1
|
Li XP, Bao ZT, Wang L, Zhang CY, Yang W. Construction of a predictive model for acute liver failure after hepatectomy based on neutrophil-to-lymphocyte ratio and albumin-bilirubin score. World J Gastrointest Surg 2024; 16:1087-1096. [PMID: 38690037 PMCID: PMC11056668 DOI: 10.4240/wjgs.v16.i4.1087] [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: 01/19/2024] [Revised: 02/18/2024] [Accepted: 03/21/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Acute liver failure (ALF) is a common cause of postoperative death in patients with hepatocellular carcinoma (HCC) and is a serious threat to patient safety. The neutrophil-to-lymphocyte ratio (NLR) is a common inflammatory indicator that is associated with the prognosis of various diseases, and the albumin-bilirubin score (ALBI) is used to evaluate liver function in liver cancer patients. Therefore, this study aimed to construct a predictive model for postoperative ALF in HCC tumor integrity resection (R0) based on the NLR and ALBI, providing a basis for clinicians to choose appropriate treatment plans. AIM To construct an ALF prediction model after R0 surgery for HCC based on NLR and ALBI. METHODS In total, 194 patients with HCC who visited The First People's Hospital of Lianyungang to receive R0 between May 2018 and May 2023 were enrolled and divided into the ALF and non-ALF groups. We compared differences in the NLR and ALBI between the two groups. The risk factors of ALF after R0 surgery for HCC were screened in the univariate analysis. Independent risk factors were analyzed by multifactorial logistic regression. We then constructed a prediction model of ALF after R0 surgery for HCC. A receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the value of the prediction model. RESULTS Among 194 patients with HCC who met the standard inclusion criteria, 46 cases of ALF occurred after R0 (23.71%). There were significant differences in the NLR and ALBI between the two groups (P < 0.05). The univariate analysis showed that alpha-fetoprotein (AFP) and blood loss volume (BLV) were significantly higher in the ALF group compared with the non-ALF group (P < 0.05). The multifactorial analysis showed that NLR, ALBI, AFP, and BLV were independent risk factors for ALF after R0 surgery in HCC. The predictive efficacy of NLR, ALBI, AFP, and BLV in predicting the occurrence of ALT after R0 surgery for HCC was average [area under the curve (AUC)NLR = 0.767, AUCALBI = 0.755, AUCAFP = 0.599, AUCBLV = 0.718]. The prediction model for ALF after R0 surgery for HCC based on NLR and ALBI had a better predictive efficacy (AUC = 0.916). The calibration curve and actual curve were in good agreement. DCA showed a high net gain and that the model was safer compared to the curve in the extreme case over a wide range of thresholds. CONCLUSION The prediction model based on NLR and ALBI can effectively predict the risk of developing ALF after HCC R0 surgery, providing a basis for clinical prevention of developing ALF after HCC R0 surgery.
Collapse
Affiliation(s)
- Xiao-Pei Li
- Department of Family Planning and Assisted Reproductive Technology, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
| | - Zeng-Tao Bao
- Department of Gastrointestinal Surgery, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
| | - Li Wang
- Department of Family Planning and Assisted Reproductive Technology, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
| | - Chun-Yan Zhang
- Department of Laboratory Medicine, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
| | - Wen Yang
- Department of Gynecology, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
| |
Collapse
|
2
|
Lin ZP, Huang DB, Zou XG, Chen Y, Li XQ, Zhang J. Percutaneous microwave ablation and transcatheter arterial chemoembolization for serum tumor markers and prognostics of middle-late primary hepatic carcinoma. World J Gastrointest Surg 2023; 15:2783-2791. [PMID: 38222024 PMCID: PMC10784823 DOI: 10.4240/wjgs.v15.i12.2783] [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: 10/26/2023] [Revised: 11/17/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Primary hepatic carcinoma (PHC) has an insidious onset and is usually diagnosed in the middle and late stages. Although transcatheter arterial chemoembolization (TACE) is the preferred option for treating middle- and advanced-stage PHC, it has limited efficacy in killing tumor cells and poor long-term efficacy. TACE plus percutaneous microwave coagulation therapy (PMCT) is more effective than interventional therapy alone and can improve survival time. However, there are few reports on the effects of TACE and PMCT on serum marker levels and the prognosis of patients with advanced PHC. AIM To investigate the effect of PMCT + TACE on serum tumor markers and the prognosis of middle-late PHC. METHODS This retrospective study included 150 patients with middle-late PHC admitted to Zhongshan People's Hospital between March 2018 and February 2021. Patients were divided into a single group (treated with TACE, n = 75) and a combined group (treated with TACE + PMCT, n = 75). Before and after treatment, the clinical efficacy and serum tumor marker levels [carbohydrate antigen 19-9 (CA19-9), alpha-fetoprotein (AFP), and carcinoembryonic antigen (CEA)] of both groups were observed. The 1-year survival rates and prognostic factors of the two groups were analyzed. RESULTS The combined group had 21 and 35 cases of complete remission (CR) and partial remission (PR), respectively. The single group had 13 and 25 cases of CR and PR, respectively. After 4 wk of treatment, the serum CA19-9, CEA, and AFP levels in the single and combined groups decreased, with the decrease in the combined group being more significant (P < 0.05). The 1-year survival rate of the combined group (80.00%) was higher than that of the single group (60.00%) (P < 0.05). The average survival time within 1 year in the combined group was 299.38 ± 61.13 d, longer than that in the single group (214.41 ± 72.97 d, P < 0.05). COX analysis revealed that tumor diameter, tumor number, and the treatment method were prognostic factors for patients with middle-late PHC (P < 0.05). CONCLUSION TACE + PMCT is effective in treating patients with mid-late PHC. It reduces the levels of tumor markers, prolongs survival, and improves prognosis.
