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Wang Z, Zhang H, Meng Q, Zhang DZ, Wu SS, Hong ZX, He GB, Yang H, Xiang BD, Li X, Jiang TA, Li K, Tang Z, Huang F, Lu M, Liu C, Yu XL, Cheng ZG, Liu FY, Han ZY, Dou JP, Yu J, Liang P. A multicenter case-controlled study on laparoscopic hepatectomy versus microwave ablation as first-line therapy for 3-5 cm hepatocellular carcinoma in patients aged 60 and older. Int J Surg 2024; 110:1356-1366. [PMID: 38320101 PMCID: PMC10942197 DOI: 10.1097/js9.0000000000000839] [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: 06/05/2023] [Accepted: 09/28/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND There is currently a lack of convincing evidence for microwave ablation (MWA) and laparoscopic liver resection (LLR) for patients ≥60 years old with 3-5 cm hepatocellular carcinoma. MATERIALS AND METHODS Patients were divided into three cohorts based on restricted cubic spline analysis: 60-64, 65-72, and ≥73 years. Propensity score matching (PSM) was performed to balance the baseline variables in a 1:1 ratio. Overall survival (OS) and disease-free survival (DFS) were assessed, followed by a comparison of complications, hospitalization, and cost. RESULTS Among 672 patients, the median age was 66 (IQR 62-71) years. After PSM, two groups of 210 patients each were selected. During the 36.0 (20.4-52.4) month follow-up period, the 1-year, 3-year, and 5-year OS rates in the MWA group were 97.6, 80.9, and 65.3% and 95.5, 78.7, and 60.4% in the LLR group (HR 0.98, P =0.900). The corresponding DFS rates were 78.6, 49.6, and 37.5% and 82.8, 67.8, and 52.9% (HR 1.52, P =0.007). The 60-64 age cohort involved 176 patients, with no a significant difference in OS between the MWA and LLR groups (HR 1.25, P =0.370), MWA was associated with a higher recurrence rate (HR 1.94, P =0.004). A total of 146 patients were matched in the 65-72 age cohort, with no significant differences in OS and DFS between the two groups (OS (HR 1.04, P =0.900), DFS (HR 1.56, P =0.110)). In 76 patients aged ≥73 years after PSM, MWA provided better OS for patients (HR 0.27, P =0.015), and there were no significant differences in DFS between the two groups (HR 1.41, P =0.380). Taken together, for patients older than 65 years, the recurrence rate of MWA was comparable with LLR. Safety analysis indicated that LLR was associated with more postoperative bleeding ( P =0.032) and hypoproteinemia ( P =0.024). CONCLUSIONS MWA was comparable to LLR in patients aged 65 years and older. MWA could be an alternative for the oldest old or the ill patients who cannot afford LLR, while LLR is still the first option of treatments for early-stage 3-5 cm hepatocellular carcinoma in capable elderly's.
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Affiliation(s)
- Zhen Wang
- Department of Interventional Ultrasound
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing
| | - Qiong Meng
- Department of Gynecology, Jinan Zhangqiu District People’s Hospital
| | - De-zhi Zhang
- Abdominal Ultrasound Department, The First Hospital of Jilin University, Changchun
| | - Song-song Wu
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fuzhou
| | - Zhi-xian Hong
- Department of Hepatobiliary Surgery, Fifth Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School
| | - Guang-bin He
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xian
| | - Hong Yang
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University
| | - Bang-de Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Tian-an Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Zhe Tang
- Department of Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu
| | - Fei Huang
- Department of General Surgery, The Second Affiliated Hospital of Guangxi Medical University, Nanning
| | - Man Lu
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu
| | - Cun Liu
- Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | | | | | | | | | | | - Jie Yu
- Department of Interventional Ultrasound
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Liang W, Hao W, Shao G, Zheng J, Zeng H, Zhou D, Yao H. Safety and Feasibility of Microwave Ablation for Hepatocellular Carcinomas in the Elderly: A Systematic Review. Front Oncol 2022; 12:855909. [PMID: 35677153 PMCID: PMC9167997 DOI: 10.3389/fonc.2022.855909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Microwave ablation (MWA) for hepatocellular carcinomas (HCCs) in the elderly has been the subject of new research in recent years. However, there are currently no strong lines of evidence for the prognosis following MWA treatment for HCC in the elderly. Therefore, we conducted a systematic review to assess the safety and feasibility of MWA for HCC in elderly patients. Methods Up until August 15, 2021, a comprehensive literature search was undertaken in PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases for all published articles. Observational studies reporting the safety and feasibility of MWA for HCC in elderly patients were included. The Newcastle–Ottawa Scale (NOS) was used to measure the quality assessment. Results Our review, composed of 7 observational studies, including a total of 7,683 HCC patients, looked at the safety and feasibility of MWA for HCC in the elderly. Current lines of evidence on the risks and outcomes of MWA of HCC treatments in elderly patients are discussed. Conclusions According to our findings, elderly patients, even those with a high comorbidity index, benefited from MWA of HCC similar to younger patients. More clinical data are needed to determine selection criteria for elderly HCC patients to increase the possibility of receiving MWA as a potential lifesaving option. As such, further studies evaluating the outcomes of MWA for HCC treatment modalities in elderly patients are warranted. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021273091.
