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Zhang Z, Yu J, Liu S, Dong L, Liu T, Wang H, Han Z, Zhang X, Liang P. Multiparametric liver MRI for predicting early recurrence of hepatocellular carcinoma after microwave ablation. Cancer Imaging 2022; 22:42. [PMID: 36042507 PMCID: PMC9429304 DOI: 10.1186/s40644-022-00471-5] [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: 03/03/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background High early recurrence (ER) of hepatocellular carcinoma (HCC) after microwave ablation (MWA) represents a sign of aggressive behavior and severely worsens prognosis. The aim of this study was to estimate the outcome of HCC following MWA and develop a response algorithmic strategy based on multiparametric MRI and clinical variables. Methods In this retrospective study, we reviewed the records of 339 patients (mean age, 62 ± 12 years; 106 men) treated with percutaneous MWA for HCC between January 2014 and December 2017 that were evaluated by multiparametric MRI. These patients were randomly split into a development and an internal validation group (3:1). Logistic regression analysis was used to screen imaging features. Multivariate Cox regression analysis was then performed to determine predictors of ER (within 2 years) of MWA. The response algorithmic strategy to predict ER was developed and validated using these data sets. ER rates were also evaluated by Kaplan–Meier analysis. Results Based on logistic regression analyses, we established an image response algorithm integrating ill-defined margins, lack of capsule enhancement, pre-ablative ADC, ΔADC, and EADC to calculate recurrence scores and define the risk of ER. In a multivariate Cox regression model, the independent risk factors of ER (p < 0.05) were minimal ablative margin (MAM) (HR 0.57; 95% CI 0.35 – 0.95; p < 0.001), the recurrence score (HR: 9.25; 95% CI 4.25 – 16.56; p = 0.021), and tumor size (HR 6.21; 95% CI 1.25 – 10.82; p = 0.014). Combining MAM and tumor size, the recurrence score calculated by the response algorithmic strategy provided predictive accuracy of 93.5%, with sensitivity of 92.3% and specificity of 83.1%. Kaplan–Meier estimates of the rates of ER in the low-risk and high-risk groups were 6.8% (95% CI 4.0 – 9.6) and 30.5% (95% CI 23.6 – 37.4), respectively. Conclusion A response algorithmic strategy based on multiparametric MRI and clinical variables was useful for predicting the ER of HCC after MWA. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00471-5.
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Affiliation(s)
- Zhaohe Zhang
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Haidian District, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Jie Yu
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Haidian District, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Sisi Liu
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Haidian District, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Linan Dong
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Haidian District, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Tiefang Liu
- Department of Medical Imaging, PLA Medical College & First Medical Center Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Haiyi Wang
- Department of Medical Imaging, PLA Medical College & First Medical Center Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhiyu Han
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Haidian District, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Xiaojing Zhang
- Department of Medical Imaging, PLA Medical College & First Medical Center Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ping Liang
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Haidian District, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
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Cost-Effectiveness Analysis of Follow-Up Schedule for Hepatocellular Carcinoma after Radiofrequency Ablation. JOURNAL OF ONCOLOGY 2022; 2022:3569644. [PMID: 35345515 PMCID: PMC8957434 DOI: 10.1155/2022/3569644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
Methods A Markov model was established to evaluate the cost-effectiveness of every 2 months or 2-3 months (2- to 3-month group) versus every 3 months or 3-4 months (3- to 4-month group) posttreatment surveillance in the first two years for HCC after RFA. Transition probabilities and utility values were derived from the literature review. Costs of follow-up were estimated from our institution. The incremental cost-effectiveness ratio (ICER), which was less than $10888 per quality-adjusted life-year (QALY), was considered cost-effective. Sensitivity analyses were performed to determine the uncertainty of the model. Results The 2- to 3-month group gained 1.196 QALYs at a cost of $2212.66, while the effectiveness and cost of the 3- to 4-month group were 1.029 QALYs and $1268.92, respectively. The ICER of the 2- to 3-month group versus the 3- to 4-month group was $5651.14 per QALY gained, which was less than the willingness-to-pay threshold of 1-time gross domestic product per capita of China ($10888/QALY). One-way sensitivity analysis showed that the model was most sensitive to the utility of progression-free survival. The probabilistic sensitivity analysis demonstrated that the 2- to 3-month group had a higher probability of being more cost-effective than the 3- to 4-month group when willingness to pay was over $1088.8. Conclusions Every 2 months or 2-3 months of follow-up intervals were more cost-effective than 3 months or 3-4 months of follow-up intervals. Thus, the intensive follow-up interval in the first two years was recommended for Child-Pugh class A or B HCC patients within the Milan criteria following RFA.