Collapse
Affiliation(s)
- Zhi-Peng Lin
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Da-Bei Huang
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Xu-Gong Zou
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Yuan Chen
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Xiao-Qun Li
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Jian Zhang
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| |
Collapse
|
3
|
Li Z, Xu K, Zhou X, Jiao D, Han X. TACE sequential MWA guided by cone-beam computed tomography in the treatment of small hepatocellular carcinoma under the hepatic dome. BMC Cancer 2023; 23:600. [PMID: 37386361 DOI: 10.1186/s12885-023-11066-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE An assessment is being conducted to determine the safety and effectiveness of using Cone-beam computed tomography (CBCT)-guided transcatheter arterial chemoembolization (TACE) and microwave ablation (MWA) sequentially to treat small hepatocellular carcinomas (HCCs) located in the hepatic dome. MATERIALS AND METHODS Fifty-three patients with small HCCs in the hepatic dome who underwent TACE combined with simultaneous CBCT-guided MWA were studied. Inclusion criteria were a single HCCs ≤ 5.0 cm or a maximum of three. The safety and interventional-related complications were monitored, and local tumor progression (LTP), overall survival (OS), and prognostic factors for LTP/OS were evaluated. RESULTS The procedures were successfully accomplished in all patients. According to Common Terminology Criteria for Adverse Events (CTCAE), adverse reactions and complications are mainly Grade 1 or 2 (mild symptoms, no or local/noninvasive intervention indicated). Liver and kidney function and alpha-fetoprotein (AFP) levels remained within a reasonable range after 4 weeks of treatment (both p < 0.001). The mean LTP was 44.406 months (95% CI: 39.429, 49.383) and the mean OS rate was 55.157 months (95% CI: 52.559, 57.754). The combination treatment achieved 1-, 3-, and 5-year LTP rates of 92.5%, 69.6%, and 34.5%, respectively; and 1-, 3-, and 5-year OS rates of 100.0%, 88.4%, and 70.2%, respectively. Results from both univariate and multivariate Cox regression analyses showed that the tumor diameter (< 3 cm) and the distance to the hepatic dome (≥ 5 mm, < 10 mm) had a significant impact on the patient's LTP and OS, and were related to better survival. CONCLUSION CBCT-guided TACE combined with simultaneous MWA was a safe and successful treatment of HCCs located under the hepatic dome.
Collapse
Affiliation(s)
- Zhaonan Li
- Medical School, Southeast University, Nanjing, 210009, China
| | - Kaihao Xu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Xueliang Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Dechao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China.
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China.
| |
Collapse
|
4
|
Chen Z, Fu X, Qiu Z, Mu M, Jiang W, Wang G, Zhong Z, Qi H, Gao F. CT-guided 125I brachytherapy for hepatocellular carcinoma in high-risk locations after transarterial chemoembolization combined with microwave ablation: a propensity score-matched study. Radiol Oncol 2023; 57:127-139. [PMID: 36942903 PMCID: PMC10039481 DOI: 10.2478/raon-2023-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/30/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the safety and efficacy of 125I brachytherapy combined with transarterial chemoembolization (TACE) and microwave ablation (MWA) for unresectable hepatocellular carcinoma (HCC) in high-risk locations. PATIENTS AND METHODS After 1:2 propensity score matching (PSM), this retrospectively study analyzed 49 patients who underwent TACE +MWA+125I brachytherapy (group A) and 98 patients who only received TACE +MWA (group B). The evaluated outcomes were progression-free survival (PFS), overall survival (OS), and treatment complications. Cox proportional hazards regression analysis survival was used to compare the two groups. RESULTS The patients in group A showed a longer PFS than group B (7.9 vs. 3.3 months, P = 0.007). No significant differences were observed in median OS between the two groups (P = 0.928). The objective response rate (ORR), disease control rate of tumors in high-risk locations, and the ORR of intrahepatic tumors were 67.3%, 93.9%, and 51.0%, respectively, in group A, and 38.8%, 79.6% and 29.6%, respectively, in group B (P < 0.001, P = 0.025 and P = 0.011, respectively). TACE-MWA-125I (HR = 0.479, P < 0.001) was a significant favorable prognostic factor that affected PFS. The present of portal vein tumor thrombosis was an independent prognostic factor for PFS (HR = 1.625, P = 0.040). The Barcelona clinic liver cancer (BCLC) stage (BCLC C vs. B) was an independent factor affecting OS (HR = 1.941, P = 0.038). The incidence of complications was similar between the two groups, except that the incidence of abdominal pain was reduced in the group A (P = 0.007). CONCLUSIONS TACE-MWA-125I resulted in longer PFS and better tumor control than did TACE-MWA in patients with unresectable hepatocellular carcinoma in high-risk locations.
