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Gao S, Sun W, Zhang Y, Wang F, Jin K, Qian X, Han J, Wang X, Dai Y, Sheng R, Zeng M. Correlation analysis of MR elastography and Ki-67 expression in intrahepatic cholangiocarcinoma. Insights Imaging 2023; 14:204. [PMID: 38001349 PMCID: PMC10673794 DOI: 10.1186/s13244-023-01559-7] [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: 02/14/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma (iCCA) is an aggressive primary liver cancer with dismal outcome, high Ki-67 expression is associated with active progression and poor prognosis of iCCA, the application of MRE in the prediction of iCCA Ki-67 expression has not yet been investigated until now. We aimed to evaluate the value of magnetic resonance elastography (MRE) in assessing Ki-67 expression for iCCA. RESULTS In the whole cohort, 97 patients (57 high Ki-67 and 40 low Ki-67; 58 males, 39 females; mean age, 58.89 years, ranges 36-70 years) were included. At the multivariate analysis, tumor stiffness (odds ratio (OR) = 1.669 [95% CI: 1.307-2.131], p < 0.001) and tumor apparent diffusion coefficient (ADC) (OR = 0.030 [95% CI: 0.002, 0.476], p = 0.013) were independent significant variables associated with Ki-67. Areas under the curve of tumor stiffness for the identification of high Ki-67 were 0.796 (95% CI 0.702, 0.871). Tumor stiffness was moderately correlated with Ki-67 level (r = 0.593, p < 0.001). When both predictive variables of tumor stiffness and ADC were integrated, the best performance was achieved with area under the curve values of 0.864 (95% CI 0.780-0.926). CONCLUSION MRE-based tumor stiffness correlated with Ki-67 in iCCA and could be investigated as a potential prognostic biomarker. The combined model incorporating both tumor stiffness and ADC increased the predictive performance. CRITICAL RELEVANCE STATEMENT MRE-based tumor stiffness might be a surrogate imaging biomarker to predict Ki-67 expression in intrahepatic cholangiocarcinoma patients, reflecting tumor cellular proliferation. The combined model incorporating both tumor stiffness and apparent diffusion coefficient increased the predictive performance. KEY POINTS • MRE-based tumor stiffness shows a significant correlation with Ki-67. • The combined model incorporating tumor stiffness and apparent diffusion coefficient demonstrated an optimized predictive performance for Ki-67 expression. • MRE-based tumor stiffness could be investigated as a potential prognostic biomarker for intrahepatic cholangiocarcinoma.
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Affiliation(s)
- Shanshan Gao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Wei Sun
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Yunfei Zhang
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Central Research Institute, United Imaging Healthcare, Shanghai, 201800, China
| | - Feihang Wang
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Kaipu Jin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Xianling Qian
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Jing Han
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Xiaolin Wang
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yongming Dai
- Central Research Institute, United Imaging Healthcare, Shanghai, 201800, China
| | - Ruofan Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Fujian, 361006, China.
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Stechele M, Wildgruber M, Markezana A, Kästle S, Öcal E, Kimm MA, Alunni-Fabbroni M, Paldor M, Haixing L, Salvermoser L, Pech M, Powerski M, Galun E, Ricke J, Goldberg SN. Prediction of Protumorigenic Effects after Image-Guided Radiofrequency Ablation of Hepatocellular Carcinoma Using Biomarkers. J Vasc Interv Radiol 2023; 34:1528-1537.e1. [PMID: 36442741 DOI: 10.1016/j.jvir.2022.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 11/01/2022] [Accepted: 11/19/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To perform radiofrequency (RF) ablation of hepatocellular carcinoma (HCC) and to assess serological and histopathological markers of tumorigenesis in distant untreated tumors to determine whether these were associated with unfavorable outcomes such as early relapse and increased biological aggressiveness. MATERIALS AND METHODS The study cohort comprised 13 patients from a prospective single-arm study. All patients underwent 2 ablation sessions of multifocal HCC nodules 14 days apart. Core biopsy samples of untreated tumors were acquired at baseline and at the time of the second ablation session. Samples were stained immunohistochemically with Ki-67 (proliferation) and CD34 (microvasculature). Blood plasma was obtained at baseline and 2 days after the initial ablation session and analyzed for hepatocyte growth factor (HGF), vascular endothelial growth factor C, and angiopoietin-2 using an enzyme-linked immunosorbent assay. The clinical follow-up period ranged from 7 to 25 months. Patients were stratified as responders (complete remission or limited and delayed recurrence at >6 months; n = 6) or nonresponders (any recurrence within 6 months or >3 new tumors or any new tumor of >3 cm thereafter; n = 7). RESULTS In 3 of 7 nonresponders, the Ki-67 index markedly increased in untreated tumors, whereas Ki-67 was stable in all responders. Microvascular density strongly increased in a single nonresponder only. HGF and angiopoietin-2 increased by >30% in 3 of 7 and 4 of 7 nonresponders, respectively, whereas they were stable or decreased in responders. Overall, ≥2 biomarkers were elevated in 6 of 7 (85.7%) nonresponders, whereas 4 of 6 responders demonstrated no increased biomarker and 2 patients demonstrated increase in 1 biomarker only (P = .002). CONCLUSIONS RF ablation of HCC can produce protumorigenic factors that induce effects in distant untreated tumors. These may potentially function as biomarkers of clinical outcome.
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Affiliation(s)
- Matthias Stechele
- Department of Radiology, University Hospital, Ludwig Maximilians University Munich, Munich, Germany.
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Aurelia Markezana
- Goldyne Savad Institute of Gene Therapy and Division of Image-Guided Therapy and Interventional Oncology, Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Sophia Kästle
- Department of Radiology, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Elif Öcal
- Department of Radiology, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Melanie A Kimm
- Department of Radiology, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Marianna Alunni-Fabbroni
- Department of Radiology, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Mor Paldor
- Goldyne Savad Institute of Gene Therapy and Division of Image-Guided Therapy and Interventional Oncology, Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Liao Haixing
- Department of Radiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Lukas Salvermoser
- Department of Radiology, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Eithan Galun
- Goldyne Savad Institute of Gene Therapy and Division of Image-Guided Therapy and Interventional Oncology, Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Shraga Nahum Goldberg
- Goldyne Savad Institute of Gene Therapy and Division of Image-Guided Therapy and Interventional Oncology, Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
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Qiu G, Chen J, Liao W, Liu Y, Wen Z, Zhao Y. Gadoxetic acid-enhanced MRI combined with T1 mapping and clinical factors to predict Ki-67 expression of hepatocellular carcinoma. Front Oncol 2023; 13:1134646. [PMID: 37456233 PMCID: PMC10348748 DOI: 10.3389/fonc.2023.1134646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives To explore the predictive value of gadoxetic acid-enhanced magnetic resonance imaging (MRI) combined with T1 mapping and clinical factors for Ki-67 expression in hepatocellular carcinoma (HCC). Methods A retrospective study was conducted on 185 patients with pathologically confirmed solitary HCC from two institutions. All patients underwent preoperative T1 mapping on gadoxetic acid-enhanced MRI. Patients from institution I (n = 124) and institution II (n = 61) were respectively assigned to the training and validation sets. Univariable and multivariable analyses were performed to assess the correlation of clinico-radiological factors with Ki-67 labeling index (LI). Based on the significant factors, a predictive nomogram was developed and validated for Ki-67 LI. The performance of the nomogram was evaluated on the basis of its calibration, discrimination, and clinical utility. Results Multivariable analysis showed that alpha-fetoprotein (AFP) levels > 20ng/mL, neutrophils to lymphocyte ratio > 2.25, non-smooth margin, tumor-to-liver signal intensity ratio in the hepatobiliary phase ≤ 0.6, and post-contrast T1 relaxation time > 705 msec were the independent predictors of Ki-67 LI. The nomogram based on these variables showed the best predictive performance with area under the receiver operator characteristic curve (AUROC) 0.899, area under the precision-recall curve (AUPRC) 0.946 and F1 score of 0.912; the respective values were 0.823, 0.879 and 0.857 in the validation set. The Kaplan-Meier curves illustrated that the cumulative recurrence probability at 2 years was significantly higher in patients with high Ki-67 LI than in those with low Ki-67 LI (39.6% [53/134] vs. 19.6% [10/51], p = 0.011). Conclusions Gadoxetic acid-enhanced MRI combined with T1 mapping and several clinical factors can preoperatively predict Ki-67 LI with high accuracy, and thus enable risk stratification and personalized treatment of HCC patients.
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Affiliation(s)
- Ganbin Qiu
- Imaging Department of Zhaoqing Medical College, Zhaoqing, China
- Department of Radiology, The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Jincan Chen
- Department of Radiology, The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Weixiong Liao
- Imaging Department of Zhaoqing Medical College, Zhaoqing, China
| | - Yonghui Liu
- Department of Radiology, The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Zhongyan Wen
- Department of Radiology, The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Yue Zhao
- Department of Radiology, Central People’s Hospital of Zhanjiang, Zhanjiang, China
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Zhang L, Duan S, Qi Q, Li Q, Ren S, Liu S, Mao B, Zhang Y, Wang S, Yang L, Liu R, Liu L, Li Y, Li N, Zhang L. Noninvasive Prediction of Ki-67 Expression in Hepatocellular Carcinoma Using Machine Learning-Based Ultrasomics: A Multicenter Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1113-1122. [PMID: 36412932 DOI: 10.1002/jum.16126] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To investigate the ability of ultrasomics to predict Ki-67 expression in hepatocellular carcinoma (HCC). METHODS A total of 244 patients from three hospitals were retrospectively recruited (training dataset, n = 168; test dataset, n = 43; and validation dataset, n = 33). Lesion segmentation of the ultrasound images was performed manually by two radiologists. In total, 1409 ultrasomics features were extracted. Feature selection was conducted using the intra-class correlation coefficient, variance threshold, mutual information, and recursive feature elimination plus eXtreme Gradient Boosting. The support vector machine was combined with the learning curve and grid search parameter tuning to construct the clinical, ultrasomics, and combined models. The predictive performance of the models was assessed using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity and accuracy. RESULTS The ultrasomics model performed well on the training, test, and validation datasets. The AUC (95% confidence interval [CI]) for these datasets were 0.955 (0.912-0.981), 0.861 (0.721-0.947), and 0.665 (0.480-0.819), respectively. The combination of ultrasomics and clinical features significantly improved model performance on all three datasets. The AUC (95% CI), sensitivity, specificity, and accuracy were 0.986 (0.955-0.998), 0.973, 0.840, and 0.869 on the training dataset; 0.871 (0.734-0.954), 0.750, 0.829, and 0.814 on the test dataset; and 0.742 (0.560-0.878), 0.714, 0.808, and 0.788 on the validation dataset, respectively. CONCLUSIONS Ultrasomics was proved to be a potential noninvasive method to predict Ki-67 expression in HCC.
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Affiliation(s)
- Linlin Zhang
- Department of Ultrasound, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Shaobo Duan
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
- Department of Health Management, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Qinghua Qi
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Li
- Department of Ultrasound, Henan Provincial Cancer Hospital, Zhengzhou, China
| | - Shanshan Ren
- Department of Ultrasound, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Shunhua Liu
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Bing Mao
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Ye Zhang
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
- Department of Health Management, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Simeng Wang
- Department of Ultrasound, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Long Yang
- Department of Ultrasound, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Ruiqing Liu
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Luwen Liu
- Department of Ultrasound, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yaqiong Li
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Na Li
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Lianzhong Zhang
- Department of Ultrasound, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
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Colorectal Cancer Liver Metastases: Genomics and Biomarkers with Focus on Local Therapies. Cancers (Basel) 2023; 15:cancers15061679. [PMID: 36980565 PMCID: PMC10046329 DOI: 10.3390/cancers15061679] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
Molecular cancer biomarkers help personalize treatment, predict oncologic outcomes, and identify patients who can benefit from specific targeted therapies. Colorectal cancer (CRC) is the third-most common cancer, with the liver being the most frequent visceral metastatic site. KRAS, NRAS, BRAF V600E Mutations, DNA Mismatch Repair Deficiency/Microsatellite Instability Status, HER2 Amplification, and NTRK Fusions are NCCN approved and actionable molecular biomarkers for colorectal cancer. Additional biomarkers are also described and can be helpful in different image-guided hepatic directed therapies specifically for CRLM. For example, tumors maintaining the Ki-67 proliferation marker after thermal ablation was shown to be particularly resilient to ablation. Ablation margin was also shown to be an important factor in predicting local recurrence, with a ≥10 mm minimal ablation margin being required to attain local tumor control, especially for patients with mutant KRAS CRLM.
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Xu H, Miao X, Chai C, Tang H, Hu J, Zhao Z, Luo W, Zhu K, Zhou W. Establishment and characterization of a new Chinese hepatocellular carcinoma cell line, Hep-X1. Hum Cell 2023; 36:434-445. [PMID: 36152230 DOI: 10.1007/s13577-022-00797-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/18/2022] [Indexed: 01/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is a highly aggressive and heterogeneous disease. Cell lines are commonly employed as in vitro models for cell type studies. However, the success rate of HCC primary culture establishment is low. In this study, we successfully established a liver cancer cell line, Hep-X1. Primary culture and passage of surgically removed tissues were used to establish hepatoma cell lines. Morphological examination, short tandem repeat (STR) analysis, immunohistochemical staining, doubling time, karyotype analysis, plate tumor formation experiments, organoid culture, and in vivo tumor formation investigations in animals were used to identify the cell lines. A novel liver cancer cell line, Hep-X1, was established based on morphology, immunophenotype, cytogenetics, and STR analysis. The novel cell line can be a valuable model for studying primary liver cancer.
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Affiliation(s)
- Hao Xu
- The Forth Department of General Surgery, The First Hospital of Lanzhou University, No.1 Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu, China.
| | - Xin Miao
- State Key Laboratory of Veterinary Etiological Biology & OIE/National Foot and Mouth Disease Reference Laboratory & Key Laboratory of Animal Virology of the Ministry of Agriculture, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, LanZhou, 730000, China
| | - Changpeng Chai
- The Forth Department of General Surgery, The First Hospital of Lanzhou University, No.1 Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu, China
| | - Huan Tang
- The Forth Department of General Surgery, The First Hospital of Lanzhou University, No.1 Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu, China
| | - Jinjing Hu
- The Forth Department of General Surgery, The First Hospital of Lanzhou University, No.1 Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu, China
| | - Zhenjie Zhao
- The Forth Department of General Surgery, The First Hospital of Lanzhou University, No.1 Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu, China
| | - Wei Luo
- The Forth Department of General Surgery, The First Hospital of Lanzhou University, No.1 Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu, China
| | - Kexiang Zhu
- The Forth Department of General Surgery, The First Hospital of Lanzhou University, No.1 Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu, China
| | - Wence Zhou
- Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou, 730000, China.