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Affiliation(s)
- Weiren Liang
- Department of Interventional Therapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Weiyuan Hao
- Department of Interventional Therapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Guoliang Shao
- Department of Interventional Therapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- *Correspondence: Guoliang Shao,
| | - Jiaping Zheng
- Department of Interventional Therapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Hui Zeng
- Department of Interventional Therapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Danping Zhou
- Department of Endoscopy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Hefeng Yao
- Department of Medical Oncology, Huzhou Traditional Chinese Medicine Hospital of Zhejiang Traditional Chinese Medical University, Huzhou, China
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Zanus G, Tagliente G, Rossi S, Bonis A, Zambon M, Scopelliti M, Brizzolari M, Grossi U, Romano M, Finotti M. Pulsed Microwave Liver Ablation: An Additional Tool to Treat Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:748. [PMID: 35159014 PMCID: PMC8833939 DOI: 10.3390/cancers14030748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/15/2022] Open
Abstract
This study aimed to analyze the outcomes of HCC patients treated with a novel technique-pulsed microwave ablation (MWA)-in terms of safety, local tumor progression (LTP), intrahepatic recurrence (IHR), and overall survival (OS). A total of 126 pulsed microwave procedures have been performed in our center. We included patients with mono- or multifocal HCC (BCLC 0 to D). The LTP at 12 months was 9.9%, with an IHR rate of 27.8% at one year. Survival was 92.0% at 12 months with 29.4% experiencing post-operative complications (28.6% Clavien-Dindo 1-2, 0.8% Clavien-Dindo 3-4). Stratifying patients by BCLC, we achieved BCLC 0, A, B, C, and D survival rates of 100%, 93.2%, 93.3%, 50%, and 100%, respectively, at one year, which was generally superior to or in line with the expected survival rates among patients who are started on standard treatment. The pulsed MWA technique is safe and effective. The technique can be proposed not only in patients with BCLC A staging but also in the highly selected cases of BCLC B, C, and D, confirming the importance of the concept of stage migration. This procedure, especially if performed with a minimally invasive technique (laparoscopic or percutaneous), is repeatable with a short postoperative hospital stay.
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Affiliation(s)
- Giacomo Zanus
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Giovanni Tagliente
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Serena Rossi
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Alessandro Bonis
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Mattia Zambon
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Michele Scopelliti
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Marco Brizzolari
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Ugo Grossi
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Maurizio Romano
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Michele Finotti
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
- Baylor Scott & White Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75204, USA
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Iwata H, Ogino H, Hattori Y, Nakajima K, Nomura K, Hayashi K, Toshito T, Sasaki S, Hashimoto S, Mizoe JE, Shibamoto Y. Image-Guided Proton Therapy for Elderly Patients with Hepatocellular Carcinoma: High Local Control and Quality of Life Preservation. Cancers (Basel) 2021; 13:cancers13020219. [PMID: 33435340 PMCID: PMC7827493 DOI: 10.3390/cancers13020219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/25/2022] Open
Abstract
This study retrospectively investigated the efficacy and safety of image-guided proton therapy (IGPT) for elderly (≥80 years old) hepatocellular carcinoma (HCC) patients. Proton therapy was performed using respiratory-gated and image-guided techniques. Seventy-one elderly HCC patients were treated using IGPT. The Child-Pugh score was A5 in 49 patients, A6 in 15, and B7-9 in 7. Forty-seven patients with a peripherally located tumor were administered 66 gray relative biological effectiveness (GyRBE) in 10 fractions, whereas 24 with a centrally located tumor received 72.6 GyRBE in 22 fractions. The median follow-up period of surviving patients was 33 months (range: 9-68). Two-year overall survival (OS) and local control (LC) rates estimated by the Kaplan-Meier method were 76% (95% confidence interval: 66-87%) and 88% (80-97%), respectively. According to the Common Terminology Criteria for Adverse Events version 4.0, no grade 2 or higher radiation-induced liver disease was observed, and only 1 patient developed grade 3 dermatitis. The quality of life score (European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 version 3.0, QLQ-HCC18, and SF-36) did not change after 1 year, except for the three-mental component summary (SF-36, improvement). IGPT is a safe and effective treatment for HCC in elderly patients.
