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Jing C, Li J, Yuan C, Hu C, Ma L, Zheng J, Zhang Y. Therapeutic analysis of 632 cases treated by transcatheter arterial chemoembolization combined with ablation in hepatocellular carcinoma: A retrospective study. Eur J Radiol 2024; 178:111619. [PMID: 39024666 DOI: 10.1016/j.ejrad.2024.111619] [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: 08/10/2023] [Revised: 06/23/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES This study aims to analyze the efficacy of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) in hepatocellular carcinoma (HCC). METHODS A retrospective analysis was conducted on 632 patients with HCC at Barcelona Clinic Liver Cancer Staging (BCLC) System stages 0, A, and B from Beijing You'an Hospital affiliated with Capital Medical University. The primary outcomes analyzed were overall survival (OS) and progression-free survival (PFS), while the secondary outcomes included one-, three-, and five-year OS rates among different groups. RESULTS The median follow-up period for 632 cases identified with HCC was 52.1 months (range: 3-162 months), while 127 patients died during follow-up. The one-, three-, and five-year OS rates were 97.1 %, 89.5 %, and 80.4 %, respectively. Moreover, the one-, three-, and five-year PFS rates were 58.1 %, 29.3 %, and 19.8 %, respectively. Multivariate analysis revealed that the BCLC stages and complete ablation were independent predictors of OS and PFS (all p < 0.05). Subgroup analysis showed no difference in OS rate among TACE-RFA, TACE-MWA, and TACE-CA groups, but TACE-CA showed better efficacy in improving the PFS rate (all p < 0.05). CONCLUSIONS The combination of TACE and ablation is effective in early-stage HCC and BCLC stage B. Complete ablation and BCLC stages are significant prognostic factors for PFS and OS. Further research, including randomized controlled trials, is needed to validate these findings.
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Affiliation(s)
- Changyou Jing
- Hepatic Disease and Tumor Interventional Treatment Center, Beijing You'an Hospital, Capital Medical University, Beijing 100069, People's Republic of China
| | - Jianjun Li
- Hepatic Disease and Tumor Interventional Treatment Center, Beijing You'an Hospital, Capital Medical University, Beijing 100069, People's Republic of China
| | - Chunwang Yuan
- Hepatic Disease and Tumor Interventional Treatment Center, Beijing You'an Hospital, Capital Medical University, Beijing 100069, People's Republic of China
| | - Caixia Hu
- Hepatic Disease and Tumor Interventional Treatment Center, Beijing You'an Hospital, Capital Medical University, Beijing 100069, People's Republic of China
| | - Liang Ma
- Hepatic Disease and Tumor Interventional Treatment Center, Beijing You'an Hospital, Capital Medical University, Beijing 100069, People's Republic of China
| | - Jiasheng Zheng
- Hepatic Disease and Tumor Interventional Treatment Center, Beijing You'an Hospital, Capital Medical University, Beijing 100069, People's Republic of China
| | - Yonghong Zhang
- Hepatic Disease and Tumor Interventional Treatment Center, Beijing You'an Hospital, Capital Medical University, Beijing 100069, People's Republic of China.