Collapse
Affiliation(s)
- Zixiong Chen
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xiaobo Fu
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Zhenkang Qiu
- Interventional Medical Center, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Maoyuan Mu
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Weiwei Jiang
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Guisong Wang
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Zhihui Zhong
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Han Qi
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Fei Gao
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| |
Collapse
|
5
|
Recurrence Outcome in Hepatocellular Carcinoma within Milan Criteria Undergoing Microwave Ablation with or without Transarterial Chemoembolization. Medicina (B Aires) 2022; 58:medicina58081016. [PMID: 36013483 PMCID: PMC9412845 DOI: 10.3390/medicina58081016] [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: 06/23/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: The recurrence outcome in patients who underwent microwave ablation (MWA) with or without transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) within Milan criteria remains unclear. The aim of this retrospective study was to identify the predictive factors of recurrence in these patients. Materials and Methods: From May 2018 to April 2021, 66 patients with HCC within Milan criteria were enrolled. Local tumor progression (LTP) and recurrence-free survival (RFS) were evaluated. Univariate and multivariate analyses were used to evaluate the risk factors of recurrence. The propensity score analysis was conducted to reduce potential confounding bias. Results: During the median follow-up of 25.07 months (95% confidence interval [CI], 21.85, 28.28), the median time to LTP and RFS were 20.10 (95%CI, 14.67, 25.53) and 13.03 (95%CI, 6.36, 19.70) months. No group difference (MWA vs. MWA + TACE) was found in 1-year cumulative LTP (p = 0.575) and RFS (p = 0.515), but meaningful significant differences were found in two-year recurrence (LTP, p = 0.007 and RFS, p = 0.037). Univariate and multivariate analyses revealed that treatment received before ablation was an independent risk factor of LTP (hazard ratio [HR] 4.37, 95%CI, 1.44, 13.32) and RFS (HR 3.41, 95%CI, 1.49, 7.81). Conclusions: The LTP and RFS in the MWA group were similar to that in the MWA combined with TACE. For HCC within Milan criteria, both groups preferentially selected MWA. More endeavor and rigorous surveillance should be taken to relapse prevention, in patients who have received previous treatment.
Collapse
|
6
|
2450-MHz microwave ablation of liver metastases under 3.0 T wide-bore magnetic resonance guidance: a pilot study. Sci Rep 2022; 12:12640. [PMID: 35879411 PMCID: PMC9314346 DOI: 10.1038/s41598-022-16989-4] [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: 12/06/2021] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
To investigate the feasibility and effectiveness of 3.0 T wide-bore magnetic resonance (MR)-guided microwave ablation (MA) of liver metastases (LM). From October 2018 to May 2020, 39 patients with 63 LM were treated with 3.0 T wide-bore MR-guided 2450-MHz MA therapy. The procedure parameters, technical success, complications, biochemical index changes, local tumor response, local tumor progression (LTP), 12-month disease-free survival (DFS) and 12-month overall survival (OS) were recorded and analyzed. The mean tumor maximum diameter and total procedure time were 3.0 cm and 55.2 min, respectively. Technical success was 100%, but 5 cases (12.8%) had grade-1 complications. Alanine transaminase, aspartate transaminase and total bilirubin showed a slight transient increase on day 3 (P < 0.05) and returned to normal by day 30 (P > 0.05). The complete ablation rates for ≤ 2.5 and > 2.5 cm lesions were 100% and 92.5%, respectively. During the median follow-up of 12.0 months, the LTP rate was 4.8% (3/63), and the 12-month DFS and OS rates were 61.3% and 92.2%, respectively. 3.0 T wide-bore MR-guided MA for LM is a safe and effective approach, especially for small LM.