- The Second Clinical Medical College, Lanzhou University, Lanzhou, 730000, China.
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Huang Z, Zhou P, Li S, Li K. Prediction of the Ki-67 marker index in hepatocellular carcinoma based on Dynamic Contrast-Enhanced Ultrasonography with Sonazoid. Insights Imaging 2022; 13:199. [PMID: 36536262 PMCID: PMC9763522 DOI: 10.1186/s13244-022-01320-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/29/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Ki-67 is widely used as a proliferative and prognostic factor in HCC. This study aimed to analyze the relationship between dynamic contrast-enhanced ultrasonography (DCE-US) parameters and Ki-67 expression. METHODS One hundred and twenty patients with histopathologically confirmed HCC who underwent DCE-US were included in this prospective study. Patients were classified according to the Ki-67 marker index into low Ki-67 (< 10%) (n = 84) and high Ki-67 (≥ 10%) groups (n = 36). Quantitative perfusion parameters were obtained and analyzed. RESULTS Clinicopathological features (pathological grade and microvascular invasion) were significantly different between the high and low Ki-67 expression groups (p = 0.029 and p = 0.020, respectively). In the high Ki-67 expression group, the peak energy (PE) in the arterial phase and fall time (FT) were significantly different between the HCC lesions and distal liver parenchyma (p = 0.016 and p = 0.025, respectively). PE in the Kupffer phase was significantly different between the HCC lesions and the distal liver parenchyma in the low Ki-67 expression group (p = 0.029). The difference in PE in the Kupffer phase between HCC lesions and distal liver parenchyma was significantly different between the high and low Ki-67 expression groups (p = 0.045). The difference in PE in the Kupffer phase between HCC lesions and distal liver parenchyma < - 4.0 × 107 a.u. may contribute to a more accurate diagnosis of the high Ki-67 expression group, and the sensitivity and specificity were 82.9% and 38.7%, respectively. CONCLUSIONS The DCE-US parameters have potential as biomarkers for predicting Ki-67 expression in patients with HCC.
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Affiliation(s)
- Zhe Huang
- grid.412793.a0000 0004 1799 5032Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - PingPing Zhou
- grid.412793.a0000 0004 1799 5032Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ShanShan Li
- grid.412793.a0000 0004 1799 5032Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaiyan Li
- grid.412793.a0000 0004 1799 5032Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Local tumour control after radiofrequency or microwave ablation for colorectal liver metastases in relation to histopathological growth patterns. HPB (Oxford) 2022; 24:1443-1452. [PMID: 35144863 DOI: 10.1016/j.hpb.2022.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/19/2021] [Accepted: 01/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Regrowth after ablation is common, but predictive factors for local control are scarce. This study investigates whether histopathological growth patterns (HGP) can be used as a predictive biomarker for local control after ablation of colorectal liver metastases (CRLM). METHODS Patients who received simultaneous resection and ablation as first treatment for CRLM between 2000 and 2019 were considered eligible. HGPs were determined on resected CRLM according to international guidelines and were classified as desmoplastic or non-desmoplastic. As minimal inter-tumoural heterogeneity has been demonstrated, the HGP of resected and ablated CRLM were presumed to be identical. Local tumour progression (LTP) was assessed on postoperative surveillance imaging. Uni- and multivariable competing risk methods were used to compare LTP. RESULTS In total 221 patients with 443 ablated tumours were analysed. A desmoplastic HGP was found in 60 (27.1%) patients who had a total of 159 (34.7%) ablated lesions. Five-year LTP [95%CI] was significantly higher for ablated CRLM with a presumed non-desmoplastic HGP (37% [30-43] vs 24% [17-32], Gray's-test p = 0.014). On multivariable analysis, a non-desmoplastic HGP (adjusted HR [95%CI]; 1.55 [1.03-2.35]) was independently associated with higher LTP rates after ablation. CONCLUSION HGP is an independent predictor of local tumour progression following ablation of CRLM.
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Vogl TJ, Zitsch M, Albrecht M, D'Angelo T, Basten L, Gruber-Rouh T, Nour-Eldin NEA, Naguib NNN. Long-term outcomes following percutaneous microwave ablation for colorectal cancer liver metastases. Int J Hyperthermia 2022; 39:788-795. [PMID: 35658772 DOI: 10.1080/02656736.2022.2077991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the overall survival (OS), local progression-free survival (PFS) and prognostic factors of patients with colorectal cancer liver metastases (CRLM) undergoing microwave ablation (MWA). METHOD A total of 132 patients were retrospectively enrolled who had been treated between 2010 and 2018. For the evaluation of survival rates, all patients were divided according to their indications (curative n = 57 and debulking (patients with additional non-target extrahepatic metastases) n = 75). In total, 257 ablations were evaluated for prognostic factors: number of liver metastases, primary tumor origin (PTO), diameter and volume of metastases, duration and energy of ablation. RESULTS The OS was 32.1 months with 93.2% of patients free from recurrence at 28.3 months (median follow-up time). The one- year and three-year OS were 82.72% and 41.66%, respectively. The OS and recurrence-free survival of the curative group were statistically significantly higher than the debulking group (p < .001). Statistically significant prognostic factors for OS included the location of the primary tumor (p < .038) and the number of metastases (all p < .017). Metastasis diameter and volume and ablation duration and energy had no significant correlation with survival (p > .05). CONCLUSIONS Satisfactory OS and local tumor PFS can be achieved in patients with CRLM using MWA with the number of metastases and the location of the primary tumor influencing the outcome of patients. The metastasis's size and the duration and energy used for ablation were not of significant prognostic value.
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Affiliation(s)
- Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Maximilian Zitsch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Moritz Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Funktional Imaging, University Hospital Messina, Messina, Italy
| | - Lajos Basten
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Nour-Eldin A Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.,Radiology Department, Faculty of Medicine, Cairo University Kasr Alainy, Cairo, Egypt
| | - Nagy N N Naguib
- Radiology Department, AMEOS Klinikum Halberstadt GmbH, Halberstadt, Germany.,Radiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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10
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De Baere T, Tselikas L, Delpla A, Roux C, Varin E, Kobe A, Yevich S, Deschamps F. Thermal ablation in the management of oligometastatic colorectal cancer. Int J Hyperthermia 2022; 39:627-632. [PMID: 35477367 DOI: 10.1080/02656736.2021.1941311] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To review available evidence on thermal ablation of oligometastatic colorectal cancer. METHODS Technical and cancer specific considerations for percutaneous image-guided thermal ablation of oligometastatic colorectal metastases in the liver and lung were reviewed. Ablation outcomes are compared to surgical and radiation therapy literature. RESULTS The application of thermal ablation varies widely based on tumor burden, technical expertise, and local cancer triage algorithms. Ablation can be performed in combination or in lieu of other cancer treatments. For surgically non-resectable liver metastases, a randomized trial has demonstrated the superiority of thermal ablation combined with chemotherapy compared to systemic chemotherapy alone in term of progression-free survival and overall survival (OS), with 5-, and 8-year OS of 43.1% and 35.9% in the combined arm vs. 30.3% and 8.9% in the chemotherapy alone arm. As ablation techniques and technology improve, the role of percutaneous thermal ablation may expand even into surgically resectable disease. Many of the prognostic factors for better OS after local treatment of lung metastases are the same for surgery and thermal ablation, including size and number of metastases, disease-free interval, complete resection/ablation, negative carcinoembryonic antigen, neoadjuvant chemotherapy, and controlled extra-pulmonary metastases. When matched for these factors, thermal ablation for lung and liver metastases appears to provide equivalent overall survival as surgery, in the range of 50% at 5 years. Thermal ablation has limitations that should be respected to optimize patient outcomes and minimize complications including targets that are well-visualized by image guidance, measure <3cm in diameter, and be located at least 3mm distance from prominent vasculature or major bronchi. CONCLUSIONS The routine incorporation of image-guided thermal ablation into the therapeutic armamentarium for the treatment of oligometastatic colorectal cancer can provide long survival and even cure.
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Affiliation(s)
- Thierry De Baere
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Lambros Tselikas
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Alexandre Delpla
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Charles Roux
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Eloi Varin
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Adrian Kobe
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Steven Yevich
- Interventional Radiology Department, MD Anderson Cancer Center, Houston, TX, USA
| | - Frederic Deschamps
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
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11
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Lin YM, Bale R, Brock KK, Odisio BC. Contemporary evidence on colorectal liver metastases ablation: toward a paradigm shift in locoregional treatment. Int J Hyperthermia 2022; 39:649-663. [DOI: 10.1080/02656736.2021.1970245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Yuan-Mao Lin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Kristy K. Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruno C. Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Kamarinos NV, Vakiani E, Fujisawa S, Gonen M, Fan N, Romin Y, Do RKG, Ziv E, Erinjeri JP, Petre EN, Sotirchos VS, Camacho JC, Solomon SB, Manova K, Sofocleous CT. Immunofluorescence Assay of Ablated Colorectal Liver Metastases: The Frozen Section of Image-Guided Tumor Ablation? J Vasc Interv Radiol 2022; 33:308-315.e1. [PMID: 34800623 PMCID: PMC9531411 DOI: 10.1016/j.jvir.2021.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/20/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To validate an immunofluorescence assay (IFA) detecting residual viable tumor (VT) as intraprocedural thermal ablation (TA) zone assessment and demonstrate its prognostic value for local tumor progression (LTP) after colorectal liver metastasis (CLM) TA. MATERIALS AND METHODS This prospective study, approved by the institutional review board, included 99 patients with 155 CLMs ablated between November 2009 and January 2019. Tissue samples from the ablation zone (AZ) center and minimal margin underwent immunofluorescent microscopic examination interrogating cellular morphology and mitochondrial viability (IFA) within 30 minutes after ablation. The same tissue samples were subsequently evaluated with standard morphologic and immunohistochemical methods. The sensitivity, specificity, and overall accuracy of IFA versus standard morphologic and immunohistochemical examination were calculated. The LTP-free survival rates were evaluated for the 12-month follow-up period. RESULTS Of the 311 tissue samples stained, 304 (98%) were deemed evaluable. Of these specimens, 27% (81/304) were considered positive for the presence of VT. The accuracy of IFA was 94% (286/304). The sensitivity and specificity were 100% (63/63) and 93% (223/241), respectively. The 18 false-positive IFA assessments corresponded to samples that included viable cholangiocytes. The 12-month LTP-free survival was 59% versus 78% for IFA positive versus negative for VT AZs, respectively (P < .001). There was no difference in LTP between margin positive only and central AZ-positive tumors (25% vs 31%, P = 1). CONCLUSIONS The IFA assessment of the AZ can be completed intraprocedurally and serve as a valid real-time biomarker of complete tumor eradication or detect residual VT after TA. This method could improve tumor control by TA.
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Affiliation(s)
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sho Fujisawa
- Department of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York,NY
| | - Mithat Gonen
- Department of Statistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ning Fan
- Department of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York,NY
| | - Yevgeniy Romin
- Department of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York,NY
| | - Richard KG Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Etay Ziv
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph P. Erinjeri
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elena N. Petre
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vlasios S. Sotirchos
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Juan C. Camacho
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen B. Solomon
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katia Manova
- Department of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York,NY
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13
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Biopsy and Margins Optimize Outcomes after Thermal Ablation of Colorectal Liver Metastases. Cancers (Basel) 2022; 14:cancers14030693. [PMID: 35158963 PMCID: PMC8833800 DOI: 10.3390/cancers14030693] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Thermal ablation (TA) is a non-surgical treatment of cancer that has been used with success in the treatment of colorectal liver metastases (CLM). TA consists of burning the cancer and a rim of surrounding tissue (margin) with a special needle placed in the tumor under image guidance. Despite the technological evolution of TA, tumor progression/recurrence rates remain higher than expected. We present a method that combines tissue and imaging tests performed immediately after ablation to determine whether there is complete tumor destruction or remaining live cancer cells that can cause tumor progression/recurrence. This information can provide guidance for additional treatments for patients with evidence of residual cancer, i.e.,: additional TA at the same or subsequent sitting, or additional chemotherapy and short-interval imaging follow-up to detect recurrence. The presented method proposes a clinical practice paradigm change that can improve clinical outcomes in a large population of patients with CLM treated by TA. Abstract Background: Thermal ablation is a definitive local treatment for selected colorectal liver metastases (CLM) that can be ablated with adequate margins. A critical limitation has been local tumor progression (LTP). Methods: This prospective, single-group, phase 2 study enrolled patients with CLM < 5 cm in maximum diameter, at a tertiary cancer center between November 2009 and February 2019. Biopsy of the ablation zone center and margin was performed immediately after ablation. Viable tumor in tissue biopsy and ablation margins < 5 mm were assessed as predictors of 12-month LTP. Results: We enrolled 107 patients with 182 CLMs. Mean tumor size was 2.0 (range, 0.6–4.6) cm. Microwave ablation was used in 51% and radiofrequency ablation in 49% of tumors. The 12- and 24-month cumulative incidence of LTP was 22% (95% confidence interval [CI]: 17, 29) and 29% (95% CI: 23, 36), respectively. LTP at 12 months was 7% (95% CI: 3, 14) for the biopsy tumor-negative ablation zone with margins ≥ 5 mm vs. 63% (95% CI: 35, 85) for the biopsy-positive ablation zone with margins < 5 mm (p < 0.001). Conclusions: Biopsy-proven complete tumor ablation with margins of at least 5 mm achieves optimal local tumor control for CLM, regardless of the ablation modality used.