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Cheng JF, Sun QL, Tang L, Xu XJ, Huang XZ. Meta-analysis of transarterial chemoembolization combined with cryoablation vs transarterial chemoembolization alone for ≥ 5 cm hepatocellular carcinoma. World J Gastrointest Oncol 2024; 16:2793-2803. [PMID: 38994165 PMCID: PMC11236240 DOI: 10.4251/wjgo.v16.i6.2793] [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: 12/11/2023] [Revised: 03/01/2024] [Accepted: 04/16/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) ranks sixth globally in cancer incidence and third in mortality rates. Unfortunately, over 70% of HCC patients forego the opportunity for curative surgery or liver transplantation due to inadequate physical examinations, poor physical condition, and limited organ availability upon diagnosis. Clinical guidelines endorse transarterial chemoembolization (TACE) as the frontline treatment for intermediate to advanced-stage HCC. Cryoablation (CRA) is an emerging local ablative therapy increasingly used in HCC management. Recent studies suggest that combining CRA with TACE offers complementary and synergistic effects, potentially improving long-term survival rates. However, the superiority of combined TACE + CRA therapy over TACE alone for HCC lesions equal to or exceeding 5 cm requires further investigation. AIM To compare the efficacy and safety of TACE combined with CRA vs TACE alone in the treatment of HCC with a diameter of ≥ 5 cm. METHODS PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and VIP databases were searched to retrieve all relevant studies on TACE and CRA up to July 2022. Meta-analysis was performed using RevMan 5.3 software. RESULTS After screening according to the inclusion and exclusion criteria, 6 articles were included, including 2 randomized controlled trials and 4 nonrandomized controlled trials, with a total of 575 patients included in the meta-analysis. The results showed that the objective response rate [odds ratio (OR) = 2.56, 95% confidence interval (CI):1.66-3.96, P < 0.0001), disease control rate (OR = 3.03, 95%CI: 1.88-4.89, P < 0.00001), 1-year survival rate (OR = 3.79, 95%CI: 2.50-5.76, P < 0.00001), 2-year survival rate (OR = 2.34, 95%CI: 1.43-3.85, P = 0.0008), and 3-year survival rate (OR = 3.34, 95%CI: 1.61-6.94, P = 0.001) were all superior to those of the control group; the postoperative decrease in alpha-fetoprotein value (OR = 295.53, 95%CI: 250.22-340.85, P < 0.0001), the postoperative increase in CD4 value (OR = 10.59, 95%CI: 8.78-12.40, P < 0.00001), and the postoperative decrease in CD8 value (OR = 6.47, 95%CI: 4.44-8.50, P < 0.00001) were also significantly higher than those in the TACE-alone treatment group. CONCLUSION Compared with TACE-alone treatment, TACE + CRA combined treatment not only improves the immune function of HCC patients with a diameter of ≥ 5 cm, but also enhances the therapeutic efficacy and long-term survival rate, without increasing the risk of complications. Therefore, TACE + CRA combined treatment may be a more recommended treatment for patients with HCC with a diameter of ≥ 5 cm.
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Affiliation(s)
- Jie-Fei Cheng
- Department of Radiology, The Fifth People’s Hospital of Taizhou, Taizhou 225300, Jiangsu Province, China
| | - Qiu-Lian Sun
- Department of Radiology, The Fifth People’s Hospital of Suzhou, Suzhou 215100, Jiangsu Province, China
| | - Ling Tang
- Department of Radiology, The Fourth People’s Hospital of Taizhou, Taizhou 225300, Jiangsu Province, China
| | - Xin-Jian Xu
- Department of Interventional Radiology, Jiangyin People Hospital, Jiangyin 214400, Jiangsu Province, China
| | - Xiang-Zhong Huang
- Department of Interventional Radiology, Jiangyin People Hospital, Jiangyin 214400, Jiangsu Province, China
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Wang Y, Li W, Man W, Dong X, Luo Y, Zhang Y, Zhang Y, Dong C, Sun W, Yang P. Comparison of Efficacy and Safety of TACE Combined with Microwave Ablation and TACE Combined with Cryoablation in the Treatment of Large Hepatocellular Carcinoma. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:9783113. [PMID: 35795769 PMCID: PMC9252684 DOI: 10.1155/2022/9783113] [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: 04/27/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
Purpose To retrospectively evaluate the efficacy and safety of TACE combined with microwave ablation (MWA) and TACE combined with cryoablation (CRA) in the treatment of large hepatocellular carcinoma. Methods A retrospective analysis was performed on 81 patients with large hepatocellular carcinoma (tumor diameter 5~8 cm cm) who received TACE combined with ablation in our hospital from February 2015 to February 2019. The study patients were divided into TACE combined with MWA group (T-MWA, n = 41) and TACE combined with CRA group (T-CRA, n = 40) according to the treatment plan. Overall survival (OS) and progress free survival (PFS) were compared between the two groups, and complications were observed. Survival curves for OS and PFS were constructed by the Kaplan-Meier method. Differences in overall survival were compared using the log-rank test. Results There was no statistical difference in general conditions between the two groups of patients. The results showed that 30 (73.2%) patients in T-MWA group achieved objective response (OR) and 39 (95.1%) patients achieved disease control (DC), compared with 24 (60.0%) patients in T-CRA group who achieved objective response (OR) and 37 (92.5%) patients who achieved disease control (DC). The median OS was 19.2 months in the T-MWA group and 18.6 months in the T-CRA group (P=0.64). The median PFS was 9.3 months in the T-MWA group and 12.3 months in the T-CRA group (P=0.6). Univariate and multivariate analysis showed that portal vein tumor thrombus (PVTT), intrahepatic tumor diameter, and the number of tumor lesions were common prognostic factors for OS and PFS. In terms of surgery-related complications and adverse reactions, abdominal pain and gastrointestinal reactions were observed in 13 (31.7%) and 11(26.8%) cases in the T-MWA group, while we observed 4 (10.0%) and 2 (5.0%) cases in the T-CRA group, respectively. The difference between the two was statistically significant (P < 0.05). Conclusion TACE combined with MWA and TACE combined with CRA were equally effective in the treatment of large hepatocellular carcinoma. TACE-CRA can effectively reduce the incidence of abdominal pain and gastrointestinal reactions in patients. However, compared with TACE-MWA, TACE-CRA is more likely to cause thrombocytopenia.