Collapse
|
7
|
Floridi C, Cellina M, Irmici G, Bruno A, Rossini N, Borgheresi A, Agostini A, Bruno F, Arrigoni F, Arrichiello A, Candelari R, Barile A, Carrafiello G, Giovagnoni A. Precision Imaging Guidance in the Era of Precision Oncology: An Update of Imaging Tools for Interventional Procedures. J Clin Med 2022; 11:jcm11144028. [PMID: 35887791 PMCID: PMC9322069 DOI: 10.3390/jcm11144028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 02/05/2023] Open
Abstract
Interventional oncology (IO) procedures have become extremely popular in interventional radiology (IR) and play an essential role in the diagnosis, treatment, and supportive care of oncologic patients through new and safe procedures. IR procedures can be divided into two main groups: vascular and non-vascular. Vascular approaches are mainly based on embolization and concomitant injection of chemotherapeutics directly into the tumor-feeding vessels. Percutaneous approaches are a type of non-vascular procedures and include percutaneous image-guided biopsies and different ablation techniques with radiofrequency, microwaves, cryoablation, and focused ultrasound. The use of these techniques requires precise imaging pretreatment planning and guidance that can be provided through different imaging techniques: ultrasound, computed tomography, cone-beam computed tomography, and magnetic resonance. These imaging modalities can be used alone or in combination, thanks to fusion imaging, to further improve the confidence of the operators and the efficacy and safety of the procedures. This article aims is to provide an overview of the available IO procedures based on clinical imaging guidance to develop a targeted and optimal approach to cancer patients.
Collapse
Affiliation(s)
- Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60126 Ancona, Italy;
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126 Ancona, Italy;
- Correspondence:
| | - Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20122 Milan, Italy;
| | - Giovanni Irmici
- Post-Graduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (G.I.); (A.A.)
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
| | - Nicolo’ Rossini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
| | - Alessandra Borgheresi
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60126 Ancona, Italy;
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.B.); (A.B.)
| | - Francesco Arrigoni
- Emergency and Interventional Radiology, San Salvatore Hospital, 67100 L’Aquila, Italy;
| | - Antonio Arrichiello
- Post-Graduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (G.I.); (A.A.)
| | - Roberto Candelari
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126 Ancona, Italy;
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.B.); (A.B.)
| | - Gianpaolo Carrafiello
- Operative Unit of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy;
- Department of Health Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60126 Ancona, Italy;
| |
Collapse
|
8
|
Wei Q, Ren Y, Zheng X, Yang S, Lu T, Ji H, Hua H, Shan K. Ginsenoside Rg3 and sorafenib combination therapy relieves the hepatocellular carcinomaprogression through regulating the HK2-mediated glycolysis and PI3K/Akt signaling pathway. Bioengineered 2022; 13:13919-13928. [PMID: 35719058 PMCID: PMC9275937 DOI: 10.1080/21655979.2022.2074616] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common pathological type of primary hepatic carcinoma. This study investigated the effects of ginsenoside Rg3 (Rg3) and sorafenib (SFN) combination therapy on HCC progression. The HCC-related data were obtained from TCGA database, and the data of HK2 mRNA, clinicopathological features, and survival outcomes were extracted using R Programming 4.0. The human hepatoma cell lines HepG2 and Bel7404 were used. Cell viability was tested using the MTT assay. Glucose consumption and lactate levels of HCC cells were detected using the corresponding kits. Western blotting was used to determine the protein expression of HK2, PI3K, and Akt. HK2 was overexpressed in patients with HCC. Compared with patients with overexpressed HK2, those with low levels of HK2 achieved a longer survival time. In addition, the Rg3 and SFN combination therapy significantly reduced cell viability, glucose consumption, lactate levels, and protein expression of HK2, PI3K, and Akt in HCC cells. Additionally, the Rg3 and SFN combination therapy exhibited a better effect than the single drug group. Inhibition of the PI3K/Akt signaling pathway or exogenous lactate intervention reversed the effects of Rg3 and SFN combination therapy in HCC cells. In conclusion, Rg3 has a synergistic effect on the sensitivity of HepG2 and Bel7404 hepatoma cells to SFN, which is related to HK2-mediated glycolysis and the PI3K/Akt signaling pathway.