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14
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Torres-Jiménez J, Esteban-Villarrubia J, Ferreiro-Monteagudo R, Carrato A. Local Treatments in the Unresectable Patient with Colorectal Cancer Metastasis: A Review from the Point of View of the Medical Oncologist. Cancers (Basel) 2021; 13:5938. [PMID: 34885047 PMCID: PMC8656541 DOI: 10.3390/cancers13235938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/12/2022] Open
Abstract
For patients with isolated liver metastases from colorectal cancer who are not candidates for potentially curative resections, non-surgical local treatments may be useful. Non-surgical local treatments are classified according to how the treatment is administered. Local treatments are applied directly on hepatic parenchyma, such as radiofrequency, microwave hyperthermia and cryotherapy. Locoregional therapies are delivered through the hepatic artery, such as chemoinfusion, chemoembolization or selective internal radiation with Yttrium 90 radioembolization. The purpose of this review is to describe the different interventional therapies that are available for these patients in routine clinical practice, the most important clinical trials that have tried to demonstrate the effectiveness of each therapy and recommendations from principal medical oncologic societies.
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Affiliation(s)
- Javier Torres-Jiménez
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.E.-V.); (R.F.-M.)
| | - Jorge Esteban-Villarrubia
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.E.-V.); (R.F.-M.)
| | - Reyes Ferreiro-Monteagudo
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.E.-V.); (R.F.-M.)
| | - Alfredo Carrato
- Medical Oncology Department, Ramón y Cajal Health Research Institute (IRYCIS), CIBERONC, Alcalá University, University Hospital Ramon y Cajal, 28034 Madrid, Spain;
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15
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Repeat Local Treatment of Recurrent Colorectal Liver Metastases, the Role of Neoadjuvant Chemotherapy: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study. Cancers (Basel) 2021; 13:cancers13194997. [PMID: 34638481 PMCID: PMC8507904 DOI: 10.3390/cancers13194997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 01/10/2023] Open
Abstract
This cohort study aimed to evaluate efficacy, safety, and survival outcomes of neoadjuvant chemotherapy (NAC) followed by repeat local treatment compared to upfront repeat local treatment of recurrent colorectal liver metastases (CRLM). A total of 152 patients with 267 tumors from the prospective Amsterdam Colorectal Liver Met Registry (AmCORE) met the inclusion criteria. Two cohorts of patients with recurrent CRLM were compared: patients who received chemotherapy prior to repeat local treatment (32 patients) versus upfront repeat local treatment (120 patients). Data from May 2002 to December 2020 were collected. Results on the primary endpoint overall survival (OS) and secondary endpoints local tumor progression-free survival (LTPFS) and distant progression-free survival (DPFS) were reviewed using the Kaplan-Meier method. Subsequently, uni- and multivariable Cox proportional hazard regression models, accounting for potential confounders, were estimated. Additionally, subgroup analyses, according to patient, initial and repeat local treatment characteristics, were conducted. Procedure-related complications and length of hospital stay were compared using chi-square test and Fisher's exact test. The 1-, 3-, and 5-year OS from date of diagnosis of recurrent disease was 98.6%, 72.5%, and 47.7% for both cohorts combined. The crude survival analysis did not reveal a significant difference in OS between the two cohorts (p = 0.834), with 1-, 3-, and 5-year OS of 100.0%, 73.2%, and 57.5% for the NAC group and 98.2%, 72.3%, and 45.3% for the upfront repeat local treatment group, respectively. After adjusting for two confounders, comorbidities (p = 0.010) and primary tumor location (p = 0.023), the corrected HR in multivariable analysis was 0.839 (95% CI, 0.416-1.691; p = 0.624). No differences between the two cohorts were found with regards to LTPFS (HR = 0.662; 95% CI, 0.249-1.756; p = 0.407) and DPFS (HR = 0.798; 95% CI, 0.483-1.318; p = 0.378). No heterogeneous treatment effects were detected in subgroup analyses according to patient, disease, and treatment characteristics. No significant difference was found in periprocedural complications (p = 0.843) and median length of hospital stay (p = 0.600) between the two cohorts. Chemotherapy-related toxicity was reported in 46.7% of patients. Adding NAC prior to repeat local treatment did not improve OS, LTPFS, or DPFS, nor did it affect periprocedural morbidity or length of hospital stay. The results of this comparative assessment do not substantiate the routine use of NAC prior to repeat local treatment of CRLM. Because the exact role of NAC (in different subgroups) remains inconclusive, we are currently designing a phase III randomized controlled trial (RCT), COLLISION RELAPSE trial, directly comparing upfront repeat local treatment (control) to neoadjuvant systemic therapy followed by repeat local treatment (intervention).
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16
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Dai Y, Zhang Y, He W, Peng C, Qiu J, Zheng N, Li H, Liu W, Zheng Y, Li B, Yuan Y, Zou R. Long-term outcome for colorectal liver metastases: combining hepatectomy with intraoperative ultrasound guided open microwave ablation versus hepatectomy alone. Int J Hyperthermia 2021; 38:372-381. [PMID: 33657952 DOI: 10.1080/02656736.2021.1892835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To compare the long-term outcome of combining hepatectomy with intraoperative ultrasound (IOUS)-guided open microwave ablation (MWA) versus hepatectomy alone in patients with colorectal cancer liver metastases (CRLM). METHOD A retrospective analysis of patients with CRLM who underwent hepatectomy alone (HT group; 380 patients) or hepatectomy combined with IOUS-guided open MWA (HT + MWA group; 57 patients) from April 2002 to September 2018 was conducted at our center. A propensity score-matched (PSM) analysis was used to reduce data bias between the two groups. RESULTS The overall survival (OS) and disease-free survival (DFS) were not significantly different between the two groups after matching. Although intrahepatic recurrence was more frequent in the HT + MWA group in both the whole and matched cohort, the two groups exhibited similar rates of extrahepatic recurrence as well as concomitant intra- and extrahepatic recurrence. A higher number of CRLM (>3), larger maximum-size and absence of response to induction chemotherapy were independent risk factors for OS. CONCLUSION The oncological outcomes of hepatectomy combined with intraoperative open ablation was not significantly different to hepatectomy alone and should be considered as a safe and fair option for patients with difficultly resectable CRLM.
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Affiliation(s)
- Yunzhu Dai
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Yuanping Zhang
- Department of Hepatobiliary Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Wei He
- Department of Hepatobiliary Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Chuan Peng
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Jiliang Qiu
- Department of Hepatobiliary Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Nan Zheng
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Huifang Li
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Wenwu Liu
- Department of Hepatobiliary Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Yun Zheng
- Department of Hepatobiliary Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Binkui Li
- Department of Hepatobiliary Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Yunfei Yuan
- Department of Hepatobiliary Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Ruhai Zou
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
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17
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Izaaryene J, Drai M, Deniel C, Bridge P, Rico G, Daidj N, Gilabert M, Ewald J, Turrini O, Piana G. Computed tomography-guided microwave ablation of perivascular liver metastases from colorectal cancer: a study of the ablation zone, feasibility, and safety. Int J Hyperthermia 2021; 38:887-899. [PMID: 34085891 DOI: 10.1080/02656736.2021.1912413] [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: 01/20/2023] Open
Abstract
OBJECTIVES To compare the ablation margins and safety of microwave ablation (MWA) of perivascular versus non-perivascular liver metastases from colorectal cancer (CRC) and to determine the risk factors for local tumor progression (LTP) after perivascular MWA. METHODS Between June 2017 and June 2019, 84 metastases were treated: 39 perivascular (<5 mm from a vessel >3 mm), and 46 non-perivascular. Perivascular metastases were treated with either conventional or optimized protocols (maximum power and/or several heating cycles after repositioning the needle regardless of the initial tumor dimensions). The mean diameter of metastases was 15.4 mm (SD: 7.56). RESULTS Vascular proximity did not result in a significant difference in ablation margins. The technical success rate, primary efficacy, and secondary efficacy were 90%, 66%, and 83%, respectively. Perivascular location was not a risk factor for time to LTP (p = 0.49), RFS (p = 0.52), or OS (p = 0.54). LTP was statistically related to the presence of a colonic obstruction (p < 0.05), number of metastases at the time of diagnosis (p < 0.05), type of protocol (p < 0.05), ablation margins (p < 0.001) and LTP was proportional to the number of liver resections before MWA (p < 0.05). There was no LTP in tumors ablated with margins over 10 mm. Two grade 4 complications occurred. CONCLUSION MWA is an effective and safe treatment for perivascular liver metastases from CRC, provided that satisfactory margins are achieved. A maximalist attitude could be related to better local control.
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Affiliation(s)
- Jean Izaaryene
- Department of Radiology, Institut Paoli Calmettes, Aix Marseille University, Marseille, France
| | - Maxime Drai
- Department of Radiology, Institut Paoli Calmettes, Aix Marseille University, Marseille, France
| | - Cécile Deniel
- Department of Radiology, Institut Paoli Calmettes, Aix Marseille University, Marseille, France
| | - Pauline Bridge
- Laboratoire Imagerie Interventionnelle Experimentale CERIMED, Marseille, France
| | - Geoffrey Rico
- Department of Radiology, Institut Paoli Calmettes, Aix Marseille University, Marseille, France
| | - Nassima Daidj
- Department of Radiology, Institut Paoli Calmettes, Aix Marseille University, Marseille, France
| | - Marine Gilabert
- Department of Oncology, Institut Paoli Calmettes, Marseille, France
| | - Jacques Ewald
- Department of Surgery, Institut Paoli Calmettes, Marseille, France
| | - Olivier Turrini
- Department of Surgery, Institut Paoli Calmettes, Marseille, France
| | - Gilles Piana
- Department of Radiology, Institut Paoli Calmettes, Aix Marseille University, Marseille, France
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18
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Wu H, Liu GJ, Zhang ZY, Wu W, Meng YF, Wang S, Yang W, Yan K. Nomogram including chemotherapy response for prediction of intrahepatic progression-free survival in patients with colorectal liver metastasis through chemotherapy followed by radiofrequency ablation. Int J Hyperthermia 2021; 38:633-639. [PMID: 33882789 DOI: 10.1080/02656736.2021.1912415] [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: 12/31/2022] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) is being considered as the favorable treatment option for unresectable colorectal cancer liver metastases (CRLM) receiving chemotherapy, yet there still exist challenges for recurrence after RFA. The present study aims to establish an effective nomogram to predict intrahepatic progression-free survival (PFS) and select RFA candidates. METHODS Patients with unresectable CRLM treated with chemotherapy followed by RFA between 2010 and 2016 were enrolled in this study. The nomogram to predict intrahepatic PFS was established based on multivariable Cox regression analysis. The predictive performance of the nomogram was assessed according to the C-index, calibration plots and Kaplan-Meier curve. RESULTS Of a total of 158 patients, the earlier new intrahepatic metastases over local tumor progression were observed in 157 patients during the follow-up, and the mean intrahepatic PFS was 16.9 ± 1.4 months in the present cohort. The optimal cutoff value of tumor size after chemotherapy was identified as 16 mm by X-tile analysis. Based on multivariate analysis, independent prognostic factors for intrahepatic PFS included primary positive lymph nodes, multiple metastases, tumor size >16 mm, no primary lesion resection, mutant KRAS and PD response after chemotherapy. The nomogram was established to predict intrahepatic PFS based on all independent factors, which achieved favorable discrimination and calibration. CONCLUSION This study firstly established the nomogram to predict intrahepatic PFS for unresectable CRLM patients receiving chemotherapy followed by RFA. It can facilitate the selection of RFA candidates, and help both surgeons and patients choose individualized regimens in the treatment decision.
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Affiliation(s)
- Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Gui-Ju Liu
- Department of Medical Oncology, People's Hospital of Zhengzhou, Zhengzhou, China
| | - Zhong-Yi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuan-Feng Meng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China.,Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Song Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
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19
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Fan Y, Yu Y, Wang X, Hu M, Hu C. Radiomic analysis of Gd-EOB-DTPA-enhanced MRI predicts Ki-67 expression in hepatocellular carcinoma. BMC Med Imaging 2021; 21:100. [PMID: 34130644 PMCID: PMC8204550 DOI: 10.1186/s12880-021-00633-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 06/04/2021] [Indexed: 02/08/2023] Open
Abstract
Background Nuclear protein Ki-67 indicates the status of cell proliferation and has been regarded as an attractive biomarker for the prognosis of HCC. The aim of this study is to investigate which radiomics model derived from different sequences and phases of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI was superior to predict Ki-67 expression in hepatocellular carcinoma (HCC), then further to validate the optimal model for preoperative prediction of Ki-67 expression in HCC. Methods This retrospective study included 151 (training cohort: n = 103; validation cohort: n = 48) pathologically confirmed HCC patients. Radiomics features were extracted from the artery phase (AP), portal venous phase (PVP), hepatobiliary phase (HBP), and T2-weighted (T2W) images. A logistic regression with the least absolute shrinkage and selection operator (LASSO) regularization was used to select features to build a radiomics score (Rad-score). A final combined model including the optimal Rad-score and clinical risk factors was established. Receiver operating characteristic (ROC) curve analysis, Delong test and calibration curve were used to assess the predictive performance of the combined model. Decision cure analysis (DCA) was used to evaluate the clinical utility. Results The AP radiomics model with higher decision curve indicating added more net benefit, gave a better predictive performance than the HBP and T2W radiomic models. The combined model (AUC = 0.922 vs. 0.863) including AP Rad-score and serum AFP levels improved the predictive performance more than the AP radiomics model (AUC = 0.873 vs. 0.813) in the training and validation cohort. Calibration curve of the combined model showed a good agreement between the predicted and the actual probability. DCA of the validation cohort revealed that at a range threshold probability of 30–60%, the combined model added more net benefit compared with the AP radiomics model. Conclusions A combined model including AP Rad-score and serum AFP levels based on enhanced MRI can preoperatively predict Ki-67 expression in HCC. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-021-00633-0.
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Affiliation(s)
- Yanfen Fan
- Department of Radiology, The First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 215006, Jiangsu, People's Republic of China.,Institute of Medical Imaging of Soochow University, Shizi Street 188, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Yixing Yu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 215006, Jiangsu, People's Republic of China.,Institute of Medical Imaging of Soochow University, Shizi Street 188, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 215006, Jiangsu, People's Republic of China.,Institute of Medical Imaging of Soochow University, Shizi Street 188, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Mengjie Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 215006, Jiangsu, People's Republic of China.,Institute of Medical Imaging of Soochow University, Shizi Street 188, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, 215006, Jiangsu, People's Republic of China. .,Institute of Medical Imaging of Soochow University, Shizi Street 188, Suzhou, 215006, Jiangsu, People's Republic of China.