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Affiliation(s)
- Yujia Wang
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Wei Li
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Wenling Man
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Xiaolin Dong
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Yinghao Luo
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Yan Zhang
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Yongchuang Zhang
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Chang Dong
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Weiwei Sun
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Po Yang
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
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Comparison of combined transarterial chemoembolization and ablations in patients with hepatocellular carcinoma: a systematic review and meta-analysis. Abdom Radiol (NY) 2022; 47:1009-1023. [PMID: 34982183 DOI: 10.1007/s00261-021-03368-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE This systematic review and meta-analysis compares the efficacy of three combination therapies, including transarterial chemoembolization (TACE) with radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CRA) for the treatment of patients with hepatocellular carcinoma (HCC). METHODS Online databases, including Scopus, Web of Science, PubMed, Embase, CNKI, Google Scholar, and Cochrane Library were searched. RESULTS Forty-two studies with 5468 pooled patients (TACE + RFA: 21 studies with 3398 patients, TACE + MWA:14 studies with 1477 patients, and TACE + CRA: 7 studies with 593 patients) reported combination therapy versus TACE alone. The TACE + MWA subcohort had the best odds of long-term overall survival (OR 4.81, 95% CI 1.44, 16.08, P = 0.011) and objective response rate (OR 3.93, 95% CI 2.34, 6.61, P < 0.001) compared with the other two combination subcohorts. The TACE + RFA and TACE + MWA subcohorts had approximately similar odds of 1-year recurrence-free survival (OR 5.21, 95% CI 2.13, 12.75, P < 0.001 and OR 4.61, 95% CI 1.70, 12.51, P = 0.003, respectively). The disease control rate was similar between the TACE + MWA and TACE + CRA subcohorts (OR 4.01, 95% CI 2.66, 6.04, P < 0.001 and OR 4.05, 95% CI 1.68, 9.74, P = 0.002) but greater than the TACE + RFA subcohort (OR 3.23, 95% CI 2.14, 4.86, P < 0.001). CONCLUSION Overall, the TACE + MWA subcohort had the best efficacy and outcomes, especially for younger patients (less than 60-year-old) with tumor size of ≤ 3 cm, compared with the TACE + RFA or TACE + CRA subcohorts.
