Radiofrequency ablation for recurrent hepatocellular carcinoma in postresectional patients: prognostic factors analysis

Predictive Value of Ablative Margin Assessment After Microwave Ablation for Local Tumor Progression in Medium and Large Hepatocellular Carcinoma: Computed Tomography-Computed Tomography Image Fusion Method Versus Side-by-Side Method

OBJECTIVE

This study aimed to explore the feasibility and predictive value for local tumor progression (LTP) of the computed tomography (CT)-CT image fusion method versus side-by-side method to assess ablative margin (AM) in hepatocellular carcinoma ≥3 cm in diameter.

MATERIALS AND METHODS

We selected patients with hepatocellular carcinoma ≥3 cm in diameter who underwent microwave ablation and had complete tumor ablation. We used the CT-CT image fusion method and side-by-side method to assess AM separately and divided the lesions into 3 groups: group I, minimum ablative margin (min-AM) <0 mm (the ablation zone did not fully cover the tumor); group II, 0 mm ≤ min-AM <5 mm; and group III, min-AM ≥5 mm.

RESULTS

A total of 71 patients involving 71 lesions were included. The κ coefficient for the agreement between the CT-CT image fusion method and the side-by-side method in assessing min-AM was 0.14 (P = 0.028). Cumulative LTP rate was significantly different between groups by min-AM from the CT-CT image fusion method (P < 0.05) but not by min-AM from the side-by-side method (P = 0.807). Seventeen of the 20 LTP lesions were located at min-AM on fused CT images, with consistency rate of 85%.

CONCLUSIONS

Compared with the side-by-side method, the CT-CT image fusion method is more accurate in assessing the AM of eccentrically ablated lesions and shows better predictive value for LTP. The min-AM based on CT-CT image fusion assessment is an important influencing factor for LTP.

Development and validation of a clinicopathological-based nomogram to predict seeding risk after percutaneous thermal ablation of primary liver carcinoma

Objectives

To develop a clinicopathological‐based nomogram to improve the prediction of the seeding risk of after percutaneous thermal ablation (PTA) in primary liver carcinoma (PLC).

Methods

A total of 2030 patients with PLC who underwent PTA were included between April 2009 and December 2018. The patients were grouped into a training dataset (n = 1024) and an external validation dataset (n = 1006). Baseline characteristics were collected to identify the risk factors of seeding after PTA. The multivariate Cox proportional hazards model based on the risk factors was used to develop the nomogram, which was used for assessment for its predictive accuracy using mainly the Harrell's C‐index and receiver operating characteristic curve (AUC).

Results

The median follow‐up time was 30.3 months (range, 3.2‐115.7 months). The seeding risk was 0.89% per tumor and 1.5% per patient in the training set. The nomogram was developed based on tumor size, subcapsular, α‐fetoprotein (AFP), and international normalized ratio (INR). The 1‐, 2‐, and 3‐year cumulative seeding rates were 0.1%, 0.7% and 1.2% in the low‐risk group, and 1.7%, 6.3% and 6.3% in the high‐risk group, respectively, showing significant statistical difference (P < .001). The nomogram had good calibration and discriminatory abilities in the training set, with C‐indexes of 0.722 (95% confidence interval [CI]: 0.661, 0.883) and AUC of 0.850 (95% CI: 0.767, 0.934). External validation with 1000 bootstrapped sample sets showed a good C‐index of 0.706 (95% CI: 0.546, 0.866) and AUC of 0.736 (95% CI: 0. 646, 0.827).

Conclusions

The clinicopathological‐based nomogram could be used to quantify the probability of seeding risk after PTA in PLC.

A tumor map generated from three-dimensional visualization of image fusion for the assessment of microwave ablation of hepatocellular carcinoma: a preliminary study

PURPOSE

This study aimed to investigate the clinical value of a tumor map for assessing the ablative effect after ultrasound-guided percutaneous microwave ablation (US-PMWA) for hepatocellular carcinoma (HCC).

METHODS

The medical records of 68 patients (49 male and 19 female, 59.9±12.7 years) with HCC who underwent US-PMWA from May 2013 to May 2017 were reviewed. A tumor map was generated from the fusion of three-dimensional (3D) visualization images based on the preoperative target tumor and postoperative ablation area, to evaluate whether the ablation area covering the tumor has reached a 5 mm ablative margin (AM). The lesions were divided into two groups according to the tumor maps: group A (failed to achieve AM) and group B (achieved AM). The cumulative local tumor progression (LTP) rates of both groups were statistically analyzed using the log-rank test.