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20
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Lei HJ, Wang SY, Chau IY, Li AFY, Chau YP, Hsia CY, Chou SC, Kao YC, Chau GY. Hepatoma upregulated protein and Ki-67 expression in resectable hepatocellular carcinoma. J Chin Med Assoc 2021; 84:623-632. [PMID: 33883465 DOI: 10.1097/jcma.0000000000000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Hepatoma upregulated protein (HURP) and Ki-67 have been identified as cancer-related genes involved in cell growth and proliferation. Previous experimental studies have suggested an essential role for HURP expression in liver carcinogenesis. However, data regarding HURP expression in hepatocellular carcinoma (HCC) and its correlation with patient outcomes are limited. In this study, we examined the clinicopathologic features associated with HURP expression in HCC, and compared them to the results of the Ki-67 study. METHODS Eighty-seven resected HCC at tumor, node, metastasis (TNM) stages I (n = 28), II (n = 29), and III (n = 30) were evaluated. HURP and Ki-67 expression were assessed by immunohistochemistry. Multivariate analysis was used to examine the prognostic significance of HURP and Ki-67 expression. RESULTS HURP expression in HCC tissue was observed in 59% of patients and associated with female sex, low white blood cell count, and low platelet count. Ki-67 expression was observed in 67% of patients and associated with younger age, higher serum α-fetoprotein (AFP) levels, and frequent microvascular invasion. Univariate analysis showed that factors related to overall survival were: age >55 years, AFP >20 ng/mL, indocyanine green retention rate at 15 minutes (ICG-15) >15%, tumor size >5 cm, multiple tumors, macrovascular invasion, microvascular invasion, Ki-67 expression, and serum vascular endothelial growth factor >170 pg/mL. HURP expression was not associated with postresection survival. Multivariate analysis indicated that macrovascular invasion, multiple tumors, ICG-15 >15%, and Ki-67 expression were independent factors for overall survival. Multiple tumors and Ki-67 expression were independent factors related to recurrence-free survival. CONCLUSION In our study, HURP expression in HCC tissue was not associated with post-resection survival. Ki-67 expression was an independent prognostic factor for survival. Our results suggest that the effect of HURP activity on growth, invasion, and postresection outcome of HCC in actual patients is less than previously demonstrated in experimental studies.
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Affiliation(s)
- Hoa-Jan Lei
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Sheng-Yu Wang
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ivy Yenwen Chau
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Anna Fen-Yau Li
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yat-Pang Chau
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan, ROC
| | - Cheng-Yuan Hsia
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shu-Cheng Chou
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Chu Kao
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Gar-Yang Chau
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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21
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Lin YM, Taiji R, Calandri M, Odisio BC. Tumor Biomarkers and Interventional Oncology: Impact on Local Outcomes for Liver and Lung Malignancy. Curr Oncol Rep 2021; 23:67. [PMID: 33855606 DOI: 10.1007/s11912-021-01056-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Interventional oncology (IO) loco-regional treatments are widely utilized in clinical practice. However, local tumor control rates are still widely variable. There is a need to identify and develop novel biomarkers prognosticators following IO therapies. Here, we review the current literature on molecular tumor biomarkers in IO, mainly focusing on patients with liver and lung cancers. RECENT FINDINGS RAS mutation is a prognosticator for patients with colorectal liver metastases. Several promising serum metabolites, gene signatures, circulating tumor nucleotides, and peptides are being evaluated for patients with hepatocellular carcinoma. Ki-67 and RAS mutation are independent risk factors for local tumor progression in the ablation of lung cancer. The relevant interplay between specific tumor biomarkers and IO loco-regional therapies outcomes has brought a new vision in the management of cancer. Further evolution of personalized interventional oncology accordingly to tumor biomarkers should improve oncologic outcomes for patients receiving IO therapies.
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Affiliation(s)
- Yuan-Mao Lin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St. FCT 14.5084, Houston, TX, 77030, USA
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ryosuke Taiji
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St. FCT 14.5084, Houston, TX, 77030, USA
- Department of Radiology, Nara Medical University, Nara, Japan
| | - Marco Calandri
- Radiology Unit, San Luigi Gonzaga University Hospital - Department of Oncology, University of Turin, Turin, Italy
| | - Bruno C Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St. FCT 14.5084, Houston, TX, 77030, USA.
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22
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Abstract
Image-guided percutaneous thermal ablation is a widely acceptable local therapy for patients with colorectal liver metastases who are noneligible for surgery or present with recurrence after hepatectomy. The increasing knowledge of factors that affect oncologic outcomes has allowed selected patients with resectable small volume colorectal liver metastases to be treated by thermal ablation with curative intent. The continuous technological evolutions in imaging and image-guidance and the wide implementation of microwave ablation that overcomes most of the limitations of radiofrequency ablation have contributed to this paradigm shift. The importance of patient selection, ablation margin evaluation, and confirmation of complete tumor ablation (A0) are discussed in this article.
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23
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Zhang Z, Huang J, Wang G, Jin F, Zheng J, Xiao H, Lei L, Luo J, Chen C. Serum miRNAs, a potential prognosis marker of loco-regionally advanced nasopharyngeal carcinoma patients treated with CCRT. BMC Cancer 2020; 20:183. [PMID: 32131777 PMCID: PMC7057605 DOI: 10.1186/s12885-020-6689-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/27/2020] [Indexed: 12/26/2022] Open
Abstract
Background Serum miRNA was once found as potential disease survival index,thus we investigated the role of miRNA in predicting prognosis in loco-regionally advanced NPC patients treated with CCRT. Methods This study included two phases: (i) We enrolled 3 NPC patients with recurrence or distant metastasis (experimental group, EG) and 3 NPC patients in clinical remission (control group, CG),who were treated with CCRT within 5 years. The paired serum was collected before and after treatment and biomarkers were discovered by LNA-TaqMan Human MicroRNA Arrays. (ii) we used the bioinformatic analysis, marker selection and an independent validation by qRT-PCR to analyse the serums of 29 NPC patients with recurrent disease or distant metastasis and 19 NPC patients in clinical remission treated with CCRT. Using the Kaplan-Meier method, log-rank test and Cox regression model to estimate the accuracy of the miRNAs to predict PFS and OS, and identified factors significantly associated with prognosis, respectively. Results Using fold change≥2.0 or ≤ 0.5 and p ≤ 0.05 as cutoff levels, we identified 1 up-regulated and 6 down-regulated miRNAs, 1 up-regulated and 9 down-regulated miRNAs in EG versus CG before and after CCRT, respectively. After these down-regulated miRNAs were dealed with bioinformatics analysis and normalization, only 5 different miRNAs were significantly reduced, which there were no significant difference in the expression of miRNA-26b, miRNA-29a and miRNA-125b before CCRT, and the expression of miRNA-143 and miRNA-29b after CCRT in the serum samples of 48 NPC patients. Based on this, we calculated a risk score with the expression of miRNA-26b、miRNA-29a、miRNA-125b、miRNA-29b、miRNA-143 and then classified patients as high or low risk group. Cox regression model suggested that combining miRNA-29a and miRNA-125b before CCRT with miRNA-26b after CCRT was independent prognostic factors for PFS (HR = 3.149, 95%CI:1.018–9.115, p = 0.034), whereas combining the former two is independent for OS (HR = 5.146, 95%CI:1.674–15.817, p = 0.04). Conclusions For loco-regionally advanced NPC patients treated with CCRT, especially high-risk patients- serum miRNAs, such as miRNA-29a, miRNA-125b and miRNA-26b etc., play an important role in predicting prognosis factors of PFS and OS, which will contribute to the strategic direction for future research.
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Affiliation(s)
- Zhimin Zhang
- Cancer Center, Institute of Surgery Research, Daping Hospital, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China.,Department of Oncology, General Hospital of Central Theater Command, People's Liberation Army, Wuhan, 430070, Hubei, China
| | - Jiangbiao Huang
- Medical College, Wuhan University of science and technology, Wuhan, 430065, Hubei, China
| | - Ge Wang
- Cancer Center, Institute of Surgery Research, Daping Hospital, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Feng Jin
- Cancer Center, Institute of Surgery Research, Daping Hospital, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Jijun Zheng
- Cancer Center, Institute of Surgery Research, Daping Hospital, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - He Xiao
- Cancer Center, Institute of Surgery Research, Daping Hospital, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Lin Lei
- Cancer Center, Institute of Surgery Research, Daping Hospital, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Jia Luo
- Cancer Center, Institute of Surgery Research, Daping Hospital, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Chuan Chen
- Cancer Center, Institute of Surgery Research, Daping Hospital, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China.
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Miura K, Hamanaka K, Uehara T, Momose M, Kanai Y, Matsuoka S, Takeda T, Agatsuma H, Hyogotani A, Ito KI. Bone morphogenetic protein-7 expression reflects the high proliferative ability and aggressiveness of thymic epithelial tumors. J Thorac Dis 2020; 12:448-456. [PMID: 32274111 PMCID: PMC7139077 DOI: 10.21037/jtd.2020.01.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Bone morphogenetic protein-7 (BMP-7) is a transforming growth factor-β superfamily member. We examined whether BMP-7 expression in thymic epithelial tumors is associated with their clinicopathological features. Methods One hundred and thirty-two clinical specimens were analyzed in this study. The expression of BMP-7 was detected using immunohistochemistry and was scored as 0, 1, 2, or 3 according to its intensity and was then classified as negative (score 0 and 1) or positive (2 and 3). In addition, Ki-67 staining was performed in type B3 thymoma and thymic cancer. Results The positive ratio of BMP-7 was 80% in thymic cancer and 70% in thymoma type B3. In contrast, the positive ratios of BMP-7 in type B2 (29.1%), B1 (3.7%), AB (26%), and A (31%) were relatively low. The mean Ki-67 labeling index of the BMP-7 positive group (10.1%±5.9%) was significantly higher than that of the BMP-7 negative group (4.9%±5.9%) in type B3 thymoma and thymic cancer (P=0.012). The BMP-7 positive group showed significantly poorer overall survival (OS) than the BMP-7 negative group across all patients with thymic epithelial tumors and in all types of thymomas (P=0.006, P=0.018); however, no difference was observed in thymic cancers. Conclusions This study showed that high expression of BMP-7 correlated with a poor prognosis in patients with thymic epithelial tumors, and the expression of BMP-7 was higher in type B3 thymomas and thymic cancers than in other types of thymomas. BMP-7 might serve as a novel prognostic biomarker for thymic epithelial tumors.
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Affiliation(s)
- Kentaro Miura
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Kazutoshi Hamanaka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Tsuyoshi Uehara
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Masanobu Momose
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Yukiko Kanai
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Shunichiro Matsuoka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Tetsu Takeda
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Hiroyuki Agatsuma
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Akira Hyogotani
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Ken-ichi Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
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Liao H, Ahmed M, Markezana A, Zeng G, Stechele M, Galun E, Goldberg SN. Thermal Ablation Induces Transitory Metastatic Growth by Means of the STAT3/c-Met Molecular Pathway in an Intrahepatic Colorectal Cancer Mouse Model. Radiology 2019; 294:464-472. [PMID: 31845846 DOI: 10.1148/radiol.2019191023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Systemic protumorigenic effects have been noted after radiofrequency ablation (RFA) of normal liver and have been linked to an interleukin 6/signal transducer and activator of transcription 3 (STAT3)/hepatocyte growth factor (HGF)/tyrosine-protein kinase Met (c-Met)/vascular endothelial growth factor (VEGF) cytokinetic pathway. Purpose To elucidate kinetics of RFA protumorigenic effects on intrahepatic metastatic implantation and growth and determine potential molecular targets for pharmacologic suppression of these effects. Materials and Methods An intrahepatic metastasis model was established by implanting CT26 and MC38 tumor cells into 216 7-8-week-old male Balb/C and C57BL6 mice, respectively, by means of splenic injection. Between June 2017 and March 2019, mice underwent tumor injection, followed 24 hours later by either standardized RFA (70°C ± 1, 5 minutes, 1-cm tip) or a sham procedure (needle placement without heating) (12 animals per arm, n = 48). Next, RFA or sham procedures were performed, followed by splenic tumor cell injection at 1 day, 3 days, or 7 days later (six animals per arm, n = 72). Finally, PHA-665752 and S3I-201 were used to block c-Met or STAT3, respectively, prior to either RFA or sham treatment (six animals per arm, n = 96). Livers were harvested at 14 days for CT26 and 21days for MC38 for tumor quantification. Ki-67 and CD34 immunohistochemistry measured proliferative indexes and microvascular density, respectively. Data were compared with analysis of variance and the two-tailed Student t test. Results RFA performed after tumor cell injection induced increased metastatic tumor number (103 ± 45 vs 52 ± 44 [CT26], P = .009 and 87 ± 51 vs 39 ± 20 [MC38], P = .007), cellular proliferation (P < .001 for both), and intratumoral neovascularization (P < .001 for both), compared with the sham procedure. Tumor cell injection performed 1 day and 3 days after RFA also increased these indexes (P < .05), while no difference was demonstrated for cell injection 7 days after RFA (P > .05). Adjuvant c-Met or STAT3 inhibition reduced intrahepatic metastatic parameters after RFA to baseline (P < .03), equivalent to the sham group (P > .05). Conclusion Radiofrequency ablation of normal liver promotes intrahepatic metastatic implantation and increased growth over a short-lived (1-3 days) temporal window in animal models. This phenomenon can be potentially neutralized with specific inhibition of pathways including hepatocyte growth factor/tyrosine-protein kinase Met and signal transducer and activator of transcription 3. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Nikolic in this issue.
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Affiliation(s)
- Haixing Liao
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
| | - Muneeb Ahmed
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
| | - Aurelia Markezana
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
| | - Guohua Zeng
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
| | - Matthias Stechele
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
| | - Eithan Galun
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
| | - S Nahum Goldberg
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
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Camacho JC, Petre EN, Sofocleous CT. Thermal Ablation of Metastatic Colon Cancer to the Liver. Semin Intervent Radiol 2019; 36:310-318. [PMID: 31680722 DOI: 10.1055/s-0039-1698754] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is responsible for approximately 10% of cancer-related deaths in the Western world. Liver metastases are frequently seen at the time of diagnosis and throughout the course of the disease. Surgical resection is often considered as it provides long-term survival; however, few patients are candidates for resection. Percutaneous ablative therapies are also used in the management of this patient population. Different thermal ablation (TA) technologies are available including radiofrequency ablation, microwave ablation (MWA), laser, and cryoablation. There is growing evidence about the role of interventional oncology and image-guided percutaneous ablation in the management of metastatic colorectal liver disease. This article aims to outline the technical considerations, outcomes, and rational of TA in the management of patients with CRC liver metastases, focusing on the emerging role of MWA.