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Percutaneous Cryoablation of Large Tumors: Safety, Feasibility, and Technical Considerations. Cardiovasc Intervent Radiol 2021; 45:69-79. [PMID: 34859309 DOI: 10.1007/s00270-021-03025-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Large tumors may prove unsuitable for surgical cure or other local therapies due to their size, involvement of critical structures, prior non-ablative treatment failure, or coexisting disease burden. This study was performed to assess the safety and feasibility of percutaneous cryoablation for treatment of large tumors exceeding 6 cm in size, and to highlight the key technical considerations inherent to such cases. MATERIALS AND METHODS This single-institution retrospective study identified 77 patients (42 male, 35 female; median age 55 years) who underwent 96 cryoablation procedures for treatment of 78 tumors (mean diameter 9.8 ± 3.6 cm) from 2008 through 2020. Technical success, procedure-related complications, mortality, oncologic outcomes, and procedural logistics were evaluated. Technical success was defined as ice ball extension at least 5 mm beyond the tumor margins. RESULTS Intentional subtotal ablations were performed in 32% of cases due to tumor encroachment on vulnerable structures or as part of staged/combined therapies. Of the 68% of cases that were planned for complete ablation, the technical success rate was 100%. Major complications occurred after 19/96 (20%) procedures, with hemorrhage and acute kidney injury each occurring in 6/96 (6%). Post-procedural myositis occurred in 24/96 (25%) cases and was not considered a major complication in the absence of acute kidney injury. Local recurrence occurred in 2/23 (8.7%) of patients undergoing ablation for cure or local control at a median follow-up duration of 13 months. CONCLUSION Percutaneous cryoablation may be used to treat large (> 6 cm) tumors with a high degree of technical success and an acceptable safety profile.
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Chen L, Ren Y, Sun T, Cao Y, Yan L, Zhang W, Ouyang T, Zheng C. The efficacy of radiofrequency ablation versus cryoablation in the treatment of single hepatocellular carcinoma: A population-based study. Cancer Med 2021; 10:3715-3725. [PMID: 33960697 PMCID: PMC8178489 DOI: 10.1002/cam4.3923] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) is an effective treatment for single hepatocellular carcinoma (HCC), but it is difficult to use against tumors in some locations and often leads to incomplete ablation as a result of the heat-sink effect. This study was conducted to evaluate the efficacy of cryoablation compared with that of RFA in the treatment of single HCC. METHODS This retrospective study was conducted based on the Surveillance, Epidemiology, and End Results (SEER) database. From 2004 to 2015, patients aged 40 to 79 diagnosed with HCC were included in the study. A propensity score matching (PSM) model was used to reduce selection biases. RESULTS Before PSM, the median overall survival (mOS) and median cancer-specific survival (mCSS) in the RFA group were slightly longer than those in the cryoablation group (p > 0.05). In the subgroup analysis, the mOS and mCSS of patients with tumor sizes <3, 3-5, and >5 cm who received RFA treatment were longer than those of patients given cryoablation treatment, but there was no significant difference (p > 0.05). Similar results were presented in patients at American Joint Committee on Cancer (AJCC) stages I and II. After PSM, the mOS and mCSS were slightly better in the RFA group than the cryoablation group but without significant differences. Univariate and multivariate analysis showed that cryoablation treatment was not an unfavorable factor for OS and CSS before or after PSM (p > 0.05). In the multivariable competing risk model, non-cancer-specific death was taken as a competing factor and cryoablation was also not unfavorable for the survival of patients before and after PSM (p > 0.05). CONCLUSION Cryoablation is non-inferior to RFA therapy for single HCC patients without lymph node invasion or distant metastasis.
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Affiliation(s)
- Lei Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.,Department of interventional radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanqiao Ren
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.,Department of interventional radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Sun
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.,Department of interventional radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanyan Cao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.,Department of interventional radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liangliang Yan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.,Department of interventional radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihua Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.,Department of interventional radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Ouyang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.,Department of interventional radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.,Department of interventional radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wei J, Cui W, Fan W, Wang Y, Li J. Unresectable Hepatocellular Carcinoma: Transcatheter Arterial Chemoembolization Combined With Microwave Ablation vs. Combined With Cryoablation. Front Oncol 2020; 10:1285. [PMID: 32850395 PMCID: PMC7426718 DOI: 10.3389/fonc.2020.01285] [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: 03/10/2020] [Accepted: 06/22/2020] [Indexed: 01/04/2023] Open
