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Lee MW, Han S, Gu K, Rhim H. Local Ablation Therapy for Hepatocellular Carcinoma: Clinical Significance of Tumor Size, Location, and Biology. Invest Radiol 2024:00004424-990000000-00231. [PMID: 38970255 DOI: 10.1097/rli.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
ABSTRACT Local ablation therapy, encompassing radiofrequency ablation (RFA), microwave ablation, and cryoablation, has emerged as a crucial strategy for managing small hepatocellular carcinomas (HCCs), complementing liver resection and transplantation. This review delves into the clinical significance of tumor size, location, and biology in guiding treatment decisions for HCCs undergoing local ablation therapy, with a focus on tumors smaller than 3 cm. Tumor size significantly influences treatment outcomes, with larger tumors associated with poorer local tumor control due to challenges in creating sufficient ablative margins and the likelihood of microvascular invasion and peritumoral satellite nodules. Advanced ablation techniques such as centripetal or no-touch RFA using multiple electrodes, cryoablation using multiple cryoprobes, and microwave ablation offer diverse options for HCC treatment. Notably, no-touch RFA demonstrates superior local tumor control compared with conventional RFA by achieving sufficient ablative margins, making it particularly promising for hepatic dome lesions or tumors with aggressive biology. Laparoscopic RFA proves beneficial for treating anterior subphrenic HCCs, whereas artificial pleural effusion-assisted RFA is effective for controlling posterior subphrenic HCCs. However, surgical resection generally offers better survival outcomes for periportal HCCs compared with RFA. Cryoablation exhibits a lower incidence of vascular or biliary complications than RFA for HCCs adjacent to perivascular or periductal regions. Additionally, aggressive tumor biology, such as microvascular invasion, can be predicted using magnetic resonance imaging findings and serum tumor markers. Aggressive HCC subtypes frequently exhibit Liver Imaging Reporting and Data System M features on magnetic resonance imaging, aiding in prognosis. A comprehensive understanding of tumor size, location, and biology is imperative for optimizing the benefits of local ablation therapy in managing HCCs.
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Affiliation(s)
- Min Woo Lee
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (M.W.L., S.H., K.G., H.R.); and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea (M.W.L., H.R.)
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Ndhlovu E, Zhang BX, Chen XP, Zhu P. Thermal ablation for hepatic tumors in high-risk locations. Clin Res Hepatol Gastroenterol 2024; 48:102300. [PMID: 38367803 DOI: 10.1016/j.clinre.2024.102300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/21/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
Thermal ablative techniques such as radiofrequency and microwave ablation are minimally invasive and cost-effective approaches that are currently being adopted as alternatives to surgical resection for primary and metastatic liver malignancies. However, they are considered to be relatively contraindicated for tumors in high-risk locations due to technical difficulties and a perceived increased risk of perioperative complications. Several techniques, including artificial ascites, non-touch multibipolar ablation, and laparoscopically assisted ablation, can be used to improve the outcomes of ablation for high-risk tumors. This review aims to provide a comprehensive summary of the techniques currently used to improve thermal ablation outcomes for high-risk liver tumors.
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Affiliation(s)
- Elijah Ndhlovu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Bi-Xiang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China.
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Li B, Ren ZW, Zhang C, Yu XX, Xu XX, Du Y, Yang HF. Computed tomography-guided percutaneous cryoablation and microwave ablation in the treatment of perivascular hepatocellular carcinoma: A comparative study with propensity score matching. Clin Res Hepatol Gastroenterol 2024; 48:102298. [PMID: 38367802 DOI: 10.1016/j.clinre.2024.102298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/13/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE To evaluate the safety and efficacy of cryoablation (CYA) and microwave ablation (MWA) in the treatment of patients with perivascular hepatocellular carcinoma (HCC). METHODS Patients with perivascular HCC who underwent computed tomography (CT)-guided percutaneous CYA or MVA treatment in our hospital from August 2009 to March 2019 were included. Propensity score matching (PSM) was performed to adjust for potential baseline differences in the two groups. The technical success rate (TS), complications, and visual analog scale (VAS) were analyzed. The overall survival (OS) was evaluated using Kaplan-Meier curves and Cox proportional hazards models. RESULTS After PSM, 32 patients from each group were selected. The technical success rate was 94 % for CYA and 91 % for MWA, and 13 patients developed recurrence (CYA, n = 5, 2 local, 3 distant; MWA, n = 8, 6 local, 2 distant). There were no significant differences in OS (36-months OS: CYA 53.1 % vs, MWA 40.6 %; P = 0.191). No intraoperative deaths or complication-related deaths were observed, and 19 patients (CYA, n = 8; MWA, n = 11) experienced complications (P = 0.435). The VAS in the MWA group (5.38 ± 1.21) was significantly higher than that in the CYA group (2.22 ± 0.87; P < 0.001). CONCLUSIONS While CYA has equal safety and high primary efficacy as MWA in the treatment of perivascular HCC, it is associated with less periprocedural pain.
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Affiliation(s)
- Bing Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Zi Wang Ren
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Chuan Zhang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Xiao Xuan Yu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Xiao Xue Xu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Yong Du
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China.
| | - Han Feng Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China.