Collapse
Affiliation(s)
- Qi Wei
- Department of Oncology, Yancheng TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, China
| | - Yuan Ren
- Department of Oncology, The Second People's Hospital of Kunshan, Suzhou, China
| | - Xia Zheng
- Department of Oncology, Affiliated Hospital of Nanjing University of Chinese Medicine, Shanghai, China
| | - Sufang Yang
- Department of Oncology, The Second People's Hospital of Kunshan, Suzhou, China
| | - Tingting Lu
- Department of Oncology, The Second People's Hospital of Kunshan, Suzhou, China
| | - Hongyao Ji
- Department of Oncology, The Second People's Hospital of Kunshan, Suzhou, China
| | - Haiqing Hua
- Department of Oncology, NanJing JinLing Hospital, Nanjing, China
| | - Kuizhong Shan
- Department of Oncology, The Second People's Hospital of Kunshan, Suzhou, China
| |
Collapse
|
9
|
Li Z, Li Q, Wang X, Chen W, Jin X, Liu X, Ye F, Dai Z, Zheng X, Li P, Sun C, Liu X, Zhang Q, Luo H, Liu R. Hyperthermia ablation combined with transarterial chemoembolization versus monotherapy for hepatocellular carcinoma: A systematic review and meta-analysis. Cancer Med 2021; 10:8432-8450. [PMID: 34655179 PMCID: PMC8633247 DOI: 10.1002/cam4.4350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/15/2021] [Accepted: 10/03/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS The existing evidence has indicated that hyperthermia ablation (HA) and HA combined with transarterial chemoembolization (HATACE) are the optimal alternative to surgical resection for patients with hepatocellular carcinoma (HCC) in the COVID-19 crisis. However, the evidence for decision-making is lacking in terms of comparison between HA and HATACE. Herein, a comprehensive evaluation was performed to compare the efficacy and safety of HATACE with monotherapy. MATERIALS AND METHODS Worldwide studies were collected to evaluate the HATACE regimen for HCC due to the practical need for global extrapolation of applicative population. Meta-analyses were performed using the RevMan 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). RESULTS Thirty-six studies involving a large sample of 5036 patients were included finally. Compared with HA alone, HATACE produced the advantage of 5-year overall survival (OS) rate (OR:1.90; 95%CI:1.46,2.46; p < 0.05) without increasing toxicity (p ≥ 0.05). Compared with TACE alone, HATACE was associated with superior 5-year OS rate (OR:3.54; 95%CI:1.96,6.37; p < 0.05) and significantly reduced the incidences of severe liver damage (OR:0.32; 95%CI:0.11,0.96; p < 0.05) and ascites (OR:0.42; 95%CI:0.20,0.88; p < 0.05). Subgroup analysis results of small (≤3 cm) HCC revealed that there were no significant differences between the HATACE group and HA monotherapy group in regard to the OS rates (p ≥ 0.05). CONCLUSIONS Compared with TACE alone, HATACE was more effective and safe for HCC. Compared with HA alone, HATACE was more effective for non-small-sized (>3 cm) HCC with comparable safety. However, the survival benefit of adjuvant TACE in HATACE regimen was not found for the patients with small (≤3 cm) HCC.
Collapse
|
10
|
Li Z, Hao D, Jiao D, Zhang W, Han X. Transcatheter Arterial Chemoembolization Combined with Simultaneous Cone-beam Computed Tomography-guided Microwave Ablation in the Treatment of Small Hepatocellular Carcinoma: Clinical Experiences From 50 Procedures. Acad Radiol 2021; 28 Suppl 1:S64-S70. [PMID: 33060007 DOI: 10.1016/j.acra.2020.08.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the technical success, safety and outcomes of transcatheter arterial chemoembolization (TACE) combined with simultaneous cone-beam computed tomography (CBCT)-guided microwave ablation (MWA) in small hepatocellular carcinoma (SHCC). MATERIALS AND METHODS Retrospective analysis of 66 lesions in 50 patients (38 men, 12 women) who underwent TACE combined with simultaneous CBCT-guided MWA for SHCC. After 1 month of treatment, the tumor responses were assessed using the mRECIST criteria, along with interventional-related complications and changes in hepatic and renal function. Moreover, progression-free survival (PFS) and overall survival (OS) were calculated. RESULTS All patients achieved technical success. The mean target tumor size was 3.4 ± 0.7 (range, 2.2-4.9) cm. The mean energy, ablation duration per tumor, and the mean safety margin were 51.3 ± 8.4 kJ, 6.7 ± 0.8 minutes and 1.4 ± 0.6 cm, respectively. The 1-, 3-, and 5-year PFS rates were 90.0%, 65.4%, and 35.7%, respectively, with a mean PFS of 43.46 months; and the 1-, 3-, and 5-year OS rates were 98.0%, 89.8%, and 74.3%, respectively, with a mean OS of 54.90 months. Multivariate Cox regression analysis further illustrated that TACE combined with MWA in the treatment of a single tumor with a diameter of less than 3 cm was an independent protective factor for PFS and OS (p < 0.001). The patients had no major complications. Among the exceptions, one patient (2%) had an asymptomatic perihepatic effusion that resolved spontaneously, two patients (4%) developed massive right pleural effusion, requiring thoracic drainage, and another patient (2%) developed a hepatic subcapsular hemorrhage required interventional embolization. CONCLUSION CBCT-guided TACE combined with simultaneous MWA was a safe and successful treatment of SHCC with a high technical efficacy.