Abstract
Background: Transcatheter arterial chemoembolization (TACE) combined with ablation has been widely used for treating unresectable hepatocellular carcinoma (HCC). However, the technique with which TACE should be combined for it to be more effective remains unknown. Purpose: To retrospectively evaluate the efficacy and safety of TACE combined with microwave ablation (MWA) vs. TACE combined with cryoablation (CRA) in treating unresectable HCC. Materials and Methods: From January 2011 to December 2018, 108 patients diagnosed with unresectable HCC were divided into either the TACE-MWA group (n = 48) or TACE-CRA group (n = 60). Overall survival (OS) and time to progression (TTP) were compared between the two groups. To reduce potential bias, a propensity score matching (PSM) was performed. Complications were observed. Kaplan-Meier survival curves were constructed and compared using the log-rank test. Results : The baseline characteristics of the two groups were balanced. The median OS was 20.9 months (95% CI 14.3-27.6 months) in the TACE-MWA group and 13.0 months (95% CI 8.8-17.1 months) in the TACE-CRA group (P = 0.096). The median TTP was 8.8 months (95% CI 4.3-13.4 months) in the TACE-MWA group and 9.3 months (95% CI 7.1-11.5 months) in the TACE-CRA group (P = 0.675). After PSM, 48 patients remained in each group. The median OS in the TACE-MWA and TACE-CRA groups was 20.9 months (95% CI 14.3-27.6 months), and 13.5 months (95% CI 8.4-18.6 months, P = 0.100), respectively. The median TTP in the TACE-MWA and TACE-CRA groups was 8.8 months (95% CI 4.3-13.4 months), and 8.6 months (95% CI 3.1-14.2 months, P = 0.909), respectively. The overall incidence rate of ablation-related complications was lower in the TACE-MWA group than in the TACE-CRA group (66.7 vs. 88.3%, P = 0.006). Multivariate analysis showed that the presence of portal vein tumor thrombus (PVTT) and the maximum diameter of intrahepatic tumor were significant prognostic factors for OS and TTP. Conclusion: The efficacy of TACE-MWA and TACE-CRA in the treatment of unresectable HCC was comparable. TACE-MWA was more promising because of a lower complication rate, especially with regard to thrombocytopenia. Further prospective randomized controlled trials are required to validate our findings.
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Affiliation(s)
- Jialiang Wei
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Cui
- Department of Interventional Therapy, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Wenzhe Fan
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Wang
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiaping Li
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Wang L, Ke Q, Lin N, Huang Q, Zeng Y, Liu J. The efficacy of transarterial chemoembolization combined with microwave ablation for unresectable hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperthermia 2020; 36:1288-1296. [PMID: 31852267 DOI: 10.1080/02656736.2019.1692148] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose: To evaluate the clinical value of transarterial chemoembolization (TACE) combined with microwave ablation (MWA) for unresectable hepatocellular carcinoma (HCC).Patients and methods: Eligible studies were identified using PubMed, MedLine, Embase, the Cochrane Library, and Web of Science, investigating the synergistic effect of TACE + MWA in the treatment of advanced HCC. Endpoints were the 1-, 2- and 3-year survival rates, local control rate (LCR), objective remission rate (ORR), and adverse event (AE). Odds ratio (OR) with 95% confidence interval (CI) was used to determine the effect size.Results: Nine studies including 351 patients in the TACE + MWA group and 653 patients in the TACE group were enrolled in this meta-analysis. The pooled OR for the 1-, 2-, and 3-year survival rates were in favor of TACE + MWA (OR = 3.29, 95% CI 2.26-4.79; OR = 2.82, 95% CI 2.01-3.95; OR = 4.50, 95% CI 2.96-6.86; respectively). The pooled OR for the ORR and LCR were also in favor of TACE + MWA (OR = 4.64, 95%CI 3.11-6.91; OR = 3.93, 95% CI 2.64-5.87; respectively). No significant difference in the incidence of severe AE was observed between TACE + MWA group and TACE group (p > .05). However, subgroup analysis showed that patients with tumor size >5 cm were more likely to be benefited from TACE + MWA, rather than patients with tumor size ≤5 cm.Conclusion: With the current data, we concluded that combination TACE and MWA was safe, and should be strongly recommended to unresectable patients with tumor size >5 cm, but TACE alone was enough for unresectable patients with tumor size ≤5 cm. However, the conclusion needs further validation.