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Affiliation(s)
- Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya 462-8508, Japan; (H.I.); (Y.H.); (K.N.); (K.N.)
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan; (S.H.); (Y.S.)
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya 462-8508, Japan; (H.I.); (Y.H.); (K.N.); (K.N.)
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan; (S.H.); (Y.S.)
- Correspondence: ; Tel.: +81-52-991-8577
| | - Yukiko Hattori
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya 462-8508, Japan; (H.I.); (Y.H.); (K.N.); (K.N.)
| | - Koichiro Nakajima
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya 462-8508, Japan; (H.I.); (Y.H.); (K.N.); (K.N.)
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan; (S.H.); (Y.S.)
| | - Kento Nomura
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya 462-8508, Japan; (H.I.); (Y.H.); (K.N.); (K.N.)
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan; (S.H.); (Y.S.)
| | - Kensuke Hayashi
- Department of Proton Therapy Technology, Nagoya Proton Therapy Center, Nagoya 462-8508, Japan;
| | - Toshiyuki Toshito
- Department of Proton Therapy Physics, Nagoya Proton Therapy Center, Nagoya 462-8508, Japan;
| | - Shigeru Sasaki
- Department of Diagnostic Radiology, Nagoya City West Medical Center, Nagoya 462-8508, Japan;
| | - Shingo Hashimoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan; (S.H.); (Y.S.)
| | - Jun-etsu Mizoe
- Sapporo High Functioning Radiotherapy Center, Hokkaido Ohno Memorial Hospital, Sapporo 063-0052, Japan;
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan; (S.H.); (Y.S.)
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Liu LX, Liu B, Yu J, Zhang DY, Shi JH, Liang P. SP1-induced upregulation of lncRNA CTBP1-AS2 accelerates the hepatocellular carcinoma tumorigenesis through targeting CEP55 via sponging miR-195-5p. Biochem Biophys Res Commun 2020; 533:779-785. [PMID: 32988587 DOI: 10.1016/j.bbrc.2020.09.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 12/14/2022]
Abstract
As reported in many research, LncRNA CTBP1 divergent transcript (CTBP1-AS2) remarkably affects the progression of several tumors. However, the precise role and function of CTBP1-AS2 in hepatocellular carcinoma (HCC) remained unknown. We found that CTBP1-AS2 expressions were increased in HCC samples and cells. After treatment with microwave ablation (MWA), CTBP1-AS2 was distinctly up-regulated in residual HCC tissues compared with HCC samples. CTBP1-AS2 was upregulated under the induction of the nuclear transcription factor SP1. As revealed by the clinical assays, high CTBP1-AS2 expression usually related to lymph node metastasis, clinical stage and weaker prognosis specific to HCC patients. Functionally, CTBP1-AS2 knockdown suppressed HCC cells in terms of the proliferation, migration, invasion, chemotherapy resistance as well as EMT progress, but promoted apoptosis. Mechanistically, CTBP1-AS2 was a sponge of miR-195-5p for elevating CEP55 expression, a target of miR-195-5p, and thereby exhibited its oncogenic roles in HCC progression. Overall, an emerging regulatory mechanism of SP1/CTBP1-AS2/miR-195-5p/CEP55 axis was reported in the paper, which possibly served as a new therapeutic HCC treatment target.
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Affiliation(s)
- Li-Xia Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Haidian, 100853, Beijing, China; Department of Ultrasound, Affiliated Hospital of Hebei University, Baoding, 071000, Hebei, China
| | - Bin Liu
- Central Laboratory, Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Affiliated Hospital of Hebei University, Institute of Life Science and Green Development, Hebei University, Baoding, Hebei, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Haidian, 100853, Beijing, China
| | - Dong-Yun Zhang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Haidian, 100853, Beijing, China
| | - Jian-Hong Shi
- Central Laboratory, Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Affiliated Hospital of Hebei University, Institute of Life Science and Green Development, Hebei University, Baoding, Hebei, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Medical School of Chinese PLA, Haidian, 100853, Beijing, China.
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