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Zou YW, Ren ZG, Sun Y, Liu ZG, Hu XB, Wang HY, Yu ZJ. The latest research progress on minimally invasive treatments for hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2023; 22:54-63. [PMID: 36041973 DOI: 10.1016/j.hbpd.2022.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 08/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide. Due to the high prevalence of hepatitis B virus (HBV) infection in China, the incidence of HCC in China is high, and liver cirrhosis caused by chronic hepatitis also brings great challenges to treatment. This paper reviewed the latest research progress on minimally invasive treatments for HCC, including percutaneous thermal ablation and new nonthermal ablation techniques, and introduced the principles, advantages, and clinical applications of various therapeutic methods in detail. DATA SOURCES The data of treatments for HCC were systematically collected from the PubMed, ScienceDirect, American Chemical Society and Web of Science databases published in English, using "minimally invasive" and "hepatocellular carcinoma" or "liver cancer" as the keywords. RESULTS Percutaneous thermal ablation is still a first-line strategy for the minimally invasive treatment of HCC. The effect of microwave ablation (MWA) on downgrading treatment before liver transplantation is better than that of radiofrequency ablation (RFA), while RFA is more widely used in the clinical practice. High-intensity focused ultrasound (HIFU) is mainly used for the palliative treatment of advanced liver cancer. Electrochemotherapy (ECT) delivers chemotherapeutic drugs to the target cells while reducing the blood supply around HCC. Irreversible electroporation (IRE) uses a microsecond-pulsed electric field that induces apoptosis and necrosis and triggers a systemic immune response. The nanosecond pulsed electric field (nsPEF) has achieved a good response in the ablation of mice with HCC, but it has not been reported in China for the treatment of human HCC. CONCLUSIONS A variety of minimally invasive treatments provide a sufficient survival advantage for HCC patients. Nonthermal ablation will lead to a new wave with its unique advantage of antitumor recurrence and metastasis.
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Affiliation(s)
- Ya-Wen Zou
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zhi-Gang Ren
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ying Sun
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zhen-Guo Liu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiao-Bo Hu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Hai-Yu Wang
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zu-Jiang Yu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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Hendriquez R, Keihanian T, Goyal J, Abraham RR, Mishra R, Girotra M. Radiofrequency ablation in the management of primary hepatic and biliary tumors. World J Gastrointest Oncol 2022; 14:203-215. [PMID: 35116111 PMCID: PMC8790419 DOI: 10.4251/wjgo.v14.i1.203] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/15/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
In the United States, 80%-90% of primary hepatic tumors are hepatocellular carcinomas and 10%-15% are cholangiocarcinomas (CCA), both with high mortality rate, particularly CCA, which portends a worse prognosis. Traditional management with surgery has good outcomes in appropriately selected patients; however, novel ablative treatment options have emerged, such as radiofrequency ablation (RFA), which can improve the prognosis of both hepatic and biliary tumors. RFA is aimed to generate an area of necrosis within the targeted tissue by applying thermal therapy via an electrode, with a goal to completely eradicate the tumor while preserving surrounding healthy tissue. Role of RFA in management of hepatic and biliary tumors forms the focus of our current mini-review article.
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Affiliation(s)
- Richard Hendriquez
- Department of Internal Medicine, University of Central Florida, Orlando, FL 32816, United States
| | - Tara Keihanian
- Department of Gastroenterology and Hepatology, University of Miami, Miami, FL 33136, United States
| | - Jatinder Goyal
- Department of Gastroenterology and Hepatology, Wellspan Digestive Health - York Hospital, York, PA 17403, United States
| | - Rtika R Abraham
- Department of Endocrinology, Swedish Medical Center, Seattle, WA 98104, United States
| | - Rajnish Mishra
- Digestive Health Institute, Section of Gastroenterology and Interventional Endoscopy, Swedish Medical Center, Seattle, WA 98104, United States
| | - Mohit Girotra
- Digestive Health Institute, Section of Gastroenterology and Interventional Endoscopy, Swedish Medical Center, Seattle, WA 98104, United States
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Yang S, Lin H, Song J. Efficacy and safety of various primary treatment strategies for very early and early hepatocellular carcinoma: a network meta-analysis. Cancer Cell Int 2021; 21:681. [PMID: 34923980 PMCID: PMC8684647 DOI: 10.1186/s12935-021-02365-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/25/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Several treatments are available for treatment of early and very early-stage Hepatocellular Carcinoma, also known as small Hepatocellular Carcinoma (SHCC). However, there is no consensus with regards to the efficacies of these methods. We aimed at identifying the most effective initial treatment strategy for SHCC through Bayesian network meta-analyses. METHODS Studies published between January, 2010, and February, 2021 were searched in EMBASE, Cochrane Library, PubMed and Web of science databases, and conference proceedings for trials. The included studies reported the survival outcomes of very early and early Hepatocellular Carcinoma patients subjected to radiofrequency ablation (RFA), microwave ablation (MWA), surgical resection (SR), transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), minimally invasive liver surgery (MIS), stereotactic body radiotherapy (SBRT) and cryoablation (CA). Then, data were extracted from studies that met the inclusion criteria. Patient survival data were retrieved from the published Kaplan-Meier curves and pooled. A Bayesian random-effects model was used to combine direct and indirect evidence. RESULTS A total of 2058 articles were retrieved and screened, from which 45 studies assessing the efficacies of 8 different treatments in 11,364 patients were selected. The included studies had high methodological quality. Recurrence free survival* (progression/recurrence/relapse/disease/tumor-free survival were combined and redefined as RFS*) and overall survival (OS) outcomes were highest in MIS-treated patients (HR 0·57, 95% confidence intervals [CI] 0·38-0·85; HR 0.48,95% CI 0.36-0.64, respectively), followed by SR-treated patients (HR 0.60, 95% CI 0.50-0.74; HR 0.62, 95% CI 0.55-0.72, respectively). TACE was highly efficacious (58.9%) at decreasing the rates of major complications. Similar findings were obtained through sensitivity analysis, and in most of the prognostic subgroups. CONCLUSIONS MIS and SR exhibited the highest clinical efficacies, however, they were associated with higher rates of complications. Ablation is effective in small tumors, whereas SBRT is a relatively promising treatment option for SHCC. More well-designed, large-scale randomized controlled trials should be performed to validate our findings.
