Prognostic significance of systemic immune-inflammation index-based nomogram for early stage hepatocellular carcinoma after radiofrequency ablation

BackgroundRadiofrequency ablation (RFA) is the recommended treatment for early stage hepatocellular carcinoma (HCC), and the prognostic value of systemic immune-inflammation index (SII) in early stage HCC is not discussed. Therefore, the purpose of the study is to explore the prognostic value of SII based on lymphocyte, neutrophil, and platelet counts in patients with HCC after RFA.MethodsWe retrospectively evaluated the prognostic value of the SII in training and validation cohorts, and then established an effective nomogram for HCC after RFA based on SII. The C-index, and area under the time-dependent receiver operating characteristic curve (t-AUC) were used to evaluate the discrimination and calibration value of the nomogram.ResultsAn optimal cut-off value for the SII of 324.55×10⁹ stratified the patients with HCC into high- and low-SII groups. Univariate and multivariate analyses revealed that SII was an independent predictor for overall survival (OS) and recurrence-free survival (RFS). Moreover, SII was an independent prognostic factor for early-stage HCC with normal alpha-fetoprotein (AFP) levels. The t-AUC of the SII was higher for OS and RFS than for neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). A high preoperative SII was associated with multiple tumors, larger tumors, and higher levels of AFP. A well-discriminated and calibrated nomogram was constructed to predict the probability of 1-, 2-, 3-, and 5-year RFS with C-indexes of 0.80, which was significantly higher than that obtained with other prognostic clinical indexes.ConclusionsThe SII is an independent prognostic factor affecting the survival outcomes of patients with early-stage HCC. The comprehensive nomogram based on SII presented in this study is a promising model for predicting RFS in HCC patients after RFA.     

Risk factors of survival after percutaneous radiofrequency ablation of hepatocellular carcinoma

AIMS: This study aimed to determine the risk factors of survival in patients with hepatocellular carcinoma (HCC) undergoing percutaneous radiofrequency ablation (PRFA). PATIENTS AND METHODS: Between August 1999 and May 2005, 281 patients (250 males and 31 females) who were 33-80 years old (mean 65.3 years) received PRFA only or PRFA in combination with percutaneous ethanol injection (PEI) in our center. Patients were treated with PRFA or PEI by a percutaneous approach with ultrasound (US) guidance and were evaluated at regular intervals to determine disease recurrence and survival. The survival curves were constructed by the Kaplan-Meier method and compared by the log-rank test. The relative significance of the variables in the risk factors of overall survival was assessed by multivariate Cox proportional hazards regression analysis. RESULTS: At the end of the study, 189 patients were alive, and 92 were dead. Median survival was 48.7 months. The overall 1-, 3-, and 5-year survival rates were 89%, 54%, and 43%, respectively. The overall 1-, 3-, and 5-year survival rates for small tumor (size < or = 3cm) were 97.8%, 65.7%, 58.6%, respectively, for medium tumor (size 3.1-5cm) 94.1%, 57.1%, 37.1%, respectively, and for large tumor (size >5cm) 62.8%, 40.3%, 0%, respectively. Survival of patients treated with PRFA was dependent on tumor size (p<0.001; risk ratio [RR] 9.6, 95% CI 5.2-17.8), number of tumors (p=0.003; RR 1.6, 95% CI 1.2-2.0), combination with PEI (p=0.01; RR 0.6, 95% CI 0.4-0.9), Child-Pugh class (p=0.002; RR 2.0, 95% CI 1.3-3.0) and safety margin (p=0.0026; RR 0.6, 95% CI 0.4-0.9). CONCLUSIONS: PRFA is an effective treatment for HCC. This study showed after PRFA, tumor size, number of tumors, combination with PEI, safety margin, and Child-Pugh class were independent risk factors of survival.     