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Affiliation(s)
- Lei Wang
- Department of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University
| | - Qiao Ke
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University
| | - Nanping Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University
| | - Qizhen Huang
- Department of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University
| | - Yongyi Zeng
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University
| | - Jingfeng Liu
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University.,Liver Disease Center, The First Affiliated Hospital of Fujian Medical University
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Huang Z, Zuo M, Ni J, Gu Y, Zhang T, Jiang Y, Zhuo S, An C, Huang J. Assessment in the Survival Outcome After Transarterial Chemoembolization Combined with Cryoablation for Hepatocellular Carcinoma (Diameter > 4cm) Based on the Albumin-Bilirubin Grade and Platelet-Albumin-Bilirubin grade: A Preliminary Study. Cancer Manag Res 2020; 12:1373-1385. [PMID: 32158269 PMCID: PMC7049291 DOI: 10.2147/cmar.s234116] [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: 10/10/2019] [Accepted: 02/13/2020] [Indexed: 12/26/2022] Open
Abstract
Objective Based on the albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grade to assess the long-term outcomes of patients with large hepatocellular carcinoma (HCC) after transarterial chemoembolization combined with cryoablation (TACE-CRA). Materials and Methods We studied 86 patients with HCC nodules (up to 3 HCCs with maximum diameters of 4.1–12.0 cm) who subsequently underwent TACE-CRA from July 2007 to August 2018. The overall survival (OS) was compared between groups classified by ALBI and PALBI grade. Baseline characteristics were collected to identify the risk factors for determination of poor OS after TACE-CRA. The prognostic performances of CTP class, ALBI and PALBI grade were compared. Results After a median follow-up time of 33.8 months, 41 patients had died. The cumulative1-, 3- and 5-year OS rates were 74.5%, 38.0% and 29.3%, respectively. Stratified according to ALBI grade, the cumulative 3- and 5-year OS rates were 41.2% and 41.2% in grade 1, respectively, and 20.9% and 9.8% in grades 2–3, respectively (P < 0.001). Stratified according to PALBI grade, the cumulative 3- and 5-year OS rates were 41.2% and 37.5% in grade 1, respectively, and 36.3% and 21.2% in grades 2–3, respectively (P = 0.002). Multivariate analysis results showed that older age, and ALBI grade 2–3 were associated with overall mortality. ALBI grade demonstrated significantly greater area under the curve values than CTP class and PALBI in predicting 1-, 3- and 5-year OS. Conclusion ALBI grade offers accurate prediction of long-term outcome for patients with HCC (diameter > 4 cm) after TACE-CRA.
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Affiliation(s)
- Zhimei Huang
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Mengxuan Zuo
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Jiayan Ni
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Yangkui Gu
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Tianqi Zhang
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Yiquan Jiang
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Shuiqing Zhuo
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Chao An
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Jinhua Huang
- Department of Minimal Invasive Intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
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10
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Ni JY, Fang ZT, Sun HL, An C, Huang ZM, Zhang TQ, Jiang XY, Chen YT, Xu LF, Huang JH. A nomogram to predict survival of patients with intermediate-stage hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation. Eur Radiol 2020; 30:2377-2390. [PMID: 31900694 DOI: 10.1007/s00330-019-06438-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/30/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To develop a prognostic nomogram based on the albumin-bilirubin (ALBI) grade for prediction of the long-term survival of patients with intermediate-stage hepatocellular carcinoma (HCC) after transarterial chemoembolization combined with microwave ablation (TACE-MWA). METHODS We retrospectively studied 546 consecutive patients with intermediate-stage HCC according to the Barcelona Clinic Liver Cancer guidelines who underwent TACE-MWA between January 2000 and December 2016. Overall survival (OS) and progression-free survival (PFS) were analyzed. The predictive value of the ALBI grade was investigated. The prognostic nomogram was constructed using the independent predictors assessed by the multivariate Cox proportional hazards model. RESULTS After a median follow-up of 35.0 months (range, 4.0-221.0 months), 380 patients had died. The median OS was 35.0 months (95% confidence interval (CI), 30.84-39.16 months), and the median PFS was 6.5 months (95% CI, 6.13-6.87 months). The ALBI grade was validated as an independent predictor of OS (p < 0.001). Multivariate analyses showed that Eastern Cooperative Oncology Group performance status score more than 0, presence of liver cirrhosis, a-fetoprotein level above 400 ng/mL, tumor size greater than 5 cm, tumor number more than 3, advanced ALBI grade, and treatment sessions of TACE or MWA fewer than 3 were independently associated with overall mortality. The prognostic nomogram incorporating these eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770 (95% CI, 0.746-0.795). CONCLUSIONS The prognostic nomogram based on the ALBI grade resulted in reliable efficacy for prediction of individualized OS in patients with intermediate-stage HCC after TACE-MWA. KEY POINTS • TACE-MWA was associated with a median overall survival of 35.0 months for patients with intermediate-stage HCC. • A prognostic nomogram was built to predict individualized survival of patients with intermediate-stage HCC after TACE-MWA. • The prognostic nomogram incorporating eight predictors achieved good calibration and discriminatory abilities with a concordance index of 0.770.