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Affiliation(s)
- Sha Yang
- Department of Surgery, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China
- National Clinical Research Center for Child Health and Disorders, Chongqing, People's Republic of China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
- Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, People's Republic of China
- Children S Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Huapeng Lin
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianning Song
- Department of General Surgery, Guiqian International General Hospital, 1 Dongfeng Dadao, Wudang District, Guiyang, Guizhou, 550018, People's Republic of China.
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Conci S, D'Onofrio M, Bianco A, Campagnaro T, Martone E, De Bellis M, Longo C, Dedoni S, Vittoria D'Addetta M, Ciangherotti A, Pedrazzani C, Dalbeni A, Campagnola P, Mansueto G, Guglielmi A, Ruzzenente A. Ablation Difficulty Score: Proposal of a new tool to predict success rate of percutaneous ablation for hepatocarcinoma. Eur J Radiol 2021; 146:110097. [PMID: 34896959 DOI: 10.1016/j.ejrad.2021.110097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Identify the factors related to failure ablation after percutaneous ultrasound guided single electrode radiofrequency ablation (RFA) for hepatocarcinoma (HCC) and propose a score for improving patient selection and treatment allocation. METHODS From 2010 to 2020 585 HCC nodules treated with RFA were prospectively collected. Ablation Difficulty Score (ADS) was built-up according to clinical and radiological factors related to failure ablation identified by Cox-logistic regression analysis. The study population was stratified in low risk (ADS 0), intermediate risk (ADS 1), and high risk (ADS ≥ 2) of failure ablation. RESULTS Overall ablation success rate was 85.5%. Morbidity and mortality rates were 3.5% and 0.0%. According to per nodule analysis the following factors resulted related to failure ablation: size > 20 mm (p = 0.002), sub-capsular location (p = 0.008), perivascular location (p = 0.024), isoechoic appearance (p = 0.008), and non-cirrhotic liver (p = 0.009). The ablation success rate was 93.5% in ADS 0, 85.8% in ADS 1 and 71.3% in ADS ≥ 2 (p < 0.001). The 1-year local tumor progression (LTP) free survival was 90.2% in ADS 0, 80.6% in ADS 1, and 72.3% in ADS ≥ 2 (p = 0.009). Nodule's size > 20 mm (p = 0.014), isoechoic appearance (p = 0.012), perivascular location (p = 0.012) resulted related to lower LTP free survival. CONCLUSION Ablation Difficulty Score could be a simple and useful tool for guiding the treatment decision making of HCC. RFA in high risk nodules (ADS ≥ 2) should be carefully evaluated and reserved for patients not suitable for surgery or liver transplantation.
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Affiliation(s)
- Simone Conci
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy.
| | - Mirko D'Onofrio
- Department of Radiology, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Andrea Bianco
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Tommaso Campagnaro
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Enrico Martone
- Department of Radiology, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Mario De Bellis
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Chiara Longo
- Department of Radiology, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Sara Dedoni
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Maria Vittoria D'Addetta
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Andrea Ciangherotti
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Andrea Dalbeni
- Division of General Medicine and Hypertension, Department of Medicine, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Pietro Campagnola
- Gastroenterology Unit, Department of Medicine, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Giancarlo Mansueto
- Department of Radiology, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Andrea Ruzzenente
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
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Lv X, Chen M, Kong C, Shu G, Meng M, Ye W, Cheng S, Zheng L, Fang S, Chen C, Wu F, Weng Q, Tu J, Zhao Z, Ji J. Construction of a novel radiomics nomogram for the prediction of aggressive intrasegmental recurrence of HCC after radiofrequency ablation. Eur J Radiol 2021; 144:109955. [PMID: 34600237 DOI: 10.1016/j.ejrad.2021.109955] [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] [Received: 02/23/2021] [Revised: 08/18/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To construct a precise prediction model of preoperative magnetic resonance imaging (MRI)-based nomogram for aggressive intrasegmental recurrence (AIR) of hepatocellular carcinoma (HCC) patients treated with radiofrequency ablation (RFA). METHODS Among 891 patients with HCC treated by RFA, 22 patients with AIR and 36 patients without AIR (non-AIR) were finally enrolled in our study, and each patient was followed up for more than 6 months to determine the occurrence of AIR. The laboratory indicators and MRI features were compared and assessed. Preoperative contrast-enhanced T1-weighted images (CE-T1WI) were used for radiomics analysis. The selected clinical indicators and texture features were finally screened out to generate the novel prediction nomogram. RESULTS Tumor shape, ADC Value, DWI signal intensity and ΔSI were selected as the independent factors of AIR by univariate and multivariate logistic regression analysis. Meanwhile, two radiomics features were selected from 396 candidate features by LASSO (P < 0.05), which were further used to calculate the Rad-score. The selected clinical factors were further integrated with the Rad-score to construct the predictive model, and the AUCs were 0.941 (95% CI: 0.876-1.000) and 0.818 (95% CI: 0.576-1.000) in the training (15 AIR and 25 non-AIR) and validation cohorts (7 AIR and 11 non-AIR), respectively. The AIR predictive model was further converted into a novel radiomics nomogram, and decision curve analysis showed good agreement. CONCLUSIONS The predictive nomogram integrated with clinical factors and CE-T1WI -based radiomics signature could accurately predict the occurrence of AIR after RFA, which could greatly help individualized evaluation before treatment.
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Affiliation(s)
- Xiuling Lv
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China
| | - Minjiang Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China
| | - Chunli Kong
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China
| | - Gaofeng Shu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China
| | - Miaomiao Meng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China
| | - Weichuan Ye
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China
| | - Shimiao Cheng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China
| | - Liyun Zheng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China
| | - Shiji Fang
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China
| | - Chunmiao Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China
| | - Fazong Wu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China
| | - Qiaoyou Weng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China
| | - Jianfei Tu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China
| | - Zhongwei Zhao
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Hospital of Zhejiang University, Lishui 323000, China; Department of Radiology, Lishui Central Hospital of Zhejiang Province, Lishui 323000, China.