肝细胞癌冷循环射频治疗与手术切除治疗的前瞻性对比研究

Objective: The aim of this study was to compare the therapeutic efficacy of radiofrequency ablation (RFA) and surgical resection for the patients with hepatocellular carcinoma (HCC). Methods: From January 2002 to June 2009, 87 HCC patients with 3 or fewer nodules, no more than 3 cm in diameter, and liver function of Child-Pugh class A or B were enrolled. Forty-seven underwent RFA while 40 underwent surgical resection. Follow-up ranged from 6 to 69 months. We compared the overall and disease-free survival ra...     

Rapid and aggressive recurrence accompanied by portal tumor thrombus after radiofrequency ablation for hepatocellular carcinoma

Although radiofrequency ablation (RFA) has been reported to be a safe and effective procedure for the treatment of hepatocellular carcinoma (HCC), patterns of recurrence and complications following RFA treatment have not been fully identified. Recently, we have experienced two cases of HCC patients who developed rapid and aggressive recurrence accompanied by portal tumor thrombus after RFA therapy. The first was a 68-year-old woman with hepatitis C virus (HCV)-positive liver cirrhosis, who received percutaneous RFA therapy for a 27-mm-diameter HCC in segment VII. The other was a 64-year-old man with hepatitis B surface antigen (HBsAg)-positive liver cirrhosis and multiple bilobar HCCs, who underwent left hemihepatectomy and intraoperative RFA for the two tumors in the remnant liver. In both patients, though immediate imaging studies suggested complete necrosis of the tumors, recurrences with massive portal tumor thrombus occurred in 4 and 6 months, respectively. At present, it is unclear whether such a recurrence pattern is directly related to the RFA procedure. However, it is implied that RFA therapy may entail a risk of promoting portal venous invasion of HCC tumors.     

Stereotactic body radiation therapy versus radiofrequency ablation for single small hepatocellular carcinoma: a propensity-score matching analysis of their impact on liver function and clinical outcomes

BackgroundStereotactic body radiation therapy (SBRT) has high efficacy for early-stage hepatocellular carcinoma (HCC) and is an accepted alternative to radiofrequency ablation (RFA). However, SBRT for HCC may cause subacute liver injury leading to negative clinical outcomes. In this study, we compared changes of liver function and prognosis after SBRT or RFA in patients with single, small HCC by using a propensity-score matching analysis.MethodsWe reviewed medical records of 140 patients with single ≤3 cm HCC treated with SBRT or RFA at Kurashiki Central Hospital between January 2014 and February 2019. Changes of albumin-bilirubin (ALBI) score, local recurrence, and overall survival were compared between the propensity-score matched groups (31 patients treated with SBRT and 62 treated with RFA).ResultsThe ALBI score increased modestly but significantly after SBRT, while it was unchanged in the RFA group; the intergroup difference was statistically significant (P=0.004). No local recurrence was identified in the SBRT group, whereas the cumulative recurrence incidence was 9.7% in the RFA group (P=0.023). Overall survival was not significantly different between the two groups (hazard ratio: 1.32, 95% confidence interval: 0.60–2.89, P=0.401).ConclusionsSBRT had modestly negative impact on liver function but with appraisable local control of HCC. Our findings should contribute to the selection of this modality for treatment of single, small HCC.     

Percutaneous CT-guided radiofrequency ablation for unresectable hepatocellular carcinoma pulmonary metastases

Purpose: This study aimed to evaluate the safety and efficacy of percutaneous CT-guided radiofrequency ablation (RFA) for unresectable hepatocellular carcinoma pulmonary metastases (HCCPM) and to identify the prognostic factors for survival.

Materials and methods: We reviewed the medical records of 320 patients with HCCPM treated between January 2005 and January 2012. Among them, 29 patients with 68 lesions of unresectable HCCPM underwent 56 RFA sessions. Safety, local efficacy, survival and prognostic factors were evaluated. Survival was analysed using the Kaplan-Meier method. Univariate analyses were evaluated by the log-rank test.