Collapse
Affiliation(s)
- Zhaonan Li
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 450000, China
| | - Dexun Hao
- Geriatric respiratory Ward, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dechao Jiao
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 450000, China
| | - Wenguang Zhang
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 450000, China
| | - Xinwei Han
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 450000, China.
| |
Collapse
|
11
|
Takaya H, Namisaki T, Takeda S, Kaji K, Ogawa H, Ishida K, Tsuji Y, Takagi H, Ozutsumi T, Fujinaga Y, Furukawa M, Kitagawa K, Nishimura N, Sawada Y, Shimozato N, Kawaratani H, Moriya K, Akahane T, Mitoro A, Yoshiji H. The Combination of Albumin-Bilirubin Score and Prothrombin Time Is a Useful Tool for Predicting Liver Dysfunction after Transcatheter Arterial Chemoembolization in Child-Pugh Class A Patients with Hepatocellular Carcinoma within Up-to-Seven Criteria. J Clin Med 2021; 10:jcm10214838. [PMID: 34768358 PMCID: PMC8585112 DOI: 10.3390/jcm10214838] [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: 09/09/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023] Open
Abstract
Mortality and recurrence rates of hepatocellular carcinoma (HCC) are high. Recent studies show that for patients with HCC beyond up-to-seven criteria, treatment with molecular-targeted agents (MTAs) is recommended because the treatment efficiency of transcatheter arterial chemoembolization (TACE) is poor; further, TACE increases decline in liver function. However, the relationship between TACE and liver function decline in patients with HCC within up-to-seven criteria has not been clarified. Hence, we aimed to investigate this relationship. This retrospective observational study included 189 HCC tumors within up-to-seven criteria in 114 Child–Pugh class A patients. Twenty-four (12.7%) tumors were changed from Child–Pugh class A to B after TACE, and 116 (61.4%) tumors exhibited recurrence within 6 months after TACE. Prothrombin time (PT) and albumin–bilirubin (ALBI) score before TACE were significantly associated with liver dysfunction from Child–Pugh class A to B. The combination of PT and ALBI score before TACE had high predictive ability for liver dysfunction from Child–Pugh class A to B after TACE (specificity = 100%, sensitivity = 91.7%). The combined use of pre-TACE PT and ALBI score has a high predictive ability for liver dysfunction after TACE for Child–Pugh class A patients with HCC within up-to-seven criteria.
Collapse
|
12
|
Li X, Yuan H, Tian X, Tang J, Liu L, Liu F. Biocompatible copper sulfide-based nanocomposites for artery interventional chemo-photothermal therapy of orthotropic hepatocellular carcinoma. Mater Today Bio 2021; 12:100128. [PMID: 34632360 PMCID: PMC8487074 DOI: 10.1016/j.mtbio.2021.100128] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 12/22/2022] Open
Abstract
Transcatheter arterial embolization has been considered as a promising targeted delivery approach for hepatocellular carcinoma (HCC). Currently, chemoembolization was the main treatment for unresectable HCC. However, the traditional chemoembolization treatment suffers from undesirable therapeutic effects and serious side-effects. In this study, the doxorubicin (DOX)-encapsulated and near-infrared (NIR)-responsible copper sulfide (CuS)-based nanotherapeutics was developed for magnetic resonance imaging (MRI)-guided chemo-photothermal therapy of HCC tumor in rats. The DOX-loaded CuS nanocomposites (DOX@BSA-CuS) demonstrated distinct NIR-triggered drug release behavior and high photothermal effect. In an orthotopic HCC rat model, DOX@BSA-CuS nanocomposites were selectively delivered to the tumor site via the intra-arterial transcatheter. The proposed DOX@BSA-CuS nanocomposites plus NIR laser irradiation exhibited significant tumor growth suppression performance. Moreover, the treatment progress can be monitored by MRI images. Finally, the preliminary toxicity estimate suggested the negligible side-effect of DOX@BSA-CuS nanocomposites during the therapeutic process. These results suggest the clinical translational potential possibility for imaging-guided arterial embolization with DOX@BSA-CuS nanocomposites for the treatment of HCC.