RESULTS

Success rate of tumor map generation was 100% (68/68), and no residual tumors were found. MWA-related 3D images, which included target tumor volume, ablation area volume, and residual liver ratio, were compared between groups A and B (P=0.295, P=0.772, and P=0.527, respectively). Technique effectiveness rate (91.7% vs 100%) was achieved in the two groups, showing no significant statistical differences (P=0.672). The 3-, 6-, 9-, and 12-month LTP rate was 8.3%, 16.7%, 20.8%, and 34%, respectively, for group A and 0%, 2.8%, 2.8%, and 2.8%, respectively, for group B, showing significant statistical differences (P<0.001) between the two groups.

CONCLUSION

The novel technology of tumor map generated from 3D visualization of image fusion is feasible and useful in evaluating the ablative effect of US-PMWA for HCC.

Efficacy of Percutaneous Thermal Ablation Combined With Transarterial Embolization for Recurrent Hepatocellular Carcinoma After Hepatectomy and a Prognostic Nomogram to Predict Survival

AIM

This study aimed to evaluate the efficacy of percutaneous thermal ablation combined with transarterial embolization for recurrent hepatocellular carcinoma after hepatectomy and establish a prognostic nomogram to predict survival.

METHODS

One hundred seventeen patients with recurrent hepatocellular carcinoma receiving ablation from 2009 to 2014 were included in primary cohort to establish a prognostic nomogram. Between 2014 and 2016, 51 patients with recurrent hepatocellular carcinoma treated by ablation were enrolled in the validation cohort to validate the predictive accuracy of the nomogram. All patients underwent locoregional ablation. Overall survival was the primary end point, and progression-free survival was the second end point. The performance of the nomogram was assessed through concordance index and calibration curve and compared with 5 conventional hepatocellular carcinoma staging systems.

RESULTS

The 1-, 3-, and 5-year overall survival rates of primary cohort were 88.4%, 70.7%, and 64.1%, respectively. The 1-, 3-, and 5-year progression-free survival rates of primary cohort were 44%, 14%, and 8.7%, respectively. The results of multivariate analysis showed that tumor size ( P = .0469; hazard ratio, 1.020; 95% confidence interval, 1.0004-1.040), preoperative extrahepatic disease ( P = .0675; hazard ratio, 2.604; 95% confidence interval, 0.933-7.264), and close to hepatic hilum <2 cm ( P = .0053; hazard ratio, 3.691; 95% confidence interval, 1.474-9.240) were predictive factors for overall survival. The study established a nomogram to predict survival (concordance index, 0.752; 95% confidence interval, 0.656-0.849). According to the predicted overall survival, patients with recurrent hepatocellular carcinoma were divided into 3 risk classes ( P < .05): low-risk group (total score <55; predicted 5-year overall survival rate, 82.9%), intermediate-risk group (55 ≤ total score < 99; predicted 5-year overall survival rate, 52.8%), and high-risk group (hazard ratio, total score ≥99; predicted 5-year overall survival rate, not available).

CONCLUSION

Percutaneous thermal ablation appears to be an effective procedure for the treatment of recurrent hepatocellular carcinoma after hepatectomy. The proposed nomogram provides a mechanism to accurately predict survival and could stratify risk among patients with recurrent hepatocellular carcinoma treated by ablation therapy.

Ultrasound-guided percutaneous microwave ablation assisted by athree-dimensional visualization treatment platform combined with transcatheter arterial chemoembolization for a single large hepatocellular carcinoma 5 cm or larger: a preliminary clinical application