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Affiliation(s)
- Juan C Camacho
- Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Constantinos T Sofocleous
- Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
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27
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Human amniotic membrane conditioned medium inhibits proliferation and modulates related microRNAs expression in hepatocarcinoma cells. Sci Rep 2019; 9:14193. [PMID: 31578445 PMCID: PMC6775050 DOI: 10.1038/s41598-019-50648-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 09/17/2019] [Indexed: 12/19/2022] Open
Abstract
The placental stem cells have called the focus of attention for their therapeutic potential to treat different diseases, including cancer. There is plenty evidence about the antiproliferative, antiangiogenic and proapoptotic properties of the amniotic membrane. Liver cancer is the fifth cause of cancer in the world, with a poor prognosis and survival. Alternative treatments to radio- or chemotherapy have been searched. In this work we aimed to study the antiproliferative properties of the human amniotic membrane conditioned medium (AM-CM) in hepatocarcinoma cells. In addition, we have analyzed the regulation of pro and antiOncomiRs expression involved in hepatocarcinoma physiology. We have determined by 3H-thymidine incorporation assay that AM-CM inhibits DNA synthesis in HepG2 cells after 72 h of treatment. AM-CM pure or diluted at 50% and 25% also diminished HepG2 and HuH-7 cells viability and cell number. Furthermore, AM-CM induced cell cycle arrest in G2/M. When proliferation mechanisms were analyzed we found that AM-CM reduced the expression of both Cyclin D1 mRNA and protein. Nuclear expression of Ki-67 was also reduced. We observed that this CM was able to promote the expression of p53 and p21 mRNA and proteins, leading to cell growth arrest. Moreover, AM-CM induced an increase in nuclear p21 localization, observed by immunofluorescence. As p53 levels were increased, Mdm-2 expression was downregulated. Interestingly, HepG2 and HuH-7 cells treatment with AM-CM during 24 and 72 h produced an upregulation of antiOncomiRs 15a and 210, and a downregulation of proOncomiRs 206 and 145. We provide new evidence about the promising novel applications of human amniotic membrane in liver cancer.
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Chai W, Zhao Q, Kong D, Jiang T. Percutaneous Laser Ablation of Hepatic Tumors Located in the Portacaval Space: Preliminary Results. Lasers Surg Med 2019; 51:866-873. [PMID: 31286541 DOI: 10.1002/lsm.23123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Limited data have been used to evaluate the feasibility and effectiveness of percutaneous laser ablation (PLA) (a modality that has been proven to be a safe method for tumors in high-risk locations) for hepatic tumors in the space between the portal vein and inferior vena cava (IVC). The goal of this study was to investigate the characteristics and therapeutic effectiveness of ultrasound-guided PLA of hepatic tumors in the portacaval space. STUDY DESIGN/MATERIALS AND METHODS Ten patients, who had hepatic tumors in the portacaval space (defined as tumors located in the space formed by the hepatic portal vein and IVC less than 5 mm from the margins of both vessels), receiving ultrasound-guided PLA between January 2016 and June 2017 were analyzed. Tumors in the type I portacaval space were enclosed on three sides of major vessels, and tumors in the type II portacaval space were enclosed on two sides of major vessels. The technical success, treatment response, complete tumor ablation (CTA), local tumor progression (LTP), and distant tumor recurrence (DTR) were assessed and recorded at the follow-up. RESULTS The mean tumor diameter was 1.8 ± 0.4 cm. Technical success and initial CTA were achieved in all 10 patients without major complications. The 6-month and 12-month LTP rates were 0% and 10%, respectively. The DTR rate was 20% at both the 6- and 12-month follow-ups. CONCLUSIONS The preliminary results showed that ultrasound-guided PLA was feasible and safe for tumors in the portacaval space, and further studies on larger populations with a longer follow-up are needed to delineate the use of PLA and evaluate its therapeutic efficacy. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Weilu Chai
- Department of Ultrasonography, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang, 310003, P.R. China.,Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang, 310003, P.R. China
| | - Qiyu Zhao
- Department of Ultrasonography, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang, 310003, P.R. China.,Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang, 310003, P.R. China
| | - Dexing Kong
- School of Mathematical Sciences, Zhejiang University, Hangzhou, 310003, P.R. China
| | - Tian'an Jiang
- Department of Ultrasonography, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang, 310003, P.R. China.,Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang, 310003, P.R. China
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29
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Sotirchos VS, Fujisawa S, Vakiani E, Solomon SB, Manova-Todorova KO, Sofocleous CT. Fluorescent Tissue Assessment of Colorectal Cancer Liver Metastases Ablation Zone: A Potential Real-Time Biomarker of Complete Tumor Ablation. Ann Surg Oncol 2019; 26:1833-1840. [PMID: 30830537 DOI: 10.1245/s10434-018-07133-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study aimed to evaluate whether rapid fluorescent tissue examination immediately after colorectal cancer liver metastasis (CLM) ablation correlates with standard pathologic and immunohistochemical (IHC) assessments. METHODS This prospective, National Institutes of Health-supported study enrolled 34 consecutive patients with 53 CLMs ablated between January 2011 and December 2014. Immediately after ablation, core needle sampling of the ablation zone was performed. Tissue samples were evaluated with fluorescent viability (MitoTracker Red) and nuclear (Hoechst) stains. Confocal microscope imaging was performed within 30 min after ablation. The same samples were subsequently fixed and stained with hematoxylin and eosin (H&E). Identified tumor cells underwent IHC staining for proliferation (Ki67) and viability (OxPhos). The study pathologist, blinded to the H&E and IHC assessment, evaluated the fluorescent images separately to detect viable tumor cells. Sensitivity, specificity, and overall concordance of the fluorescent versus H&E and IHC assessments were calculated. RESULTS A total of 63 tissue samples were collected and processed. The overall concordance rate between the immediate fluorescent and the subsequent H&E and IHC assessments was 94% (59/63). The fluorescent assessment sensitivity and specificity for the identification of tumor cells were respectively 100% (18/18) and 91% (41/45). CONCLUSIONS The study showed a high concordance rate between the immediate fluorescent assessment and the standard H&E and IHC assessment of the ablation zone. Given the documented prognostic value of ablation zone tissue characteristics for outcomes after ablation of CLM, the fluorescent assessment offers a potential intra-procedural biomarker of complete tumor ablation.
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Affiliation(s)
- Vlasios S Sotirchos
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Sho Fujisawa
- Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B Solomon
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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30
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Jiang BB, Yan K, Zhang ZY, Yang W, Wu W, Yin SS, Chen MH. The value of KRAS gene status in predicting local tumor progression of colorectal liver metastases following radiofrequency ablation. Int J Hyperthermia 2019; 36:211-219. [PMID: 30663903 DOI: 10.1080/02656736.2018.1556818] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE We investigated the relationships between KRAS gene status and local tumor progression (LTP) of colorectal liver metastases (CLMs) after treatment with percutaneous ultrasound-guided radiofrequency ablation (RFA). MATERIALS AND METHODS Clinical and imaging data from 76 patients (154 lesions) with CLM who underwent percutaneous ultrasound-guided RFA and had KRAS gene test results between January 2012 and June 2016 were analyzed. The average lesion size was 2.3 ± 1.0 cm (range 0.9-5.7 cm); 38 cases (82 lesions) had wild-type KRAS, and 38 cases (72 lesions) had KRAS mutations. RESULTS The technique effectiveness was 98.1% (151/154), and the LTP rate was 18.2% (28/154) after RFA, which was performed between January 2012 and November 2017. The mean and median follow-up were 32.7 ± 2.5 and 32.0 ± 2.6 months (range 1-70 months), respectively. Cumulative LTP rates at 6 months and 1, 2 and 3 years post-RFA for all patients were 7.4, 14.5, 17.8 and 19.2%, respectively. The LTP rate for patients with mutant KRAS (27.8% [20/72]) was significantly higher than that in patients with wild-type KRAS (9.8% [8/82]; p = .004). The cumulative LTP rates at 6 months and 1, 2 and 3 years post-RFA were 4.0, 11.1, 11.1 and 11.1%, respectively, for patients with wild-type KRAS and 11.2, 18.4, 25.2 and 36.2%, respectively, for patient with mutant KRAS (p = .011). Univariate (p = .011) and multivariate analyses (p = .005) showed that KRAS genotype in liver metastases was predictive of LTP. Multivariate analysis also showed that ablation margin size (p< .001) and modified clinical risk score (CRS; p = .033) were independent prognostic factors for LTP. CONCLUSIONS KRAS gene status of liver metastatic lesions was associated with LTP rates after RFA of CLM. Ablation margin size and modified CRS were also independent prognostic factors for LTP.
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Affiliation(s)
- Bin-Bin Jiang
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
| | - Kun Yan
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
| | - Zhong-Yi Zhang
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
| | - Wei Yang
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
| | - Wei Wu
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
| | - Shan-Shan Yin
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
| | - Min-Hua Chen
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
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31
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Schicho A, Niessen C, Haimerl M, Wiesinger I, Stroszczynski C, Beyer LP, Wiggermann P. Long-term survival after percutaneous irreversible electroporation of inoperable colorectal liver metastases. Cancer Manag Res 2018; 11:317-322. [PMID: 30643457 PMCID: PMC6312065 DOI: 10.2147/cmar.s182091] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background For colorectal liver metastases (CRLM) that are not amenable to surgery or thermal ablation, irreversible electroporation (IRE) is a novel local treatment modality and additional option. Methods This study is a retrospective long-term follow-up of patients with CRLM who underwent IRE as salvage treatment. Results Of the 24 included patients, 18 (75.0%) were male, and the median age was 57 (range: 28-75) years. The mean time elapsed from diagnosis to IRE was 37.9±37.3 months. Mean overall survival was 26.5 months after IRE (range: 2.5-69.2 months) and 58.1 months after diagnosis (range: 14.8-180.1 months). One-, three-, and five-year survival rates after initial diagnosis were 100.0%, 79.2%, and 41.2%; after IRE, the respective survival rates were 79.1%, 25.0%, and 8.3%. There were no statistically significant differences detected in survival after IRE with respect to gender, age, T- or N-stage at the time of diagnosis, size of metastases subject to IRE, number of hepatic lesions, or time elapsed between IRE and diagnosis. Conclusion For nonresectable CRLM, long-term survival data emphasize the value of IRE as a new minimally invasive local therapeutic approach in multimodal palliative treatment, which is currently limited to systemic or regional therapies in this setting.
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Affiliation(s)
- Andreas Schicho
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany,
| | - Christoph Niessen
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany,
| | - Michael Haimerl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany,
| | - Isabel Wiesinger
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany,
| | | | - Lukas P Beyer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany,
| | - Philipp Wiggermann
- Department of Radiology and Nuclear Medicine, Klinikum Braunschweig, Braunschweig, Germany
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32
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Cornelis FH, Petre EN, Vakiani E, Klimstra D, Durack JC, Gonen M, Osborne J, Solomon SB, Sofocleous CT. Immediate Postablation 18F-FDG Injection and Corresponding SUV Are Surrogate Biomarkers of Local Tumor Progression After Thermal Ablation of Colorectal Carcinoma Liver Metastases. J Nucl Med 2018; 59:1360-1365. [PMID: 29439012 DOI: 10.2967/jnumed.117.194506] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/03/2018] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to determine whether intraprocedural 18F-FDG PET/CT can be used as a predictor of local tumor progression after percutaneous ablation of colorectal liver metastases. Methods: In this institutional review board-approved prospective study, 39 patients (19 men and 20 women; median age, 56 y) underwent split-dose 18F-FDG PET/CT-guided ablation followed by immediate biopsy and contrast-enhanced CT imaging of the ablation zone. Binary categorization of biopsy tissues was performed on the basis of the presence of only nonviable coagulation necrosis or viable tumor cells. Minimum ablation margin measurements from contrast-enhanced CT imaging were categorized as 0 mm, 1-4 mm, 5-9 mm, or greater than or equal to 10 mm. SUVs were obtained from PET/CT imaging, and SUV ratios were calculated from 3-dimensional regions of interest located in the ablation zone and surrounding normal liver. All predictive variables (biopsy, minimum margin distance, and SUV ratio) were evaluated as predictors of time to local tumor progression identified on imaging using competing-risks regression models (uni- and multivariate analyses). Results: A total of 62 consecutive ablations were evaluated. The mean SUV ratio was significantly higher for viable tumor-positive immediate postablation biopsies (n = 10) than for tumor-negative biopsies (n = 52) (85.8 ± 92.2 vs. 42.3 ± 45.5) (P = 0.03) and for a minimum margin size of less than 5 mm (n = 15) than for a minimum margin size of greater than or equal to 5 mm (n = 47) (78.5 ± 99.1 vs. 38.3 ± 78.5) (P = 0.01). After a median follow-up period of 22.5 (range, 7-52) months, 23 of 62 ablated tumors showed local tumor progression (37.1%). The local tumor progression rate was significantly higher for viable tumor-positive biopsies (8/10) than for negative biopsies (15/52) (80% vs. 29%) (P = 0.001) and for a minimum margin size of less than 5 mm (9/15) than for a minimum margin size of greater than or equal to 10 mm (2/15) (60% vs. 13%) (P = 0.02) but not 5-9 mm (37.5%; 12/32) (P = 0.5). In a competing-risks analysis, biopsy results (P = 0.07) and the minimum margin size (P = 0.08) were borderline significant, but the SUV ratio was not (P = 0.22). However, for negative biopsy ablations, the minimum margin size and SUV ratio were predictive imaging factors for local tumor progression; subdistribution hazard ratios were 0.564 (0.325-0.978) (P = 0.04) and 1.005 (1.001-1.009) (P = 0.005), respectively. Conclusion: The SUV ratio and minimum margin size can independently predict colorectal metastasis local tumor progression after liver ablation when there are no viable tumor cells on immediate postablation biopsies.