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Percutaneous Radiofrequency Ablation for Recurrent Intrahepatic Cholangiocarcinoma After Curative Resection: Multivariable Analysis of Factors Predicting Survival Outcomes. AJR Am J Roentgenol 2021; 217:426-432. [PMID: 34076458 DOI: 10.2214/ajr.20.23461] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE. The purpose of this study was to evaluate the factors associated with local tumor progression (LTP) and overall survival (OS) in patients who have undergone percutaneous radiofrequency ablation (RFA) for recurrent intrahepatic cholangiocarcinoma (iCCA) after curative resection. MATERIALS AND METHODS. Data from 40 patients (mean age, 56.3 years) with 64 recurrent iCCAs (median diameter, 1.5 cm) who underwent percutaneous RFA between 1999 and 2019 were retrospectively analyzed. Patients were included if they had three or fewer metastases, a maximum tumor diameter of 5 cm or less, and disease confined to the liver. RESULTS. Technical success was achieved in all patients, with no procedure-related mortality. During follow-up, local progression of treated lesions was observed in 31.3% of tumors. The median OS and 5-year survival rate from initial RFA were 26.6 months and 18.3%, respectively. Multivariable analysis showed that a larger tumor diameter (> 2 cm, p = .004) was significantly associated with reduced LTP-free survival and that both a larger tumor diameter and less than 1 year from surgery to recurrence (p = .005 and .006, respectively) were statistically significant predictors of reduced OS after RFA. CONCLUSION. Percutaneous RFA may offer a well-tolerated and successful approach to local tumor control in patients with recurrent iCCA after curative surgery. Patients with a small-diameter tumor (≤ 2 cm) and late hepatic recurrence (≥ 1 year after curative resection) benefited most from RFA treatment.
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10
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Zhang L, Hu J, Hao M, Bu L. Long noncoding RNA Linc01296 promotes hepatocellular carcinoma development through regulation of the miR-26a/PTEN axis. Biol Chem 2021; 401:407-416. [PMID: 31318685 DOI: 10.1515/hsz-2019-0231] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 07/09/2019] [Indexed: 01/01/2023]
Abstract
Long noncoding RNA 01296 (Lnc01296) is dysregulated in malignant tumors. However, the detailed effect of Linc01296 on hepatocellular carcinoma (HCC) remains largely unknown. In this study, we identified the biological role of Linc01296 in HCC. The levels of Linc01296 in HCC tissues and a panel of cell lines were assessed by quantitative real-time polymerase chain reaction (qRT-PCR). The effects of Linc01296 on HCC progression were explored using a Cell Counting Kit-8 (CCK-8), flow cytometry, migration and Transwell invasion assays. The interactions among Linc01296, miR-26a and PTEN were determined using luciferase, RNA immunoprecipitation (RIP) and Western blot assays. Tumor xenograft models were utilized to confirm the in vivo functional roles of Linc01296 in HCC development. Linc01296 expression was increased in both HCC tissue samples and cell lines. Knockdown of Linc01296 suppressed HCC cell processes, such as proliferation, migration and invasion, and enhanced apoptosis in vitro; these effects were reversed by a miR-26a mimic or PTEN overexpression. Furthermore, knockdown of Linc01296 suppressed HCC growth in vivo. These findings indicated that Linc01296 is involved in HCC progression via regulating miR-26a/PTEN.
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Affiliation(s)
- Libin Zhang
- Department of Thoracic Surgery, First People's Hospital of Yunnan Province, Kunming 650031, China
| | - Jing Hu
- Department of Medical Oncology, First People's Hospital of Yunnan Province, Kunming 650031, China.,Anesthesia Department, First People's Hospital of Yunnan Province, Kunming 650031, China
| | - Menghui Hao
- Department of Thoracicsurgery, Kailuan General Hospital Affiliated to North China University of Technology, Tangshang 063000, China
| | - Liang Bu
- Department of Thoracic Surgery, First People's Hospital of Yunnan Province, Kunming 650031, China.,Medical School of Kunming University of Science and Technology, Kunming 650031, China
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11
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Poch FGM, Geyer B, Neizert CA, Gemeinhardt O, Niehues SM, Vahldiek JL, Frericks B, Lehmann KS. Periportal fields cause stronger cooling effects than veins in hepatic microwave ablation: an in vivo porcine study. Acta Radiol 2021; 62:322-328. [PMID: 32493033 DOI: 10.1177/0284185120928929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vascular cooling effects are a well-known source for tumor recurrence in thermal in situ ablation techniques for hepatic malignancies. Microwave ablation (MWA) is an ablation technique to be considered in the treatment of malignant liver tumors. The impact of vascular cooling in MWA is still controversial. PURPOSE To evaluate the influence of different intrahepatic vessel types, vessel sizes, and vessel-to-antenna-distances on MWA geometry in vivo. MATERIAL AND METHODS Five MWAs (902-928 MHz) were performed with an energy input of 24.0 kJ in three porcine livers in vivo. MWA lesions were cut into 2-mm slices. The minimum and maximum radius of the ablation area was measured for each slice. Distances were measured from ablation center toward all adjacent hepatic vessels with a diameter of ≥1 mm and within a perimeter of 20 mm around the antenna. The respective vascular cooling effect relative to the maximum ablation radius was calculated. RESULTS In total, 707 vessels (489 veins, 218 portal fields) were detected; 370 (76%) hepatic veins and 185 (85%) portal fields caused a cooling effect. Portal fields resulted in higher cooling effects (37%) than hepatic veins (26%, P < 0.01). No cooling effect could be observed in close proximity of vessels within the central ablation zone. CONCLUSION Hepatic vessels influenced MWA zones and caused a distinct cooling effect. Portal fields resulted in more pronounced cooling effect than hepatic veins. No cooling effect was observed around vessels situated within the central white zone.