Results: Pneumothorax requiring chest tube placement occurred in five (8.9%, 5/56) RFA sessions. During the median follow-up period of 23 months (range 6–70), 18 patients (62.1%, 18/29) died of tumour progression and 11 (37.9%, 11/29) were alive. The 1-, 2- and 3-year overall survival rates were 73.4%, 41.1% and 30%, respectively. The median progression-free survival was 18 months (95% confidence interval (CI) 9.8–26.2) and the median overall survival time was 21 months (95%CI, 9.7–32.3). The maximum tumour diameter ≤3?cm (p?=?0.002), the number of pulmonary metastases ≤3 (p?=?0.014), serum AFP level ≤400?ng/mL (p?=?0.003), and the controlled status of intrahepatic tumour after lung RFA (p?=?0.001) were favourable prognostic factors for overall survival.

Conclusions: Our study indicates that percutaneous CT-guided RFA, as an alternative treatment procedure to pulmonary metastasectomy, can be a safe and effective therapeutic option for unresectable HCCPM.     

Percutaneous radiofrequency ablation for the treatment of hepatocellular carcinoma in the caudate lobe

Aims

This study aimed to evaluate the efficacy and safety of percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma (HCC) in the caudate lobe.

Patients and methods

Between January 2001 and December 2006, 17 patients (twelve males and five females) who were between 33 and 68 years old (mean 54.3), with caudate lobe HCC [2.0–6.5 cm in diameter (mean 3.1)] were treated with either PRFA alone (n = 14), or PRFA with percutaneous ethanol injection (n = 3) under ultrasound guidance. The right or the anterior approach was used in 12 and 5 patients, respectively.

Results

All procedures were performed successfully. There was no mortality and major morbidity due to PRFA. Fourteen tumors (82%) were completely ablated after one to two sessions of treatment. During follow-up (range 3–60, mean 29.1 months), two (14%) developed local recurrence. Intrahepatic metastases developed in 9 of 17 patients (53%). No distant metastasis was found. Four patients died (24%), 3 from tumor progression and 1 from hepatic failure. The 1-, 2-, and 4-year overall survivals were 88%, 80%, and 72%, respectively, and the progress free survivals were 47%, 20%, and 10%, respectively.

Conclusions

PRFA is efficacious and safe for patients with HCC in the caudate lobe.     

经皮肝穿刺射频热凝对复发性肝癌的治疗意义

目的 探讨对于无再次手术指征的复发性肝癌行B超引导经皮肝穿刺射频热凝(PRFA)治疗的意义。方法 1999年10月～2001年7月经病理证实为原发性肝癌，术后影像学和血清肿瘤标记物证实为肝癌复发的47患者进行B超引导PRFA治疗。复发瘤灶为单发者24例、多发者23例，其中复发灶为单发且小于3．5cm者12例。定期随访，复查AFP、肝功能和B超，1个月后复查MRI或CT了解肿瘤坏死情况，以后每3个月复查。Kaplan—Meier法计算累积生存率。结果 复发灶为单发者1、2、3年的生存率分别为65.2％、37．5％、37．5％，复发灶为单发且小于3.5cm者1、2、3年的生存率分别为83.3％、51．4％、51．4％。复发灶为多发者1、2年的生存率为41．7％、19．5％。结论 B超引导经皮肝穿刺射频热凝是肝癌综合治疗中一种重要手段，对于无再次手术指征的复发性肝癌可以根据复发瘤灶的大小、范围、复发时间，决定单独或结合TACE给予B超引导经皮肝穿刺射频热凝(PRFA)治疗，可以更加有效地控制复发、提高生存率。     

Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis

Purpose: Radiofrequency ablation (RFA) and microwave ablation (MWA) are the two main percutaneous techniques for the treatment of unresectable hepatocellular carcinoma (HCC). However, to date, studies comparing the two therapies have provided discordant results. The aim of this meta-analysis is to evaluate the efficacy and safety of the two treatments for HCC patients. Materials and methods: A computerised bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. The rates of complete response (CR), local recurrence (LRR), 3-year survival (SR) and major complications were compared between the two treatment groups by using the Mantel-Haenszel test in cases of low heterogeneity or the DerSimonian and Laird test in cases of high heterogeneity. Sources of heterogeneity were investigated using subgroup analyses. In order to confirm our finding, sensitivity analysis was performed restricting the analysis to high-quality studies. Results: One randomised controlled trial (RCT) and six retrospective studies with 774 patients were included in the meta-analysis. A non-significant trend of higher CR rates in the patients treated with MWA was found (odds ratio (OR)?=?1.12, 95% confidence interval (CI) 0.67–1.88, p?=?0.67]. Overall LRR was similar between the two treatment groups (OR 1.01, 95% CI 0.53–1.87, p?=?0.98) but MWA outperformed RFA in cases of larger nodules (OR 0.46, 95% CI 0.24–0.89, p?=?0.02). 3-year SR was higher after RFA without statistically significant difference (OR 0.95, 95% CI 0.58–1.57, p?=?0.85). Major complications were more frequent, although not significantly, in MWA patients (OR 1.63, 95% CI 0.88–3.03, p?=?0.12). Conclusions: Our results indicate a similar efficacy between the two percutaneous techniques with an apparent superiority of MWA in larger neoplasms.     

Clinical significance of preoperative platelet-to-lymphocyte ratio in recurrent hepatocellular carcinoma after thermal ablation: A retrospective analysis

Abstract

Purpose: The aim of this study was to elucidate the clinical significance of preoperative Platelet-to-lymphocyte ratio (PLR) in recurrent hepatocellular carcinoma (RHCC) patients after thermal ablation.

Materials and methods: We retrospectively reviewed 414 patients with RHCC treated with ultrasound-guided thermal ablation percutaneously between January 2010 and March 2014. The correlation of recurrence-free survival (RFS) with 15 clinical parameters was analysed by Cox multivariate proportional hazard model analysis. The best cut-off value of preoperative PLR was determined with time-dependent receiver operating characteristic (ROC) curve analysis. The value of PLR in predicting recurrence was analysed by Kaplan-Meier.

Results: Multivariate Cox proportional hazard model analysis showed that tumour differentiation, prothrombin time (PT), absolute lymphocyte count (ALC) and PLR were risk factors for recurrence in RHCC patients. PLR?≥?87.87 was considered for evaluation (AUROC?=?0.667; P?<?0.05), and 166 of 414 patients (40.1%) had PLR of more than 87.87. During the follow-up period (12–52 months), the 1- and 3-year recurrence rates were 39.9% and 54.8% in the low PLR group, which were significantly better than those in the high PLR group (56.0% and 79.5%) (P?<?0.05). Kaplan-Meier analysis demonstrated that the RFS in the low PLR group was 45.2% which was significantly higher than that of the high PLR group (20.5%) (X2?=?24.019, P?<?0.05). This result suggested that preoperative PLR is a predictor for recurrence followed thermal ablation in RHCC patients, and patients with PLR?≥?87.87 indicated higher RFS, which may improve the clinical management of RHCC patients. Further studies are warranted to validated this finding and test its clinical applicability in RHCC.     

Laparoscopic radiofrequency ablation of solitary small hepatocellular carcinoma in the caudate lobe

Objective

Surgical resection in the treatment of hepatocellular carcinoma (HCC) originating in the caudate lobe is challenging because of its deep location in the liver and possibly worse prognosis. We evaluated the overall survival of patients with solitary caudate small HCC who underwent laparoscopic radiofrequency ablation (RFA).

Methods

This is a retrospective study on patients who underwent laparoscopic RFA (RFA) for solitary small HCC.

Results

Twenty-seven (27) patients underwent laparoscopic caudate lobe RFA for solitary small HCC. The average tumor size was 2.8 cm. The overall survival rates were 96.3%, 88.9%, 74.1%, 74.1% and 62.9% at 1, 2, 3, 4 and 5 years respectively. The disease-free survival after RFA was 92.6%, 52.9%, 44.4%, 33.3% and 33.3% at 1, 2, 3, 4 and 5 years respectively. Most common postoperative complication was pleural effusion (7/27, 25.9%), and followed by transient hemoglobinuria (2/27, 7.4%).