Objective: To assess the clinical efficiency and feasibility of ultrasound-guided percutaneous microwave ablation (US-PMWA) assisted by a three-dimensional (3D) visualization platform for treating a single large hepatocellular carcinoma (HCC) (diameter ≥5 cm).Methods: We included 40 patients with a single large HCC from May 2015 to August 2017. Nineteen patients who underwent US-PMWA assisted by a 3D visualization platform formed the 3D group; 21 patients without 3D visualization assistance formed the control group. Preoperative planning and post-procedural evaluation were performed successfully with the 3D visualization treatment platform. Thermal ablative parameters, survival and recurrence were compared between groups.Results: The primary efficacy rate and recurrence-free survival (RFS) rate in the 3D group were higher than those in the control group (p = .007 and p = .014, respectively). The number of inserted probes in the 3D group was higher than that in the control group (p = .016). The overall survival (OS) rate in the 3D group was comparable to that of controls (p = .745). Estimated 3-year OS and RFS rates were 38.5% and 64.6% in the 3D group and 34.4% and 18.8% in the control group, respectively. Treatment effects were evaluated using a tumor map and confirmed by traditional contrast-enhanced ultrasound in the 3D group. After the first treatment, nine patients (47.4%) achieved complete ablation with a 5-mm safety margin. No major complications related to ablation occurred.Conclusions: US-PMWA assisted by a 3D visualization treatment platform can improve treatment efficiency and appears to be a safe, effective and innovative technique to manage a single large HCC.

Role of radiofrequency ablation in patients with hepatocellular carcinoma who undergo prior transarterial chemoembolization: long-term outcomes and predictive factors

Background/Aims

The role of radiofrequency ablation (RFA) remains uncertain in patients with viable hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE).

Methods

A total of 101 patients (April 2007 to August 2010) underwent RFA for residual or recurrent HCC after TACE. We analyzed their long-term outcomes and predictive factors.

Results

The overall survival rates after RFA were 93.1%, 65.4%, and 61.0% at 1, 3, and 5 years, respectively. Predictive factors for favorable overall survival were Child-Pugh class A (hazard ratio [HR], 3.45; p=0.001), serum α-fetoprotein (AFP) level <20 ng/mL (HR, 2.90; p=0.02), and recurrent tumors after the last TACE (HR, 3.14; p=0.007). The cumulative recurrence-free survival rate after RFA at 6 months was 50.1%. Predictive factors for early recurrence (within 6 months) were serum AFP level 20 ng/mL (HR, 3.02; p<0.001), tumor size 30 mm at RFA (HR, 2.90; p=0.005), and nonresponse to the last TACE (HR, 2.13; p=0.013).

Conclusions

Patients with recurrent or residual HCC who undergo prior TACE show a favorable overall survival, although their tumors seem to recur early and frequently. While good liver function, a low serum AFP level, and recurrent tumors were independent predictive factors for a favorable overall survival, poor response to TACE, a high serum AFP level, and large tumors are associated with early recurrence.

Percutaneous ablative therapies of recurrent hepatocellular carcinoma after hepatectomy: proposal of a prognostic model

BACKGROUND

Percutaneous ablative therapies (PAT) are valuable modalities for posthepatectomy recurrent hepatocellular carcinoma (RHCC), but its impact on long-term outcome and prognosis prediction have not been well documented. The present study aimed to analyze prognostic factors and to propose a prognosis-predicting model for RHCC treated with PAT.

METHODS

A total of 288 patients with posthepatectomy RHCC treated with percutaneous ethanol ablation, radiofrequency ablation, microwave ablation, or ethanol ablation combined with radiofrequency ablation were included. Survival and prognostic factors were analyzed. A prognosis-predicting model was created by quantifying and integrating all prognostic factors.

RESULTS

Three-, 5-, and 7-year postablation survival rates were 37.8, 20.7, and 14.2 %, respectively. Multivariate analysis revealed that interval between recurrence and initial hepatectomy, tumor number, largest diameter of tumor, and Barcelona Clinic Liver Cancer stage at hepatectomy were independent prognostic factors for survival. A scoring system for prognostic factors was proposed, and summation of 4 prognostic factors (prognostic score) was ranged from 4 to 10. Prognostic score was classified into three strata, designated as prognostic classes A (score 4 and 5), B (score 6 and 7), and C (≥8). Three-, 5-, and 7-year postablation survival rates were 62.8, 39.4, and 26.9 % in class A, 36.9, 15.5, and 7.2 % in B, and 5.5, 0, and 0 % in class C, respectively (p = 0.00). Three-, 5-, 7-, and 10-year survival rates after initial hepatectomy were 82.4, 66.3, 52.1, and 36.4 % in class A, 51.6, 34.8, 20.7, and 6.6 % in class B, and 11.9, 7.8, 0, and 0 % in class C, respectively (p = 0.00).

CONCLUSIONS

The prognostic model developed in the study could clearly predict different long-term outcomes for patients with posthepatectomy RHCC and thus help decide appropriate therapeutic strategy.