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Affiliation(s)
- Francois H Cornelis
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Radiology, Université Pierre et Marie Curie, Sorbonne Université, Tenon Hospital, Paris, France
| | - Elena N Petre
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - David Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Jeremy C Durack
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph Osborne
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Constantinos T Sofocleous
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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33
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Shady W, Petre EN, Vakiani E, Ziv E, Gonen M, Brown KT, Kemeny NE, Solomon SB, Solit DB, Sofocleous CT. Kras mutation is a marker of worse oncologic outcomes after percutaneous radiofrequency ablation of colorectal liver metastases. Oncotarget 2017; 8:66117-66127. [PMID: 29029497 PMCID: PMC5630397 DOI: 10.18632/oncotarget.19806] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/19/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Kras mutation has been associated with shorter overall survival and time to disease recurrence after resection of colorectal liver metastases (CLM). This study evaluated the prognostic value of Kras mutation in patients with CLM treated by percutaneous radiofrequency ablation (RFA). METHODS This is an IRB waived retrospective analysis of the impact of KRAS mutation status on oncologic outcomes after CLM RFA. The endpoints were overall survival (OS), local tumor progression (LTP) rates, and incidence of new liver, lung, and peritoneal metastases. Survival times were calculated using Kaplan-Meier methodology from the time of RFA. RESULTS The study enrolled 97 patients. Kras exon 2 mutation was detected in 39% (38/97) of patients. On univariate analysis, Kras mutation (P=0.016) (HR: 1.8; 95% CI: 1.1 - 2.9) was a significant predictor of OS and retained significance on multivariate analysis. Kras mutation was a significant predictor of new liver metastases (P=0.037) (SHR: 2.0; CI: 1.0-3.7) and peritoneal metastases (P=0.015) (sHR: 3.0; 95% CI: 1.2-7.2) on multivariate analysis. Kras mutation was a significant predictor of LTP after RFA of CLM ablated with margins of 1-5 mm (P=0.018) (SHR: 3.0; 95% CI: 1.2-7.7) with an LTP rate of 80% (12/15) versus 41% (11/27) for wild type. CONCLUSION Kras mutation is a significant predictor of overall survival, new liver, and peritoneal metastases after RFA of CLM. A minimal radiographic ablation margin ≥ 6 mm is essential for local tumor control especially for mutant CLM.
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Affiliation(s)
- Waleed Shady
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Elena N. Petre
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Etay Ziv
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Karen T. Brown
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Nancy E. Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Stephen B. Solomon
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - David B. Solit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Constantinos T. Sofocleous
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Deng HY, Chen ZH, Wang ZQ, Wang YC, Li EM, Xu LY, Lin YD, Chen LQ. High expression of Ki-67 is an independent favorable prognostic factor for esophageal small cell carcinoma. Oncotarget 2017; 8:55298-55307. [PMID: 28903420 PMCID: PMC5589659 DOI: 10.18632/oncotarget.19426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/12/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The prognostic value of Ki-67 expression in small cell carcinoma of the esophagus (SCCE) has not been explored in any previous studies. Therefore, we conducted this retrospective study to investigate the prognostic role of Ki-67 in SCCE for the first time. RESULTS A total of 44 patients were included for analysis. The baseline clinicopathological data of these SCCE patients shared similar characteristics with previous studies. Ten patients were at stage I, 17 at stage II, and the remaining 17 were at stage III. Postoperatively, 23 patients received adjuvant therapy. Twenty-eight patients were found to have a high expression of Ki-67 (> 50%). After a median follow-up time of 54.8 months, the median survival time of those patients was 22.1 months. Early TNM stage, application of adjuvant therapy, and high expression of Ki-67 (Hazard Ratio = 0.314, 95% CI: 0.127-0.774; P = 0.012) were found to be favorable prognostic factors of patients with SCCE. In subgroup analysis, adjuvant therapy could only bring significant survival benefit for patients with high expression of Ki-67 (P = 0.008). MATERIALS AND METHODS Patients undergoing esophagectomy with lymphadenectomy for SCCE from January 2009 to January 2015 in our department were retrospectively analyzed. Data for analysis included demographic data, pathologic findings, tumor stage, adjuvant therapy, and survival time as well as Ki-67 index. CONCLUSIONS This study suggested that high expression of Ki-67 may not only serve as a favorable prognostic factor of SCCE but also an indication of providing adjuvant therapy for SCCE patients with surgical resection.
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Affiliation(s)
- Han-Yu Deng
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Zi-Hang Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zhi-Qiang Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Yun-Cang Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - En-Min Li
- The Key Laboratory of Molecular Biology for High Cancer Incidence Coastal Chaoshan Area and Department of Biochemistry and Molecular Biology, Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Li-Yan Xu
- The Key Laboratory of Molecular Biology for High Cancer Incidence Coastal Chaoshan Area and Institute of Oncologic Pathology, Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Yi-Dan Lin
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
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Micropapillary and/or Solid Histologic Subtype Based on Pre-Treatment Biopsy Predicts Local Recurrence After Thermal Ablation of Lung Adenocarcinoma. Cardiovasc Intervent Radiol 2017; 41:253-259. [PMID: 28770314 DOI: 10.1007/s00270-017-1760-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/25/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND To investigate whether histologic subtyping from biopsies can predict local recurrence after thermal ablation for lung adenocarcinoma. METHODS Patients treated with CT-guided thermal ablation for lung adenocarcinoma that had pre-ablation needle biopsy with analysis of histologic components were identified. Age, gender, smoking status, treatment indication (primary stage 1 tumor versus salvage), histologic subtype, ground-glass radiographic appearance, tumor size, ablation modality, and ablation margin were evaluated in relation to time to local recurrence (TTLR). Cumulative incidence of recurrence (CIR) was calculated using competing risks analysis and compared across groups using Fine and Grey method with clustering. Multivariate analysis was conducted with stepwise regression. RESULTS There were 53 patients with 57 tumors diagnosed as adenocarcinoma on pre-ablation biopsy and with histologic subtype analysis. Of these, 19% (11) had micropapillary components, 14% (8) had solid components, and 26% (15) had micropapillary and/or solid components. In the univariate analysis, solid (subdistribution hazard ratio [SHR] = 4.04, p = 0.0051, 95% confidence interval [CI] = 1.52-10.7), micropapillary (SHR = 3.36, p = 0.01, CI = 1.33-8.47), and micropapillary and/or solid components (SHR = 5.85, p = 0.00038, CI = 2.21-15.5) were significantly correlated with shorter TTLR. On multivariate analysis, the presence of micropapillary and/or solid component (SHR = 11.4, p = 0.00021, CI: 3.14-41.3) was the only independent predictor of TTLR. The 1-, 2-, and 3-year CIR in patients with micropapillary and/or solid components was 33, 49, and 66% compared to 5, 14, and 18% in patients with no micropapillary or solid components on biopsy specimens. CONCLUSION Micropapillary and/or solid histologic components identified in pre-ablation biopsy are associated with shorter TTLR after thermal ablation of lung adenocarcinoma.
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Petre EN, Sofocleous C. Thermal Ablation in the Management of Colorectal Cancer Patients with Oligometastatic Liver Disease. Visc Med 2017; 33:62-68. [PMID: 28612019 DOI: 10.1159/000454697] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Surgical resection of limited colorectal liver disease improves long-term survival and can be curative in a subset of selected cases. Image-guided percutaneous ablation therapies have emerged as safe and effective alternative options for selected patients with unresectable colorectal liver metastases (CLM) that can be ablated with margins. Ablation causes focal destruction of tissue and has increasingly been shown to provide durable eradication of tumors. METHODS A selective review of literature was conducted in PubMed, focusing on recent studies reporting on the safety, efficacy, and long-term outcomes of percutaneous ablation modalities in the treatment of CLM. The present work gives an overview of the different ablation techniques, their current clinical indications, and reported outcomes from most recently published studies. The 'test of time' concept for using ablation as a first local therapy is also described. RESULTS There are several thermal ablative tools currently available, including radiofrequency ablation (RFA), microwave ablation, and cryoablation. Most data to date originated from the application of RFA. Adjuvant thermal ablation in the treatment of oligometastatic colon cancer liver disease offers improved oncologic outcomes. The ideal CLM amenable to percutaneous ablation is a solitary tumor with the largest diameter up to 3 cm that can be completely ablated with a sufficient margin. 5-year overall survival rates up to 70% after ablation of unresectable CLM have been reported. Pathologic confirmation of complete tumor necrosis with margins over 5 mm provides best long-term local tumor control by thermal ablation. CONCLUSION Current evidence suggests that percutaneous ablation as adjuvant to chemotherapy improves oncologic outcomes of patients with CLM. For small tumors that can be ablated completely with clear margins, percutaneous ablation may offer outcomes similar to those of surgery.
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Affiliation(s)
- Elena Nadia Petre
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Constantinos Sofocleous
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Gavriilidis P, Askari A, Azoulay D. Survival following redo hepatectomy vs radiofrequency ablation for recurrent hepatocellular carcinoma: a systematic review and meta-analysis. HPB (Oxford) 2017; 19:3-9. [PMID: 28341429 DOI: 10.1016/j.hpb.2016.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/24/2016] [Accepted: 10/02/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Redo hepatic resection (RHR) and radiofrequency ablation (RFA) are salvage treatment choices for recurrent hepatocellular carcinoma (RHCC). As yet, it is unclear as to which treatment modality is superior in terms of long term survival. The aim of this study was to compare the survival benefits and treatment efficacy of RHR and RFA for recurrent HCC. METHODS A literature review using the EMBASE, Medline, Google scholar, and Cochrane databases was performed. Meta-analyses were performed using an inference of variance, random effects model for 1, 3 and 5-year Disease Free Survival (DFS) and Overall Survival (OS). Secondary outcomes were major morbidity and mortality. RESULTS Five retrospective studies including 639 patients were eligible. Overall, there were no differences in 1, 3 and 5-year DFS or OS for patients undergoing RHR or RFA for recurrent HCC. Comparison between the two groups demonstrated similar 5-year DFS (HR 0.86, 95% CI 0.67-1.11, p = 0.250) and 5-year OS (HR 1.03, 95% CI 0.83-1.27, p = 0.082). However, RFA had a lower morbidity rate (2%) compared with RHR (17%, p < 0.001). CONCLUSION This study demonstrates, neither RHR nor RFA appeared to be superior in terms of DFS and OS. Well-constructed, randomised, multicenter trials will be required to determine if a true difference exists.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of HPB Surgery and Liver Transplantation, Henri Mondor University Hospital, Créteil, France; Department of HPB and Transplant Surgery, St James's University Hospital, Beckett Str, Leeds LS9 7TF, UK
| | | | - Daniel Azoulay
- Department of HPB Surgery and Liver Transplantation, Henri Mondor University Hospital, Créteil, France; INSERM U 955, Créteil, France.
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Velez E, Goldberg SN, Kumar G, Wang Y, Gourevitch S, Sosna J, Moon T, Brace CL, Ahmed M. Hepatic Thermal Ablation: Effect of Device and Heating Parameters on Local Tissue Reactions and Distant Tumor Growth. Radiology 2016; 281:782-792. [PMID: 27409564 DOI: 10.1148/radiol.2016152241] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose To determine whether variable hepatic microwave ablation (MWA) can induce local inflammation and distant pro-oncogenic effects compared with hepatic radiofrequency ablation (RFA) in an animal model. Materials and Methods In this institutional Animal Care and Use Committee-approved study, F344 rats (150 gm, n = 96) with subcutaneous R3230 breast adenocarcinoma tumors had normal non-tumor-bearing liver treated with RFA (70°C × 5 minutes), rapid higher-power MWA (20 W × 15 seconds), slower lower-power MWA (5 W × 2 minutes), or a sham procedure (needle placement without energy) and were sacrificed at 6 hours to 7 days (four time points; six animals per arm per time point). Ablation settings produced 11.4 mm ± 0.8 of coagulation for all groups. Distant tumor growth rates were determined to 7 days after treatment. Liver heat shock protein (HSP) 70 levels (at 72 hours) and macrophages (CD68 at 7 days), tumor proliferative indexes (Ki-67 and CD34 at 7 days), and serum and tissue levels of interleukin 6 (IL-6) at 6 hours, hepatocyte growth factor (HGF) at 72 hours, and vascular endothelial growth factor (VEGF) at 72 hours after ablation were assessed. All data were expressed as means ± standard deviations and were compared by using two-tailed t tests and analysis of variance for selected group comparisons. Linear regression analysis of tumor growth curves was used to determine pre- and posttreatment growth curves on a per-tumor basis. Results At 7 days, hepatic ablations with 5-W MWA and RFA increased distant tumor size compared with 20-W MWA and the sham procedure (5-W MWA: 16.3 mm ± 1.1 and RFA: 16.3 mm ± 0.9 vs sham: 13.6 mm ± 1.3, P < .01, and 20-W MWA: 14.6 mm ± 0.9, P < .05). RFA and 5-W MWA increased postablation tumor growth rates compared with the 20-W MWA and sham arms (preablation growth rates range for all arms: 0.60-0.64 mm/d; postablation: RFA: 0.91 mm/d ± 0.11, 5-W MWA: 0.91 mm/d ± 0.14, P < .01 vs pretreatment; 20-W MWA: 0.69 mm/d ± 0.07, sham: 0.56 mm/d ± 1.15; P = .48 and .65, respectively). Tumor proliferation (Ki-67 percentage) was increased for 5-W MWA (82% ± 5) and RFA (79% ± 5), followed by 20-W MWA (65% ± 2), compared with sham (49% ± 5, P < .01). Likewise, distant tumor microvascular density was greater for 5-W MWA and RFA (P < .01 vs 20-W MWA and sham). Lower-energy MWA and RFA also resulted in increased HSP 70 expression and macrophages in the periablational rim (P < .05). Last, IL-6, HGF, and VEGF elevations were seen in 5-W MWA and RFA compared with 20-W MWA and sham (P < .05). Conclusion Although hepatic MWA can incite periablational inflammation and increased distant tumor growth similar to RFA in an animal tumor model, higher-power, faster heating protocols may potentially mitigate such undesired effects. © RSNA, 2016.