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Nam D, Chapiro J. Machine Learning-Based Surveillance Strategy after Complete Ablation of Initially Recurrent Hepatocellular Carcinoma: Worth the Risk? J Vasc Interv Radiol 2021; 32:1558-1559. [PMID: 34717834 DOI: 10.1016/j.jvir.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- David Nam
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar Street, The Anlyan Center, N312A, New Haven, CT 06520
| | - Julius Chapiro
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar Street, The Anlyan Center, N312A, New Haven, CT 06520.
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Sun X, Yang Z, Mei J, Lyu N, Lai J, Chen M, Zhao M. The guiding value of microvascular invasion for treating early recurrent small hepatocellular carcinoma. Int J Hyperthermia 2021; 38:931-938. [PMID: 34121576 DOI: 10.1080/02656736.2021.1937715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) have worse survival. Whether the presence of MVI indicates the necessity of more aggressive locoregional treatments for recurrences remains to be elucidated. METHODS We reviewed patients who underwent curative hepatectomy for primary HCC in our institution, and 379 patients with recurrent HCC up to three nodules smaller than 3 cm were enrolled. The Kaplan-Meier method was adopted to compare the secondary recurrence-free survival (sRFS) and post-recurrence survival (PRS) among patients undergoing hepatectomy, RFA and transarterial chemoembolization plus RFA (TACE-RFA). Cox regression analyses were performed to identify independent prognostic factors. RESULTS Both the sRFS and PRS of the MVI (-) group were significantly longer than those of the MVI (+) group (p = 0.001 and 0.011). For patients with MVI (-), no significant difference was found in sRFS or PRS among recurrent HCC patients receiving hepatectomy, RFA or TACE-RFA (p = 0.149 and 0.821). A similar trend was found in patients with MVI (+) (p = 0.851 and 0.960). Further analysis found that TACE-RFA provided better sRFS than hepatectomy or RFA alone in patients with MVI (+) and early recurrence within two years (p = 0.036 and 0.044). CONCLUSION For HCC patients with MVI (+) and early small recurrence, TACE-RFA could achieve better prognosis than hepatectomy or RFA alone, while RFA alone provided comparable survival benefits compared with hepatectomy or TACE-RFA in other HCC patients with small recurrence.
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Affiliation(s)
- Xuqi Sun
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Ziliang Yang
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jie Mei
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ning Lyu
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Minimally Invasive Interventional Division, Liver Cancer Group, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jinfa Lai
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Minimally Invasive Interventional Division, Liver Cancer Group, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Minshan Chen
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ming Zhao
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Minimally Invasive Interventional Division, Liver Cancer Group, Sun Yat-Sen University Cancer Center, Guangzhou, China
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Mocan T, Nenu I, Crăciun R, Spârchez Z. Treatment of hepatitis C virus infection in patients with hepatocellular carcinoma: Truth or dare? J Gastroenterol Hepatol 2021; 36:1518-1528. [PMID: 33326142 DOI: 10.1111/jgh.15376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/08/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022]
Abstract
The discovery of direct acting antivirals (DAA) with high rates of sustained virusological response is the biggest epoch-making event in the history of hepatitis C virus (HCV) treatment. DAAs improve liver function, prevent hepatic decompensation, and might even reverse liver fibrosis. Although initial research pointed towards a potential drawback, it is now known beyond doubt that DAA treatment reduces hepatocellular carcinoma (HCC) occurrence or recurrence after curative treatments. Unfortunately, the story has reached another plot twist, as several other issues have emerged: (i) Should we treat patients with early HCC and HCV before or after surgery/ablation? (ii) Should patients with HCC on the waiting list receive DAA before or after liver transplantation? (iii) Should we use interferon-free in patients with intermediate stage HCC or in patients under systemic treatments? In this review, we aim to offer some evidence-based answers to these changing clinical dilemmas where possible, or at least some educated guesses in cases were no or little data exists.
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Affiliation(s)
- Tudor Mocan
- 3rd Medical Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Institute for Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania
| | - Iuliana Nenu
- 3rd Medical Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Institute for Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania
| | - Rareș Crăciun
- 3rd Medical Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Institute for Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania
| | - Zeno Spârchez
- 3rd Medical Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Institute for Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania
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