Oxford Institute, Nuffield Department of Medicine, Oxford University, Oxford, UK.
| | - Yonghong Zhang
- Biomedical Information Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China.
- Interventional Therapy Center of Liver Disease, Beijing YouAn Hospital, Capital Medical University, Beijing, China.
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11
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Zhang L, Yan ZP, Hou ZH, Huang P, Yang MJ, Zhang S, Zhang S, Zhang SH, Zhu XL, Ni CF, Li Q. Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Outcomes in Patients With Unresectable Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization Plus Sorafenib. Front Mol Biosci 2021; 8:624366. [PMID: 34124139 PMCID: PMC8194392 DOI: 10.3389/fmolb.2021.624366] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/15/2021] [Indexed: 12/26/2022] Open
Abstract
Objectives: To investigate the predictive value of inflammatory biomarkers in patients with unresectable hepatocellular carcinoma (HCC) for outcomes following the combination treatment of transarterial chemoembolization (TACE) plus sorafenib. Materials and Methods: A total of 314 (270 male and 44 female) treatment-naïve patients with unresectable HCC treated by TACE plus sorafenib between January 2011 and December 2018 were enrolled in the retrospective study. The primary outcome was overall survival (OS). The secondary outcome was progression-free survival (PFS). Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were obtained within 3–7 days before the initial TACE and the median value of the NLR and PLR was considered as the cut-off value. Results: The median value of NLR and PLR was 2.42 and 100, respectively. The median OS and PFS of the entire cohort were 18.7 months (95% CI: 16.8–20.6) and 9.1 months (95% CI: 8.5–9.8), respectively. The low NLR and PLR group showed improved OS and PFS compared with the high NLR and PLR group [21.8 months (95% CI: 15.2–28.5) vs. 15.4 months (95% CI: 12.4–18.3), p < 0.0001; 21.6 months (95% CI: 15.8–27.5) vs. 14.9 months (95% CI: 11.9–17.8), p = 0.00027, respectively]. In addition, the low NLR and PLR group also provided a longer PFS than the high NLR and PLR group [10.4 months (95% CI: 8.9–12.0) vs. 8.1 months (95% CI: 7.1–9.2), p = 0.00022; 10.3 months (95% CI: 8.6–11.9) vs. 8.2 months (95% CI: 7.2–9.2), p < 0.0001, respectively]. High NLR and PLR at baseline were predictive factors of poor OS (p = 0.02 and p = 0.004) and PFS (p = 0.045 and p = 0.005). Conclusion: This study showed the prognostic value of quantitative inflammatory biomarkers in correlation with OS and PFS in unresectable HCC patients undergoing TACE plus sorafenib treatment.
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Affiliation(s)
- Lei Zhang
- Department of Radiology, The Affiliated People's Hospital of Ningbo University, Ningbo, China.,Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhi-Ping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institution of Medical Imaging, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhong-Heng Hou
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Huang
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Min-Jie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institution of Medical Imaging, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shuai Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shen Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shao-Hua Zhang
- Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen, China
| | - Xiao-Li Zhu
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cai-Fang Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Interventional Radiology and Vascular Surgery, The Dushu Lake Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiang Li
- Department of Radiology, The Affiliated People's Hospital of Ningbo University, Ningbo, China
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12
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Wang TC, An TZ, Li JX, Zhang ZS, Xiao YD. Development and Validation of a Predictive Model for Early Refractoriness of Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma. Front Mol Biosci 2021; 8:633590. [PMID: 33816555 PMCID: PMC8012485 DOI: 10.3389/fmolb.2021.633590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/07/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives: To develop and validate a predictive model for early refractoriness of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Methods: In this multicenter retrospective study, a total of 204 consecutive patients who initially underwent TACE were included. Early TACE refractoriness was defined as patients presented with TACE refractoriness after initial two consecutive TACE procedures. Of all patients, 147 patients (approximately 70%) were assigned to a training set, and the remaining 57 patients (approximately 30%) were assigned to a validation set. Predictive model was established using forward stepwise logistic regression and nomogram. Based on factors selected by logistic regression, a one-to-one propensity score matching (PSM) was conducted to compare progression-free survival (PFS) between patients who were present or absent of early TACE refractoriness. PFS curve was estimated by Kaplan-Meier method and compared by log-rank test. Results: Logistic regression revealed that bilobar tumor distribution (p = 0.002), more than three tumors (p = 0.005) and beyond up-to-seven criteria (p = 0.001) were significantly related to early TACE refractoriness. The discriminative abilities, as determined by the area under the receiver operating characteristic (ROC) curve, were 0.788 in the training cohort and 0.706 in the validation cohort. After PSM, the result showed that patients who were absent of early TACE refractoriness had a significantly higher PFS rate than those of patients who were present (p < 0.001). Conclusion: This study presents a predictive model with moderate accuracy to identify patients with high risk of early TACE refractoriness, and patients with early TACE refractoriness may have a poor prognosis.
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Affiliation(s)
- Tian-Cheng Wang
- Department of Radiology, Secong Xiangya Hospital, Central South University, Changsha, China
| | - Tian-Zhi An
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jun-Xiang Li
- Department of Interventional Radiology, Guizhou Medical University Affiliated Cancer Hospital, Guiyang, China
| | - Zi-Shu Zhang
- Department of Radiology, Secong Xiangya Hospital, Central South University, Changsha, China
| | - Yu-Dong Xiao
- Department of Radiology, Secong Xiangya Hospital, Central South University, Changsha, China
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