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Affiliation(s)
- Erik Velez
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - S Nahum Goldberg
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Gaurav Kumar
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Yuanguo Wang
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Svetlana Gourevitch
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Jacob Sosna
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Tyler Moon
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Christopher L Brace
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Muneeb Ahmed
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
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Tselikas L, de Baere T, Deschamps F, Hakimé A, Besse B, Teriitehau C, de Montpreville V, Adam J. Diagnostic yield of a biopsy performed immediately after lung radiofrequency ablation. Eur Radiol 2016; 27:1211-1217. [PMID: 27300196 DOI: 10.1007/s00330-016-4447-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/24/2016] [Accepted: 05/23/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of lung biopsies performed immediately after radiofrequency ablation (RFA). METHODS Twenty consecutive patients were treated with lung RFA. A biopsy was performed immediately after RFA, through the cannula used to insert the RFA probe to avoid hampering the RFA probe placement. Biopsies were analysed for diagnostic of malignancy and tumour morphological characteristics. Recurrence of RFA and procedure-related complications are reported. RESULTS Mean tumour size was 17.3 mm (±6.2 mm). Ninety per cent (18/20) of biopsies were able to help diagnose malignancy. Cancer subtype and origin were determined in 70 % (14/20) of tumours, including 12 metastases and two primary lung cancers. During a median follow-up of 24 months, one tumour demonstrated local progression (5 %). The overall survival, lung disease-free survival and progression-free survival rates at 12 months were 100 %, 75 % and 65 %, respectively. Adverse events of the procedure including RFA and biopsy were five pneumothoraces requiring chest tube placement (25 %), seven minor pneumothoraces (35 %) and one subsegmental intrapulmonary haemorrhage (5 %) not requiring any treatment. CONCLUSIONS A biopsy performed immediately after lung RFA allowed diagnosis of malignancy in 90 % of cases. This diagnosis is obtained without the need for additional puncture and does not hamper the accuracy of the initial RF probe placement. KEY POINTS • Treatment and biopsy are feasible during the same procedure, avoiding multiple punctures. • The best puncture path can be preserved to treat the lung tumour. • Malignancy can be determined on a post-RFA biopsy in 90 % of cases. • Cancer classification can be assessed in 70 % of cases after lung RFA.
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Affiliation(s)
- Lambros Tselikas
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, F-94805, Villejuif, France.
| | - Thierry de Baere
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, F-94805, Villejuif, France
| | - Frederic Deschamps
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, F-94805, Villejuif, France
| | - Antoine Hakimé
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, F-94805, Villejuif, France
| | - Benjamin Besse
- Medical Oncology Department, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Christophe Teriitehau
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, F-94805, Villejuif, France
| | - Vincent de Montpreville
- Department of Pathology, Institut d'Oncologie Thoracique, Centre Chirurgical Marie Lannelongue, 92350, Le Plessis Robinson, France
| | - Julien Adam
- Department of Pathology, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
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Sotirchos VS, Petrovic LM, Gönen M, Klimstra DS, Do RKG, Petre EN, Garcia AR, Barlas A, Erinjeri JP, Brown KT, Covey AM, Alago W, Brody LA, DeMatteo RP, Kemeny NE, Solomon SB, Manova-Todorova KO, Sofocleous CT. Colorectal Cancer Liver Metastases: Biopsy of the Ablation Zone and Margins Can Be Used to Predict Oncologic Outcome. Radiology 2016; 280:949-59. [PMID: 27010254 DOI: 10.1148/radiol.2016151005] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose To establish the prognostic value of biopsy of the central and marginal ablation zones for time to local tumor progression (LTP) after radiofrequency (RF) ablation of colorectal cancer liver metastasis (CLM). Materials and Methods A total of 47 patients with 67 CLMs were enrolled in this prospective institutional review board-approved and HIPAA-compliant study between November 2009 and August 2012. Mean tumor size was 2.1 cm (range, 0.6-4.3 cm). Biopsy of the center and margin of the ablation zone was performed immediately after RF ablation (mean number of biopsy samples per ablation zone, 1.9) and was evaluated for the presence of viable tumor cells. Samples containing tumor cells at morphologic evaluation were further interrogated with immunohistochemistry and were classified as either positive, viable tumor (V) or negative, necrotic (N). Minimal ablation margin size was evaluated in the first postablation CT study performed 4-8 weeks after ablation. Variables were evaluated as predictors of time to LTP with the competing-risks model (uni- and multivariate analyses). Results Technical effectiveness was evident in 66 of 67 (98%) ablated lesions on the first contrast material-enhanced CT images at 4-8-week follow-up. The cumulative incidence of LTP at 12-month follow-up was 22% (95% confidence interval [CI]: 12, 32). Samples from 16 (24%) of 67 ablation zones were classified as viable tumor. At univariate analysis, tumor size, minimal margin size, and biopsy results were significant in predicting LTP. When these variables were subsequently entered in a multivariate model, margin size of less than 5 mm (P < .001; hazard ratio [HR], 6.7) and positive biopsy results (P = .008; HR, 3.4) were significant. LTP within 12 months after RF ablation was noted in 3% (95% CI: 0, 9) of necrotic CLMs with margins of at least 5 mm. Conclusion Biopsy proof of complete tumor ablation and minimal ablation margins of at least 5 mm are independent predictors of LTP and yield the best oncologic outcomes. (©) RSNA, 2016.
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Affiliation(s)
- Vlasios S Sotirchos
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Lydia M Petrovic
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Mithat Gönen
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - David S Klimstra
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Richard K G Do
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Elena N Petre
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Alessandra R Garcia
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Afsar Barlas
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Joseph P Erinjeri
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Karen T Brown
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Anne M Covey
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - William Alago
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Lynn A Brody
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Ronald P DeMatteo
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Nancy E Kemeny
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Stephen B Solomon
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Katia O Manova-Todorova
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Constantinos T Sofocleous
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
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Cornelis F, Sotirchos V, Violari E, Sofocleous CT, Schoder H, Durack JC, Siegelbaum RH, Maybody M, Humm J, Solomon SB. 18F-FDG PET/CT Is an Immediate Imaging Biomarker of Treatment Success After Liver Metastasis Ablation. J Nucl Med 2016; 57:1052-7. [PMID: 26912433 DOI: 10.2967/jnumed.115.171926] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 02/03/2016] [Indexed: 01/26/2023] Open
Abstract
UNLABELLED The rationale of this study was to examine whether (18)F-FDG PET/CT and contrast-enhanced CT performed immediately after percutaneous ablation of liver metastases are predictors of local treatment failure at 1 y. METHODS This Health Insurance Portability and Accountability Act-compliant, Institutional Review Board-approved retrospective study reviewed 25 PET/CT-guided thermal ablations performed from September 2011 to March 2013 on 21 patients (11 women and 10 men; mean age, 56.8 y; range, 35-79 y) for the treatment of liver metastases (colorectal, n = 23; breast, n = 1; and sarcoma, n = 1). One to 3 tumors (mean size, 2.3 cm; range, 0.7-4.6 cm; mean SUVmax, 22.7; range, 9.5-77.1) were ablated using radiofrequency (n = 16) or microwave (n = 9) energy in a single session. Immediate-postablation enhanced CT and PET/CT scans were qualitatively evaluated by 2 reviewers independently, and the results were compared with clinical and imaging outcome at 1 y. The PET/CT scans were also analyzed to determine tissue radioactivity concentration (TRC) from 3-dimensional regions of interest in the ablation zone, the margin, and the surrounding normal liver to calculate a TRC ratio, which was then compared with outcome at 1 y. Receiver operating characteristics (ROC) were used, and the maximal-accuracy threshold in predicting recurrence was calculated. RESULTS Eleven (44%) of the 25 tumors recurred within 1 y. Enhanced CT did not significantly correlate with recurrence (P = 0.288). Accuracy was 64% (16/25), and the area under the ROC curve was 0.601 (95% confidence interval [95% CI], 0.387-0.789). The accuracy of the qualitative analysis of (18)F-FDG PET was 92% (23/25) (P < 0.001), and the area under the ROC curve was 0.929 (95% CI, 0.740-0.990). The mean TRC ratio was 40.6 in the recurrence group (SD, 9.2; range, 29.3-53.9) and 15.9 in the group without recurrence (SD, 7.3; range, 3-27.3). A TRC ratio of 28.3 predicted recurrence at 1 y with 100% accuracy (25/25) (P < 0.001), and the area under the ROC curve was 1 (95% CI, 0.863-1). CONCLUSION Immediate PET/CT accurately predicts the success of liver metastasis ablation at 1 y and is superior to immediate enhanced CT.
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Affiliation(s)
- Francois Cornelis
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York Department of Radiology, Pellegrin Hospital, Bordeaux, France
| | - Vlasios Sotirchos
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena Violari
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Constantinos T Sofocleous
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Heiko Schoder
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Jeremy C Durack
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert H Siegelbaum
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Majid Maybody
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John Humm
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Shady W, Petre EN, Gonen M, Erinjeri JP, Brown KT, Covey AM, Alago W, Durack JC, Maybody M, Brody LA, Siegelbaum RH, D’Angelica MI, Jarnagin WR, Solomon SB, Kemeny NE, Sofocleous CT. Percutaneous Radiofrequency Ablation of Colorectal Cancer Liver Metastases: Factors Affecting Outcomes--A 10-year Experience at a Single Center. Radiology 2016; 278:601-11. [PMID: 26267832 PMCID: PMC4734163 DOI: 10.1148/radiol.2015142489] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To identify predictors of oncologic outcomes after percutaneous radiofrequency ablation (RFA) of colorectal cancer liver metastases (CLMs) and to describe and evaluate a modified clinical risk score (CRS) adapted for ablation as a patient stratification and prognostic tool. MATERIALS AND METHODS This study consisted of a HIPAA-compliant institutional review board-approved retrospective review of data in 162 patients with 233 CLMs treated with percutaneous RFA between December 2002 and December 2012. Contrast material-enhanced CT was used to assess technique effectiveness 4-8 weeks after RFA. Patients were followed up with contrast-enhanced CT every 2-4 months. Overall survival (OS) and local tumor progression-free survival (LTPFS) were calculated from the time of RFA by using the Kaplan-Meier method. Log-rank tests and Cox regression models were used for univariate and multivariate analysis to identify predictors of outcomes. RESULTS Technique effectiveness was 94% (218 of 233). Median LTPFS was 26 months. At univariate analysis, predictors of shorter LTPFS were tumor size greater than 3 cm (P < .001), ablation margin size of 5 mm or less (P < .001), high modified CRS (P = .009), male sex (P = .03), and no history of prior hepatectomy (P = .04) or hepatic arterial infusion chemotherapy (P = .01). At multivariate analysis, only tumor size greater than 3 cm (P = .01) and margin size of 5 mm or less (P < .001) were independent predictors of shorter LTPFS. Median and 5-year OS were 36 months and 31%. At univariate analysis, predictors of shorter OS were tumor size larger than 3 cm (P = .005), carcinoembryonic antigen level greater than 30 ng/mL (P = .003), high modified CRS (P = .02), and extrahepatic disease (EHD) (P < .001). At multivariate analysis, tumor size greater than 3 cm (P = .006) and more than one site of EHD (P < .001) were independent predictors of shorter OS. CONCLUSION Tumor size of less than 3 cm and ablation margins greater than 5 mm are essential for satisfactory local tumor control. Tumor size of more than 3 cm and the presence of more than one site of EHD are associated with shorter OS.
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Affiliation(s)
- Waleed Shady
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Elena N. Petre
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Mithat Gonen
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Joseph P. Erinjeri
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Karen T. Brown
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Anne M. Covey
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - William Alago
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Jeremy C. Durack
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Majid Maybody
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Lynn A. Brody
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Robert H. Siegelbaum
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Michael I. D’Angelica
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - William R. Jarnagin
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Stephen B. Solomon
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Nancy E. Kemeny
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Constantinos T. Sofocleous
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
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Wimmer T, Srimathveeravalli G, Silk M, Monette S, Gutta N, Maybody M, Erinjery JP, Coleman JA, Solomon SB, Sofocleous CT. Feasibility of a Modified Biopsy Needle for Irreversible Electroporation Ablation and Periprocedural Tissue Sampling. Technol Cancer Res Treat 2015; 15:749-758. [PMID: 26443800 DOI: 10.1177/1533034615608739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/29/2015] [Accepted: 09/03/2015] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To test the feasibility of modified biopsy needles as probes for irreversible electroporation ablation and periprocedural biopsy. METHODS Core biopsy needles of 16-G/9-cm were customized to serve as experimental ablation probes. Computed tomography-guided percutaneous irreversible electroporation was performed in in vivo porcine kidneys with pairs of experimental (n = 10) or standard probes (n = 10) using a single parameter set (1667 V/cm, ninety 100 µs pulses). Two biopsy samples were taken immediately following ablation using the experimental probes (n = 20). Ablation outcomes were compared using computed tomography, simulation, and histology. Biopsy and necropsy histology were compared. RESULTS Simulation-suggested ablations with experimental probes were smaller than that with standard electrodes (455.23 vs 543.16 mm2), although both exhibited similar shape. Computed tomography (standard: 556 ± 61 mm2, experimental: 515 ± 67 mm2; P = .25) and histology (standard: 313 ± 77 mm2, experimental: 275 ± 75 mm2; P = .29) indicated ablations with experimental probes were not significantly different from the standard. Histopathology indicated similar morphological changes in both groups. Biopsies from the ablation zone yielded at least 1 core with sufficient tissue for analysis (11 of the 20). CONCLUSIONS A combined probe for irreversible electroporation ablation and periprocedural tissue sampling from the ablation zone is feasible. Ablation outcomes are comparable to those of standard electrodes.