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Affiliation(s)
- Franz GM Poch
- Department of General, Visceral and Vascular Surgery, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Beatrice Geyer
- Department of General, Visceral and Vascular Surgery, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Christina A Neizert
- Department of General, Visceral and Vascular Surgery, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ole Gemeinhardt
- Department of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Stefan M Niehues
- Department of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Janis L Vahldiek
- Department of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Bernd Frericks
- DRK Kliniken Berlin Westend, Institut for Diagnostic and Interventional Radiology, Berlin, Germany
| | - Kai S Lehmann
- Department of General, Visceral and Vascular Surgery, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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12
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Ting CT, Cheng YY, Tsai TH. Preclinical Pharmacokinetic Interaction and Histopathological Analyses of Hedyotis diffusa on Sorafenib in Rats. ACS OMEGA 2021; 6:3060-3067. [PMID: 33553923 PMCID: PMC7860071 DOI: 10.1021/acsomega.0c05461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
Sorafenib is one of the most effective target therapeutic agents for patients with late-stage hepatocellular carcinoma. To seek possible alternative adjuvant agents to enhance the efficacy and improve the side effect of sorafenib, Hedyotis diffusa, one of the most prescribed phytomedicines for treating liver cancer patients in Taiwan, was evaluated in this work. We hypothesized that H. diffusa extract is a safety herb combination on the pharmacokinetic and pharmacodynamic effects of sorafenib. We designed treatments of sorafenib in combination with or without H. diffusa extract to examine its pharmacokinetic properties and effects on liver inflammation. The HPLC-photodiode-array method was designed for monitoring the plasma level and pharmacokinetic parameter of sorafenib in rat plasma. The pharmacokinetic results demonstrated that the area under the curve of sorafenib (10 mg/kg, p.o.) in combination with various doses of H. diffusa formulation (1, 3, and 10 g/kg, p.o.) for 5 consecutive days were 5560 ± 1392, 7965 ± 2055, 7271 ± 1371, and 8821 ± 1705 min μg/mL, respectively, no significant difference when compared with sorafenib treatment alone. Furthermore, the hepatic activity in rats administered with sorafenib with/without H. diffusa extract was quantitatively scored by modified hepatic activity index grading. H. diffusa extract in the range of 1 to 10 g/kg per day did not elicit significant herb-induced hepatotoxicity in rats, based on the histopathological study. Consequently, our findings provided positive safety outcomes for the administration of sorafenib in combination with the phytomedicine H. diffusa.
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Affiliation(s)
- Chin-Tsung Ting
- Division
of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei 10629, Taiwan
- General
Education Center, University of Taipei, Taipei 10617, Taiwan
- Institute
of Traditional Medicine, School of Medicine,National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yung-Yi Cheng
- Natural
Products Research Laboratories, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina 27599, United States
| | - Tung-Hu Tsai
- Institute
of Traditional Medicine, School of Medicine,National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Graduate
Institute of Acupuncture Science, China
Medical University, Taichung 40402, Taiwan
- School of
Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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13
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An C, Li WZ, Huang ZM, Yu XL, Han YZ, Liu FY, Wu SS, Yu J, Liang P, Huang J. Small single perivascular hepatocellular carcinoma: comparisons of radiofrequency ablation and microwave ablation by using propensity score analysis. Eur Radiol 2021; 31:4764-4773. [PMID: 33399908 PMCID: PMC8213545 DOI: 10.1007/s00330-020-07571-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/17/2020] [Accepted: 11/27/2020] [Indexed: 01/31/2023]
Abstract
Objectives We aimed to compare the therapeutic outcomes of radiofrequency ablation (RFA) and microwave ablation (MWA) as first-line therapies in patients with small single perivascular hepatocellular carcinoma (HCC). Methods A total of 144 eligible patients with small (≤ 3 cm) single perivascular (proximity to hepatic and portal veins) HCC who underwent RFA (N = 70) or MWA (N = 74) as first-line treatment were included. The overall survival (OS), disease-free survival (DFS), and local tumor progression (LTP) rates between the two ablation modalities were compared. The inverse probability of treatment weighting (IPTW) method was used to reduce selection bias. Subgroup analysis was performed according to the type of hepatic vessels. Results After a median follow-up time of 38.2 months, there were no significant differences in OS (5-year OS: RFA 77.7% vs. MWA 74.6%; p = 0.600) and DFS (5-year DFS: RFA 24.7% vs. MWA 40.4%; p = 0.570). However, a significantly higher LTP rate was observed in the RFA group than the MWA group (5-year LTP: RFA 24.3% vs. MWA 8.4%; p = 0.030). IPTW-adjusted analyses revealed similar results. The treatment modality (RFA vs. MWA: HR 7.861, 95% CI 1.642–37.635, p = 0.010) was an independent prognostic factor for LTP. We observed a significant interaction effect of ablation modality and type of peritumoral vessel on LTP (p = 0.034). For patients with periportal HCC, the LTP rate was significantly higher in the RFA group than in the MWA group (p = 0.045). However, this difference was not observed in patients with perivenous HCC (p = 0.116). Conclusions In patients with a small single periportal HCC, MWA exhibited better tumor control than RFA. Key Points • Microwave ablation exhibited better local tumor control than radiofrequency ablation for small single periportal hepatocellular carcinoma. • There was a significant interaction between the treatment effect of ablation modality and type of peritumoral vessel on local tumor progression. • The type of peritumoral vessel is vital in choosing ablation modalities for hepatocellular carcinoma. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-020-07571-5.