Collapse
Affiliation(s)
- X. Li
- Department of Interventional Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, PR China
| | - H.J. Yuan
- Department of Interventional Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, PR China
| | - X.M. Tian
- Department of Interventional Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, PR China
| | - J. Tang
- Department of Interventional Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, PR China
| | - L.F. Liu
- Department of Gerontology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310006, PR China
| | - F.Y. Liu
- Department of Interventional Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, PR China
| |
Collapse
|
13
|
Li Z, Jiao D, Si G, Han X, Zhang W, Li Y, Zhou X, Liu J, Li J, Liu Z. Making timely remedial measures after TACE based on the results of cone-beam CT liver perfusion. Int J Hyperthermia 2021; 38:428-436. [PMID: 33691589 DOI: 10.1080/02656736.2021.1895331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and safety of using cone-beam CT (CBCT) to measure changes in parenchymal blood volume (PBV) of patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) and to guide microwave ablation (MWA) for residual tumors. METHODS A retrospective study was performed on 42 patients with HCC who completed TACE and received CBCT-guided perfusion imaging. The residual active lesions after TACE were supplemented with MWA to complete the treatment process according to the residual PBV. The outcomes were analyzed, including PBV changes, interventional-related complications, local tumor progression (LTP) and overall survival (OS). RESULTS Technical success was achieved in all lesions. Correlation analysis revealed that greater volume of residual PBV after MWA is negatively correlated with LTP. (p = .000); and the decrease of PBV was positively correlated with LTP (p = .000). All adverse events and complications were CTCAE Grade 1/2. After combination treatment, the 1-, 3-, and 5-year LTP-free survival were 97.6%, 69.0% and 15.1%, respectively, with a median LTP of 49.0 months (95% CI:43.129,54.871). Multivariate Cox regression revealed that the residual PBV > 13 ml/1000 was an independent factor predicting a shorter OS and LTP (Both p< .05). For LTP, multivariate Cox regression showed that a tumor in a single lesion were independently predicted to have a longer LTP in patients with HCC (p = .033). CONCLUSION CBCT is feasible and safe to use to measure changes in the PBV before and after TACE treatment, while it can also guide MWA for the treatment of residual tumors in one session.
Collapse
Affiliation(s)
- Zhaonan Li
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - DeChao Jiao
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guangyan Si
- Department of Interventional Radiology, The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenguang Zhang
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yahua Li
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xueliang Zhou
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juanfang Liu
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin Li
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zaoqu Liu
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
14
|
MR-Guided Microwave Ablation in T1 Renal Cell Carcinoma: Initial Results in Clinical Routine. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5537192. [PMID: 34055980 PMCID: PMC8147533 DOI: 10.1155/2021/5537192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/03/2021] [Indexed: 11/23/2022]
Abstract
Objective Percutaneous tumor ablation is usually performed using computed tomography (CT) or ultrasound (US) guidance, although reliable visualization of the target tumor could be challenging. Magnetic resonance- (MR-) guided ablation provides more reliable visualization of the target tumors and allows multiplanar imaging of the treatment process, making it the modality of choice, in particular if lesions are small. Methods From March 2016 to January 2018, 32 patients scheduled for percutaneous treatment of T1 RCC underwent MR-guided MWA. Complications were classified according to the Clavien grade. Kaplan–Meier survival estimates were calculated to evaluate progression-free survival (PFS). Results Technical success was achieved in all lesions. The mean energy and procedure duration were 61.6 ± 8.7 kJ and 118.2 ± 26.7 min, respectively. The glomerular filtration rate (GFR) dropped rapidly after 1 month of treatment and slowly recovered within three months (P < 0.05). Postoperative pain and fever were the most common adverse events after treatment. Perirenal hematoma, thermal injury of the psoas muscle, and abdominal distension were common complications after MWA, and the incidence rates were 9.4% (3/32), 6.3% (2/32), and 6.3% (2/32), respectively. According to the Clavien grade classification, serious complications include hydrothorax, bowel injury, and renal failure, all of which have a probability of 3.1%. Of note, the three serious complications occurred in one patient. The 1-, 2-, and 3-year PFS rates were 96.9%, 93.8%, and 83.9%, respectively. The mean PFS rates were 33.972 months (95% CI: 33.045, 35.900). Conclusion Microwave ablation is feasible under MR guidance and provides effective treatment of RCC in one session.