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Affiliation(s)
- Jia-Yan Ni
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Road West, Guangzhou, 510120, Guangdong Province, People's Republic of China
| | - Zhu-Ting Fang
- Department of Interventional Radiology, Fujian Provincial Hospital, Provincial Clinic College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Hong-Liang Sun
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Road West, Guangzhou, 510120, Guangdong Province, People's Republic of China
| | - Chao An
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhi-Mei Huang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Tian-Qi Zhang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Xiong-Ying Jiang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Road West, Guangzhou, 510120, Guangdong Province, People's Republic of China
| | - Yao-Ting Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Road West, Guangzhou, 510120, Guangdong Province, People's Republic of China
| | - Lin-Feng Xu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Road West, Guangzhou, 510120, Guangdong Province, People's Republic of China.
| | - Jin-Hua Huang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China.
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11
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Hu J, Chen S, Wang X, Lin N, Yang J, Wu S. Image-Guided Percutaneous Microwave Ablation Versus Cryoablation For Hepatocellular Carcinoma In High-Risk Locations: Intermediate-Term Results. Cancer Manag Res 2019; 11:9801-9811. [PMID: 31819618 PMCID: PMC6873974 DOI: 10.2147/cmar.s227961] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/25/2019] [Indexed: 12/24/2022] Open
Abstract
Objective The aims of this study were to compare the clinical outcomes between image-guided percutaneous microwave ablation (MWA) and cryoablation (CRA) in patients with hepatocellular carcinoma (HCC) in high-risk locations and to identify the prognostic factors associated with the two treatment methods. Methods This retrospective study was institutional review board approved. A total of 120 patients (88 men and 32 women) with one hundred and thirty-four HCC lesions in high-risk locations from April 2014 to March 2018 were reviewed. Sixty-four patients underwent MWA and 56 patients underwent CRA. Survival, recurrence and complications were compared between the two groups. Effect of changes in key outcomes (i.e., overall survival (OS), recurrence-free survival (RFS) and local tumor progression (LTP)) was statistically analyzed with the log rank test. Univariate and multivariate analysis were performed on clinicopathological variables to identify factors affecting intermediate-term outcomes. Results The OS and RFS after MWA were comparable to those of CRA (P =0.141, and P=0.469, respectively). The LTP and major complication in MWA group was higher than those in CRA group (P=0.003, and P=0.039). Univariate analysis showed that age (P=0.007), tumor size (P=0.001), and Child-Turcotte-Pugh (CTP) grade (P=0.003) were risk factors for OS, and multivariate analysis results showed that older age (≥65 years) (P=0.002, HR:3.338, 95% CI:1.928–5.281), 3.0–5.0 cm in size (P<0.001, HR: 3.312, 95% CI: 1.872–4.489) and CTP grade B (P=0.001, HR:3.382, 95% CI: 1.882–5.902) were independently associated with poor OS. Conclusion CRA had comparable oncologic outcomes with MWA and could be a safe and effective treatment for HCC in high-risk locations.
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Affiliation(s)
- Jiahui Hu
- Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, People's Republic of China
| | - Sheng Chen
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, People's Republic of China
| | - Xin Wang
- Department of Oncology, Fuzhou Hospital of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350001, People's Republic of China
| | - Ning Lin
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, People's Republic of China
| | - Jianchuan Yang
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, People's Republic of China
| | - Songsong Wu
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, People's Republic of China
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