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Affiliation(s)
- Thomas Wimmer
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA .,Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | | | - Mikhail Silk
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Sebastien Monette
- Laboratory of Comparative Pathology, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, The Rockefeller University, New York, NY, USA
| | - Narendra Gutta
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Majid Maybody
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Joseph P Erinjery
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Stephen B Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Constantinos T Sofocleous
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Luo Y, Ren F, Liu Y, Shi Z, Tan Z, Xiong H, Dang Y, Chen G. Clinicopathological and prognostic significance of high Ki-67 labeling index in hepatocellular carcinoma patients: a meta-analysis. Int J Clin Exp Med 2015; 8:10235-10247. [PMID: 26379815 PMCID: PMC4565198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 06/30/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND The relationship between Ki-67 labeling index (LI) and clinical outcome in hepatocellular carcinoma (HCC) has been investigated by various studies, but no consistent result has been concluded. To define the prognostic significance of Ki-67 LI in patients with HCC, we performed a meta-analysis. METHODS We searched for literatures in the following databases: PubMed, ISI Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, Science Direct, Wiley Online Library, Google Scholar, China National Knowledge Infrastructure (CNKI), Chinese VIP and WanFang Databases. Our search ended on April 6th, 2015. Data were extracted from eligible studies and the correlation between Ki-67 LI and clinicopathological features of HCC was analyzed and pooled hazard ratios (HRs) for eligible studies were calculated by STATA 11.0 (STATA Corp., College, TX). RESULTS In total, 54 studies involving 4996 patients were included in the current meta-analysis. The meta-analysis provided evidence that high Ki-67 LI was closely associated with histological grade, tumor size, number of tumor nodes, the status of metastasis, cirrhosis and vein invasion in HCC patients. The pooled HRs showed that high Ki-67 LI had an unfavorable impact on disease-free survival (DFS) (HR=1.626, 95% confidence interval (CI): 1.364-1.939, P<0.001), relapse-free survival (RFS) (HR=1.820, 95% CI: 1.215-2.725, P=0.004) and overall survival (OS) (HR=1.170, 95% CI: 1.102-1.243, P<0.001), respectively. Additionally, subgroup analysis indicated that high Ki-67 LI was related to poorer DFS, RFS and OS independent of regions, treatment strategies or statistical methods, except that no statistical significance was found on RFS (HR=2.413, 95% CI: 0.523-11.142, P=0.259) and OS (HR=1.998, 95% CI: 0.797-5.009, P=0.14) in patients with liver transplantation. CONCLUSIONS Our meta-analysis suggests that higher Ki-67 LI confers a fast progression and poor prognosis for HCC patients.
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Affiliation(s)
- Yihuan Luo
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, P. R. China
| | - Fanghui Ren
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, P. R. China
| | - Yongru Liu
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, P. R. China
| | - Zhenhong Shi
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, P. R. China
| | - Zhong Tan
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, P. R. China
| | - Huojie Xiong
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, P. R. China
| | - Yiwu Dang
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, P. R. China
| | - Gang Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, P. R. China
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Song KD, Lim HK, Rhim H, Lee MW, Kim YS, Lee WJ, Paik YH, Gwak GY, Kim JM, Kwon CHD, Joh JW. Repeated Hepatic Resection versus Radiofrequency Ablation for Recurrent Hepatocellular Carcinoma after Hepatic Resection: A Propensity Score Matching Study. Radiology 2015; 275:599-608. [PMID: 25559235 DOI: 10.1148/radiol.14141568] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the long-term outcomes of repeated hepatic resection and radiofrequency (RF) ablation for recurrent hepatocellular carcinoma (HCC) by using propensity score matching. MATERIALS AND METHODS This retrospective study was approved by the institutional review board, and the requirement to obtain informed consent was waived. Thirty-nine patients who underwent repeated hepatic resection and 178 who underwent RF ablation for recurrent HCC (mean tumor size ± standard deviation, 1.8 cm ± 0.7) between November 1994 and December 2012 were included in the study. Patients ranged in age from 24 to 85 years (mean, 54.9 years). Men ranged in age from 25 to 85 years (mean, 54.8 years), and women ranged in age from 24 to 76 years (mean, 55.4 years). A 1:2 repeated hepatic resection group-RF ablation group matching was done by using propensity score matching. The overall survival (OS) and disease-free survival (DFS) were compared before and after propensity score matching. Complications were assessed. RESULTS Before matching, OS rates at 1, 3, 5, and 8 years were 88.8%, 88.8%, 83.9%, and 56.3%, respectively, with repeated hepatic resection and 98.9%, 82.5%, 71.0%, and 58.3% for RF ablation. DFS rates at 1, 3, and 5 years were 66.1%, 48.5%, and 43.1% for repeated hepatic resection and 70.1%, 40.8%, and 30.0% for RF ablation. After matching, the OS rates at 1, 3, 5, and 8 years were 98.7%, 85.7%, 72.1%, and 68.6%, respectively, and the DFS rates at 1, 3, and 5 years were 71.8%, 45.1%, and 39.4% in the RF ablation group (n = 78). Neither the OS nor DFS rate was significantly different between the two groups before matching (P = .686 and P = .461) and after matching (P = .834 and P = .960). The postoperative mortality rate was 2.6% in the repeated hepatic resection group and 0% in the RF ablation group. CONCLUSION The long-term OS and DFS were not significantly different between repeated hepatic resection and RF ablation for patients with recurrent HCC after hepatic resection.
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Affiliation(s)
- Kyoung Doo Song
- From the Department of Radiology and Center for Imaging Science (K.D.S., H.K.L., H.R., M.W.L., Y.S.K., W.J.L.), Department of Medicine (Y.H.P., G.Y.G.), and Department of Surgery (J.M.K., C.H.D.K., J.W.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 135-710, Republic of Korea
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Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, Chen MH, Choi BI, de Baère T, Dodd GD, Dupuy DE, Gervais DA, Gianfelice D, Gillams AR, Lee FT, Leen E, Lencioni R, Littrup PJ, Livraghi T, Lu DS, McGahan JP, Meloni MF, Nikolic B, Pereira PL, Liang P, Rhim H, Rose SC, Salem R, Sofocleous CT, Solomon SB, Soulen MC, Tanaka M, Vogl TJ, Wood BJ, Goldberg SN. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. J Vasc Interv Radiol 2014; 25:1691-705.e4. [PMID: 25442132 PMCID: PMC7660986 DOI: 10.1016/j.jvir.2014.08.027] [Citation(s) in RCA: 336] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/11/2014] [Accepted: 03/26/2014] [Indexed: 12/12/2022] Open
Abstract
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
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Affiliation(s)
- Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center 1 Deaconess Rd, WCC-308B, Boston, MA 02215.
| | - Luigi Solbiati
- Department of Radiology, Ospedale Generale, Busto Arsizio, Italy
| | - Christopher L Brace
- Departments of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David J Breen
- Department of Radiology, Southampton University Hospitals, Southampton, England
| | | | | | - Min-Hua Chen
- Department of Ultrasound, School of Oncology, Peking University, Beijing, China
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Thierry de Baère
- Department of Imaging, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Gerald D Dodd
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Damian E Dupuy
- Department of Diagnostic Radiology, Rhode Island Hospital, Providence, Rhode Island
| | - Debra A Gervais
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Gianfelice
- Medical Imaging, University Health Network, Laval, Quebec, Canada
| | | | - Fred T Lee
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Edward Leen
- Department of Radiology, Royal Infirmary, Glasgow, Scotland
| | - Riccardo Lencioni
- Department of Diagnostic Imaging and Intervention, Cisanello Hospital, Pisa University Hospital and School of Medicine, University of Pisa, Pisa, Italy
| | - Peter J Littrup
- Department of Radiology, Karmonos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | - David S Lu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John P McGahan
- Department of Radiology, Ambulatory Care Center, UC Davis Medical Center, Sacramento, California
| | | | - Boris Nikolic
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Philippe L Pereira
- Clinic of Radiology, Minimally-Invasive Therapies and Nuclear Medicine, Academic Hospital Ruprecht-Karls-University Heidelberg, Heilbronn, Germany
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Hyunchul Rhim
- Department of Diagnostic Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Steven C Rose
- Department of Radiology, University of California, San Diego, San Diego, California
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | | | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael C Soulen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Bradford J Wood
- Radiology and Imaging Science, National Institutes of Health, Bethesda, Maryland
| | - S Nahum Goldberg
- Department of Radiology, Image-Guided Therapy and Interventional Oncology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Zen Y, Heaton N. Elevated Ki-67 labeling index in 'synchronous liver metastases' of well differentiated enteropancreatic neuroendocrine tumor. Pathol Int 2014; 63:532-8. [PMID: 24274715 DOI: 10.1111/pin.12108] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/09/2013] [Indexed: 11/28/2022]
Abstract
There is no consensus as to whether or not metastatic nodules in the liver should be biopsied for tumor grading in cases of neuroendocrine tumors with 'synchronous liver metastasis'. In this study, we compared the Ki-67 labeling index between the primary tumor and synchronous liver metastasis in 30 patients, who had received simultaneous resections. Examined tumors were of the small bowel (n = 18) or pancreas (n = 12), and G1 or G2 in primary histologic grade. In 20 patients (67%), the Ki-67 index was similar between the primary tumor and liver metastasis, but 10 (33%) showed an elevation of 3.4-14.4% in the liver, which increased the tumor grade in 4 cases. The Ki-67 elevation in the liver was more common in G2 than G1 neoplasms (P = 0.002). The size, but not number, of liver metastases was significantly larger in patients with an elevated Ki-67 index (P = 0.006). Using 40 mm as a provisional cutoff for the greatest diameter of liver metastases, the positive predictive value of this discriminator for elevated Ki-67 was 56%, and the negative predictive value was 93%. In conclusion, synchronous liver metastases can yield a higher Ki-67 labeling index than primary neuroendocrine tumours, particularly when the secondary is greater than 40 mm.
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Affiliation(s)
- Yoh Zen
- Histopathology Section, King's College London School of Medicine at King's College Hospital, London, UK
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48
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Sofocleous CT, Sideras P, Petre EN. "How we do it" - a practical approach to hepatic metastases ablation techniques. Tech Vasc Interv Radiol 2014; 16:219-29. [PMID: 24238377 DOI: 10.1053/j.tvir.2013.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Secondary liver malignancies are associated with significant mortality and morbidity if left untreated. Colorectal cancer is the most frequent origin of hepatic metastases. A multidisciplinary approach to the treatment of hepatic metastases includes medical, surgical, radiation and interventional oncology. The role of interventional oncology in the management of hepatic malignancies continues to evolve and applies to a large and continuous spectrum of metastatic disease, from the relatively small solitary metastasis to larger tumors and multifocal liver disease. Within the past 10 years, several publications of percutaneous image-guided ablation indicated the effectiveness and safety of this minimally invasive therapy for selected patients with limited number (arguably up to 4 metastases) of relatively small (less than 5cm) hepatic metastases. Different image-guided procedures such radiofrequency, microwave, and laser cause thermal ablation and coagulation necrosis or cell death of the target tumor. Cryoablation, causing cell death via cellular freezing, has also been used. Recently, irreversible electroporation, a nonthermal modality, has also been used for liver tumor ablation. In the following section, we review the different liver ablation techniques, as well as indications for ablation, specific patient preparations, and different "tricks of the trade" that we use to achieve safe and effective liver tumor ablation. We also discuss appropriate imaging and clinical patient follow-up and potential complications of liver tumor ablation.
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49
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Su G, Ma YL, Ou SQ, Zhao C, Song QF. Clinical significance of Ki-67 and p130 expression in liver needle biopsy from patients with hepatocellular carcinoma treated by transcatheter arterial chemoembolization. Shijie Huaren Xiaohua Zazhi 2014; 22:1146-1152. [DOI: 10.11569/wcjd.v22.i8.1146] [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] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical significance of Ki-67 and p130 expression in liver needle biopsy from patients with hepatocellular carcinoma (HCC) treated by transcatheter arterial chemoembolization (TACE).
METHODS: Medical records for 41 HCC patients treated by TACE between January 2005 and August 2010 were reviewed and the major clinical features, treatment modalities and outcomes were analyzed. The protein expression of Ki-67 and p130 was detected by S-P immunohistochemical method in 41 liver needle biopsies from patients with HCC.
RESULTS: The total positive rates of Ki-67 and p130 expression in HCC were 63.41% (26/41) and 51.52% (21/41), respectively. The expression of Ki-67 and p130 proteins was related to histological grade and prognosis (P < 0.05 for both), but not to sex, age, tumor size, TNM stage or serum level of AFP (P > 0.05 for all). There was a significant negative correlation between Ki-67 and p130 protein expression (r = -0.371, P < 0.05). The prognosis of the 41 patients with HCC treated by TACE was related to TNM stage and expression of Ki-67 and p130 (P < 0.05 for all), but not to sex, age, tumor size, histological grade or serum level of AFP (P > 0.05 for all).
CONCLUSION: Ki-67 and p130 play important roles in occurrence and development of HCC.Ki-67 and p130 can be used as predictive markers for HCC patients treated with TACE.
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50
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Zhang Y, White SB, Nicolai JR, Zhang Z, West DL, Kim DH, Goodwin AL, Miller FH, Omary RA, Larson AC. Multimodality imaging to assess immediate response to irreversible electroporation in a rat liver tumor model. Radiology 2014; 271:721-9. [PMID: 24555632 DOI: 10.1148/radiol.14130989] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare changes on ultrasonographic (US), computed tomographic (CT), and magnetic resonance (MR) images after irreversible electroporation (IRE) ablation of liver and tumor tissues in a rodent hepatoma model. MATERIALS AND METHODS Studies received approval from the institutional animal care and use committee. Forty-eight rats were used, and N1-S1 tumors were implanted in 24. Rats were divided into groups and allocated for studies with each modality. Imaging was performed in normal liver tissues and tumors before and after IRE. MR imaging was performed in one group before and after IRE after hepatic vessel ligation. US images were graded to determine echogenicity changes, CT attenuation was measured (in Hounsfield units), and MR imaging signal-to-noise ratio (SNR) was measured before and after IRE. Student t test was used to compare attenuation and SNR measurements before and after IRE (P < .05 indicated a significant difference). RESULTS IRE ablation produced greater alterations to echogenicity in normal tissues than in tumors. Attenuation in ablated liver tissues was reduced compared with that in control tissues (P < .001), while small attenuation differences between ablated (42.11 HU ± 2.11) and control (45.14 HU ± 2.64) tumors trended toward significance (P = .052). SNR in ablated normal tissues was significantly altered after IRE (T1-weighted images: pre-IRE, 145.95 ± 24.32; post-IRE, 97.80 ± 18.03; P = .004; T2-weighted images, pre-IRE, 47.37 ± 18.31; post-IRE, 90.88 ± 37.15; P = .023). In tumors, SNR differences before and after IRE were not significant. No post-IRE signal changes were observed after hepatic vessel ligation. CONCLUSION IRE induces rapid changes on gray-scale US, unenhanced CT, and MR images. These changes are readily visible and may assist a performing physician to delineate ablation zones from the unablated surrounding parenchyma.
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Affiliation(s)
- Yue Zhang
- From the Department of Bioengineering, University of Illinois at Chicago, Chicago, Ill (Y.Z., A.C.L.); Department of Radiology (Y.Z., S.B.W., J.R.N., Z.Z., D.L.W., D.H.K., A.L.G., F.H.M., R.A.O., A.C.L.) and Robert H. Lurie Comprehensive Cancer Center (A.C.L.), Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.B.W.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (A.C.L.)
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