Collapse
|
15
|
Li Z, Wang C, Si G, Zhou X, Li Y, Li J, Jiao D, Han X. Image-guided microwave ablation of hepatocellular carcinoma (≤5.0 cm): is MR guidance more effective than CT guidance? BMC Cancer 2021; 21:366. [PMID: 33827464 PMCID: PMC8028080 DOI: 10.1186/s12885-021-08099-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/24/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Given their widespread availability and relatively low cost, percutaneous thermal ablation is commonly performed under the guidance of computed tomography (CT) or ultrasound (US). However, such imaging modalities may be restricted due to insufficient image contrast and limited tumor visibility, which results in imperfect intraoperative treatment or an increased risk of damage to critical anatomical structures. Currently, magnetic resonance (MR) guidance has been proven to be a possible solution to overcome the above shortcomings, as it provides more reliable visualization of the target tumor and allows for multiplanar capabilities, making it the modality of choice. Unfortunately, MR-guided ablation is limited to specialized centers, and the cost is relatively high. Is ablation therapy under MR guidance better than that under CT guidance? This study retrospectively compared the efficacy of CT-guided and MR-guided microwave ablation (MWA) for the treatment of hepatocellular carcinoma (HCC ≤ 5.0 cm). METHODS In this retrospective study, 47 patients and 54 patients received MWA under the guidance of CT and MR, respectively. The inclusion criteria were a single HCC ≤ 5.0 cm or a maximum of three. The local tumor progression (LTP), overall survival (OS), prognostic factors for local progression, and safety of this technique were assessed. RESULTS All procedures were technically successful. The complication rates of the two groups were remarkably different with respect to incidences of liver abscess and pleural effusion (P < 0.05). The mean LTP was 44.264 months in the CT-guided group versus 47.745 months in the MR-guided group of HCC (P = 0.629, log-rank test). The mean OS was 56.772 months in the patients who underwent the CT-guided procedure versus 58.123 months in those who underwent the MR-guided procedure (P = 0.630, log-rank test). Multivariate Cox regression analysis further illustrated that tumor diameter (< 3 cm) and the number of lesions (single) were important factors affecting LTP and OS. CONCLUSIONS Both CT-guided and MR-guided MWA are comparable therapies for the treatment of HCC (< 5 cm), and there was no difference in survival between the two groups. However, MR-guided MWA could reduce the incidence of complications.
Collapse
Affiliation(s)
- Zhaonan Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Chaoyan Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Guangyan Si
- Department of Interventional Radiology, The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, 646000, China
| | - Xueliang Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Yahua Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Jing Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China
| | - Dechao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China.
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, 450000, Henan Province, China.
| |
Collapse
|
16
|
Zaitoun MMA, Elsayed SB, Zaitoun NA, Soliman RK, Elmokadem AH, Farag AA, Amer M, Hendi AM, Mahmoud NEM, Salah El Deen D, Alsowey AM, Shahin S, Basha MAA. Combined therapy with conventional trans-arterial chemoembolization (cTACE) and microwave ablation (MWA) for hepatocellular carcinoma >3-<5 cm. Int J Hyperthermia 2021; 38:248-256. [PMID: 33615957 DOI: 10.1080/02656736.2021.1887941] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To compare safety and efficacy of combined therapy with conventional transarterial chemoembolization (cTACE)+microwave ablation (MWA) versus only TACE or MWA for treatment of hepatocellular carcinoma (HCC) >3-<5 cm. METHODS This randomized controlled trial (NCT04721470) screened 278 patients with HCC >3-<5 cm. Patients were randomized into three groups: 90 underwent TACE (Group 1); 95 underwent MWA (Group 2); and 93 underwent combined therapy (Group 3). Patients were followed-up with contrast-enhanced CT or MRI. Images were evaluated and compared for treatment response and adverse events based on modified response evaluation criteria in solid tumor. Serum alpha-fetoprotein (AFP) concentration was measured at baseline and during every follow-up visit. RESULTS Final analysis included 265 patients (154 men, 111 women; mean age = 54.5 ± 11.8 years; range = 38-76 years). Complete response was achieved by 86.5% of patients who received combined therapy compared with 54.8% with only TACE and 56.5% with only MWA (p = 0.0002). The recurrence rate after 12 months was significantly lower in Group 3 (22.47%) than Groups 1 (60.7%) and 2 (51.1%) (p = 0.0001). The overall survival rate (three years after therapy) was significantly higher in Group 3 (69.6%) than Groups 1 (54.7%) and 2 (54.3%) (p = 0.02). The mean progression-free survival was significantly higher in Group 3 than groups 1 and 2 (p < 0.001). A decrease in AFP concentration was seen in 75%, 63%, and 48% patients of Group 3, 2, and 1, respectively. CONCLUSIONS Combined therapy with cTACE + MWA is safe, well-tolerated, and more effective than TACE or MWA alone for treatment of HCC >3-<5 cm.
Collapse
Affiliation(s)
- Mohamed M A Zaitoun
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Diagnostic Radiology Department, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Saeed B Elsayed
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nahla A Zaitoun
- Family Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Radwa K Soliman
- Diagnostic Radiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ali H Elmokadem
- Diagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alaa A Farag
- Internal medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud Amer
- Internal medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ali M Hendi
- Diagnostic Radiology Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Nader E M Mahmoud
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Dalia Salah El Deen
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed M Alsowey
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Shahenda Shahin
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | |
Collapse
|