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Affiliation(s)
- Chao An
- Department of Minimal Invasive Intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wang-Zhong Li
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Zhi-Mei Huang
- Department of Minimal Invasive Intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, 100853, China
| | - Yu-Zhi Han
- Department of Interventional Ultrasound, State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, 100853, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, 100853, China
| | - Song-Song Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Jie Yu
- Department of Interventional Ultrasound, State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, 100853, China
| | - Ping Liang
- Department of Interventional Ultrasound, State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, 100853, China
| | - Jinhua Huang
- Department of Minimal Invasive Intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
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Danni HMS, Qiao JMD, Huitong LMD, Xuankun LMM, Lujing LMM, Fengping LMM, Xianxiang WMM, Kun YMS, Zuofeng XMD. A New-Designed Microwave Ablation System: Testing in ex vivo and in vivo Liver Model. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.200014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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15
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Han K, Kim JH, Yang SG, Park SH, Choi HK, Chun SY, Kim PN, Park J, Lee M. A Single-Center Retrospective Analysis of Periprocedural Variables Affecting Local Tumor Progression after Radiofrequency Ablation of Colorectal Cancer Liver Metastases. Radiology 2020; 298:212-218. [PMID: 33170105 DOI: 10.1148/radiol.2020200109] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Local tumor progression (LTP) is associated with poorer survival in patients undergoing radiofrequency ablation (RFA) for colorectal liver metastasis (CLM). An algorithmic strategy to predict LTP may help in selection of patients who would benefit most from RFA for CLM. Purpose To estimate local tumor progression-free survival (LTPFS) following RFA of CLM and develop an algorithmic strategy based on clinical variables. Materials and Methods In this retrospective study, between March 2000 and December 2014, patients who underwent percutaneous RFA for CLM were randomly split into development (60%) and internal validation (40%) data sets. Kaplan-Meier method was used to estimate LTPFS and overall survival (OS) rates. Independent factors affecting LTPFS in the development data set were investigated by using multivariable Cox proportional hazard regression analysis. Risk scores were assigned to the risk factors and applied to the validation data set. Results A total of 365 patients (mean age, 60 years ± 11 [standard deviation]; 259 men) with 512 CLMs were evaluated. LTPFS and OS rates were 85% and 92% at 1 year, 73% and 41% at 5 years, 72% and 30% at 10 years, and 72% and 28% at 15 years, respectively. Independent risk factors for LTP included tumor size of 2 cm or greater (hazard ratio [HR], 3.8; 95% CI: 2.3, 6.2; P < .001), subcapsular tumor location (HR, 1.9; 95% CI: 1.1, 3.1; P = .02), and minimal ablative margin of 5 mm or less (HR, 11.7; 95% CI: 4.7, 29.2; P < .001). A prediction model that used the risk factors had areas under the curve of 0.89, 0.92, and 0.90 at 1, 5, and 10 years, respectively, and it showed significantly better areas under the curve when compared with the model using the minimal ablative margin of 5 mm or less alone. Conclusion Radiofrequency ablation provided long-term control of colorectal liver metastases. Although minimal ablative margin of 5 mm or less was the most dominant factor, the multifactorial approach including tumor size and subcapsular location better predicted local tumor progression-free survival. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Soulen and Sofocleous in this issue.
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Affiliation(s)
- Kichang Han
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Jin Hyoung Kim
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Seul Gi Yang
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Seong Ho Park
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Hyun-Kyung Choi
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Seng-Yong Chun
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Pyo Nyun Kim
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Jihong Park
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Myeongjee Lee
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
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Abstract
Hepatocellular carcinoma is one of the leading causes of cancer related death in the world. Biannual surveillance for the disease in patients with cirrhosis and in high risk carriers of hepatitis B virus allows early stage cancer detection and treatment with good long term outcomes. Liver ultrasonography and serum α fetoprotein are the most commonly used surveillance tests. If suspicious results are found on the surveillance test, multiphasic computed tomography or magnetic resonance imaging should be undertaken to confirm the diagnosis of hepatocellular carcinoma. If radiologic tests show inconclusive results, liver biopsy or repeat imaging could be considered for confirmation of hepatocellular carcinoma. Management of the disease is complex. Patients should be evaluated by a multidisciplinary team, and the selection of treatment should consider factors such as tumor burden, severity of liver dysfunction, medical comorbidities, local expertise, and preference of patients. Early stage hepatocellular carcinoma is best managed by curative treatment, which includes resection, ablation, or transplantation. Patients with intermediate stage disease often receive locoregional treatment. Systemic treatment is reserved for patients with advanced disease. Several positive, phase III, randomized controlled trials have expanded the systemic treatment options for advanced hepatocellular carcinoma with promising long term outcomes, especially trials using combination treatments, which could also have eventual implications for the treatment of earlier stage disease.
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Affiliation(s)
- Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Julie K Heimbach
- Division of Transplant Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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17
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Jiang B, Luo H, Yan K, Zhang Z, Li X, Wu W, Yang W, Chen M. Ten-Year Outcomes of Percutaneous Radiofrequency Ablation for Colorectal Cancer Liver Metastases in Perivascular vs. Non-Perivascular Locations: A Propensity-Score Matched Study. Front Oncol 2020; 10:553556. [PMID: 33178581 PMCID: PMC7596897 DOI: 10.3389/fonc.2020.553556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/25/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To compare long-term outcomes of percutaneous radiofrequency ablation for colorectal liver metastases in perivascular versus non-perivascular locations. Methods This retrospective study included 388 consecutive patients with colorectal liver metastases (246 men, 142 women; age range 27–86 years) who underwent percutaneous radiofrequency ablation between January 2006 and December 2018. Propensity-score matching was performed for groups with perivascular and non-perivascular colorectal liver metastases. Rates of accumulative local tumor progression, overall survival, intra/extrahepatic recurrence, and complications were compared between the two groups. Results We successfully matched 104 patients each in the perivascular and non-perivascular groups (mean age: 60.1 ± 11.5 and 60.1 ± 11.3 years, respectively). Cumulative local tumor progression rates at 6 months, 1 years, 3 years, and 5 years, respectively, were 8.8%,14.8%, 18.9%, and 18.9% in the perivascular group and 8.8%, 13.1%, 15.5%, and 15.5% in the non-perivascular group. The 1-, 3-, 5-, and 10-year overall survival rates, respectively, were 91.3%, 45.6%, 23.9%, and 18.7% in the perivascular group and 88.0%, 47.2%, 27.2%, and 22.6% in the non-perivascular group. No significant between-group differences were detected in cumulative local tumor progression (p=0.567, hazard ratio: 1.224) or overall survival (p = 0.801, hazard ratio: 1.047). The major complication rate was 1.0% (1/104, p > 0.999) in both groups. Tumor size was the only independent prognostic factor for local tumor progression (hazard ratio: 2.314; p = 0.002). On multivariate analysis for overall colorectal liver metastases, tumor diameter >3 cm, tumor location in the right colon, multiple tumors, and extrahepatic metastases before radiofrequency ablation (hazard ratios: 2.046, 1.920, 1.706, and 1.892, respectively; all p < 0.001) and intrahepatic recurrence (hazard ratio: 1.564; p = 0.002) were associated with poor overall survival. Conclusion Cumulative local tumor progression, overall survival, and major complications rates did not differ significantly between perivascular and non-perivascular colorectal liver metastases after percutaneous radiofrequency ablation. For perivascular colorectal liver metastases, percutaneous radiofrequency ablation is a safe and effective treatment option.
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Affiliation(s)
- Binbin Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hongjie Luo
- Department of Hepatobiliary, Pancreatic and Minimally Invasive Surgery, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhongyi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaoting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, 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
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Minhua Chen
- 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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18
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Arellano RS. What's New in Percutaneous Ablative Strategies for Hepatocellular Carcinoma and Colorectal Hepatic Metastases? 2020 Update. Curr Oncol Rep 2020; 22:105. [PMID: 32725433 DOI: 10.1007/s11912-020-00967-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Ablation techniques are now well-established treatment options available for the management of primary and secondary hepatic malignancies. Currently available ablative techniques include radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation, and irreversible electroporation (IRE). Along with advances in navigational devices and targeting technologies, ablation combined with other therapies may be the next therapeutic option in thermal ablation. The purpose of this review is to evaluate the current status of ablative technologies in interventional and medical oncology for management of liver malignancies. RECENT FINDINGS With the use of combination techniques (i.e., ablation and transarterial embolization procedures), thermal ablation is now moving toward treating tumors larger than 3 cm in size or tumors with macrovascular invasion. Ongoing trials are examining the optimum timing of combination therapies. Thermal ablation combined with hepatic resection may increase the number of patients with metastatic colorectal carcinoma to the liver who qualify for curative surgery. Combination therapies of thermal ablation and transarterial embolization allow for promising treatment responses for larger HCC. Surgery combined with thermal ablation can potentially increase the number of patients with metastatic colon cancer to the liver who qualify for curative surgery.
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Affiliation(s)
- Ronald S Arellano
- Division of Interventional Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA, 02114, USA.
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Abstract
Endoscopic and percutaneous therapies have been shown to prolong life and reduce morbidity for patients with unresectable advanced stages of primary hepatobiliary malignancies. This article reviews pertinent studies published within the last 5 years that involve locoregional techniques to manage hepatocellular carcinoma, perihilar and distal cholangiocarcinoma. A major emphasis is placed on photodynamic therapy, radiofrequency ablation, irreversible electroporation, and microwave ablation. Technical advances, combinational therapies, and postintervention outcomes are discussed. Despite widespread application, high-quality evidence does not show superiority of any particular locoregional technique for treating advanced hepatobiliary cancers.
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RF Ablation Versus Cryoablation for Small Perivascular Hepatocellular Carcinoma: Propensity Score Analyses of Mid-Term Outcomes. Cardiovasc Intervent Radiol 2019; 43:434-444. [PMID: 31844951 DOI: 10.1007/s00270-019-02394-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/06/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE This study aimed to compare radiofrequency (RF) ablation with cryoablation in patients with perivascular hepatocellular carcinoma (HCC) and evaluate the mid-term outcomes of both therapies. MATERIALS AND METHODS Between January 2015 and April 2018, 111 patients who underwent percutaneous cryoablation (n = 61) or RF ablation (n = 50) for a single perivascular HCC were included. Perivascular HCC was defined as the presence of contacting peritumoral hepatic vessels that were 3 mm or larger in axial diameter. Local tumor progression (LTP) rates were compared by propensity score matching. Procedure-related complications were also assessed. RESULTS The median follow-up was 23 months (range 2-45 months). Twenty-five patients were matched in each group. The cumulative LTP rates at 1 and 3 years were 8.3% and 17.3% in the cryoablation group and 8.7% and 26.1% in the RF ablation group, with no significant difference (p = 0.379). Although there were no significant differences between the two groups, vascular thrombosis (16.0% vs. 9.8%, p = 0.493) and hepatic infarction (12.0% vs. 3.3%, p = 0.137) more frequently occurred in the RF ablation group than in the cryoablation group. CONCLUSION In patients with perivascular HCC, cryoablation is an effective alternative treatment compared with RF ablation regarding local tumor control and complications. LEVEL OF EVIDENCE Level 4 (retrospective case-control study).
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An C, Wu S, Huang Z, Ni J, Zuo M, Gu Y, Zhang T, Huang J. A novel nomogram to predict the local tumor progression after microwave ablation in patients with early-stage hepatocellular carcinoma: A tool in prediction of successful ablation. Cancer Med 2019; 9:104-115. [PMID: 31714685 PMCID: PMC6943142 DOI: 10.1002/cam4.2606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To develop a nomogram for the local tumor progression (LTP) in patients with early-stage hepatocellular carcinoma (HCC) after computed tomography-guided percutaneous microwave ablation (CT-PMWA) and to assess clinical-pathologic risk factors for individual LTP estimation. Furthermore, we compared the prognostic predictive ability for LTP between the nomogram and the traditional staging systems. METHODS This retrospective study was approved by the institutional review board. Five hundred and forty treatment-naïve patients with HCC according to the Milan criteria, who subsequently underwent CT-PMWA were reviewed from 2009 to 2019. Baseline characteristics were collected to identify the risk factors for the determination of LTP after CT-PMWA. The multivariate Cox proportional-hazards model based on significant prognostic factors of LTP was used to construct the nomogram, which was then assessed for its predictive accuracy using mainly the Harrell's C-index and time-dependent area under the curve (tAUC). RESULTS After a median follow-up time of 28.7 months, 6.5% (35/540) patients had LTP. The nomogram was developed based on the tumor size, tumor number, Child-Turcotte-Pugh (CTP) grade, platelet, and alanine aminotransferase (ALT). The nomogram had good calibration and discriminatory abilities in the training set, with C-indexes of 0.799 (95% confidence interval (CI): 0.738, 0.860), and tAUCs of 0.844 (CI: 0.728, 0.895), that were greater than those of traditional staging systems. Internal validation with 1000 bootstrap resamples had a good C-index of 0.735 (CI: 0.648, 0.816). CONCLUSIONS The nomogram model can be used to predict accurately LTP after CT-PMWA for early-stage HCC, as well as to assist physicians during the therapeutic decision-making process.
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Affiliation(s)
- Chao An
- State Key Laboratory of Oncology in South China, Department of Minimal Invasive Intervention, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Songsong Wu
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, PR China
| | - Zhimei Huang
- State Key Laboratory of Oncology in South China, Department of Minimal Invasive Intervention, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jiayan Ni
- State Key Laboratory of Oncology in South China, Department of Minimal Invasive Intervention, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mengxuan Zuo
- State Key Laboratory of Oncology in South China, Department of Minimal Invasive Intervention, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yangkui Gu
- State Key Laboratory of Oncology in South China, Department of Minimal Invasive Intervention, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tianqi Zhang
- State Key Laboratory of Oncology in South China, Department of Minimal Invasive Intervention, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jinhua Huang
- State Key Laboratory of Oncology in South China, Department of Minimal Invasive Intervention, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Yang JD, Hainaut P, Gores GJ, Amadou A, Plymoth A, Roberts LR. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol 2019; 16:589-604. [PMID: 31439937 PMCID: PMC6813818 DOI: 10.1038/s41575-019-0186-y] [Citation(s) in RCA: 2331] [Impact Index Per Article: 466.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2019] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide. Risk factors for HCC include chronic hepatitis B and hepatitis C, alcohol addiction, metabolic liver disease (particularly nonalcoholic fatty liver disease) and exposure to dietary toxins such as aflatoxins and aristolochic acid. All these risk factors are potentially preventable, highlighting the considerable potential of risk prevention for decreasing the global burden of HCC. HCC surveillance and early detection increase the chance of potentially curative treatment; however, HCC surveillance is substantially underutilized, even in countries with sufficient medical resources. Early-stage HCC can be treated curatively by local ablation, surgical resection or liver transplantation. Treatment selection depends on tumour characteristics, the severity of underlying liver dysfunction, age, other medical comorbidities, and available medical resources and local expertise. Catheter-based locoregional treatment is used in patients with intermediate-stage cancer. Kinase and immune checkpoint inhibitors have been shown to be effective treatment options in patients with advanced-stage HCC. Together, rational deployment of prevention, attainment of global goals for viral hepatitis eradication, and improvements in HCC surveillance and therapy hold promise for achieving a substantial reduction in the worldwide HCC burden within the next few decades.
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Affiliation(s)
- Ju Dong Yang
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Pierre Hainaut
- Tumor Molecular Biology and Biomarkers Group, Institute for Advanced Biosciences, Inserm U 1209 CNRS UMR5309, Université Grenoble Alpes, Grenoble, France
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Amina Amadou
- Tumor Molecular Biology and Biomarkers Group, Institute for Advanced Biosciences, Inserm U 1209 CNRS UMR5309, Université Grenoble Alpes, Grenoble, France
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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Ridouani F, Srimathveeravalli G. Percutaneous image-guided ablation: From techniques to treatments. Presse Med 2019; 48:e219-e231. [PMID: 31447333 DOI: 10.1016/j.lpm.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023] Open
Abstract
Image-guided ablation is performed by percutaneously introducing ablation probes to deliver energy into a tumor to destroy it in a controlled and localized fashion. Ablation modalities can be broadly classified as thermal or non-thermal based on the mechanism of tumor destruction and are performed using different types of image guidance for planning, delivering and follow-up of the treatment. Ablation is performed in a minimally invasive fashion, providing greater residual organ preservation with minimal morbidity to the patient. Image-guided ablation is being used in the clinic for the treatment of primary and metastatic tumors, and this article reviews state of the art for the treatment of malignancies in the liver, lung, kidney and musculoskeletal tissue.
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Affiliation(s)
- Fourat Ridouani
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, USA
| | - Govindarajan Srimathveeravalli
- University of Massachusetts, Institute for Applied Life Sciences, Department of Mechanical and Industrial Engineering, Amherst, USA.
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Zhang TQ, Huang SM, Gu YK, Jiang XY, Huang ZM, Deng HX, Huang JH. Sequential and Simultaneous 4-Antenna Microwave Ablation in an Ex Vivo Bovine Liver Model. Cardiovasc Intervent Radiol 2019; 42:1466-1474. [DOI: 10.1007/s00270-019-02241-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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