Conclusions

Laparoscopic RFA for caudate lobe small HCC is a safe and feasible procedure without perioperative mortality. Through a systematic review of other therapeutic options on caudate HCC, its overall outcome is comparable to that of surgical resection.     

Radiofrequency ablation or microwave ablation combined with transcatheter arterial chemoembolization in treatment of hepatocellular carcinoma by comparing with radiofrequency ablation alone简

Objective：To compare radiofrequency ablation （RFA） or microwave ablation （MWA） and transcatheter arterial chemoembolization （TACE） with RFA or MWA monotherapy in hepatocellular carcinoma （HCC）.Methods：A prospective,randomized,controlled trial was conducted on 94 patients with HCC ≤7 cm at a single tertiary referral center from June 2008 to June 2010 at the Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Southeast University.The patients were randomly assigned into the TACERFA or TACE-MWA （combined treatment group） and the RFA-alone or MWA-alone groups （control group）.The primary end point was overall survival.The secondary end point was recurrence-free survival,and the tertiary end point was adverse effects.Results：Until the time of censor,17 patients in the TACE-RFA or TACE-MWA group had died.The median follow-up time of the patients who were still alive for the TACE-RFA or TACE-MWA group was 47.5±11.3 months （range,29 to 62 months）.The 1-,3-and 5-year overall survival for the TACE-RFA or TACE-MWA group was 93.6％,68.1％ and 61.7％,respectively.Twenty-five patients in the RFA or MWA group had died.The median follow-up time of the patients who were still alive for the RFA or MWA group was 47.0±12.9 months （range,28 to 62 months）.The 1-,3-and 5-year overall survival for the RFA or MWA group was 85.1％,59.6％ and 44.7％,respectively.The patients in the TACE-RFA or TACE-MWA group had better overall survival than the RFA or MWA group [hazard ratio （HR）,0.526; 95％ confidence interval （95％ CO,0.334-0.823; P=0.002],and showed better recurrence-free survival than the RFA or MWA group （HR,0.582; 95％ CI,0.368-0.895; P=0.008）.Conclusions：RFA or MWA combined with TACE in the treatment of HCC ≤7 cm was superior to RFA or MWA alone in improving survival by reducing arterial and portal blood flow due to TACE with iodized oil before RFA.     

High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer

BACKGROUND AND OBJECTIVES: To report and discuss the effect, complications and mortality of cool-tip radiofrequency ablation (RFA) for unresectable pancreatic cancer. METHODS: During October 2003 to July 2004, sixteen patients with unresectable pancreatic cancer were treated by open cool-tip RFA. One-half of the 16 patients had tumors located in the pancreatic head. A 5-mm minimum safe distance between RFA site and major peripancreatic vessels was kept to avoid injury to the vessels. RESULTS: Six of twelve patients with back pain got pain relief postoperatively. Pancreatic fistula occurred in three patients (18.8%) and healed smoothly in 7-10 days with routine abdominal drainage. The mortality was 25% (4/16). In the four death cases, tumors were all located in the pancreatic head; three patients with tumor close to portal vein died suddenly of massive gastrointestinal hemorrhage on the 4th, 30th, 40th postoperative day respectively and a 79-year-old patient died of acute renal failure on the 2nd postoperative day. CONCLUSIONS: Standard use of cool-tip RFA was dangerous for pancreatic head cancer close to portal vein, in which a 5-mm minimum safe distance between RFA site and major peripancreatic vessels might not be enough to avoid injury to the vessels.     

Combined transcatheter arterial chemoembolization and radiofrequency ablation in single‐session for solitary hepatocellular carcinoma larger than 7 cm

1 Aims

To evaluate technical feasibility and treatment results of combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) in single‐session for solitary hepatocellular carcinoma (HCC) larger than 7 cm in diameter.

2 Methods

Institutional review board approved this retrospective study. Written informed consent was obtained from all patients. Between June 2007 and July 2013, 87 patients (75 men, 12 women; mean age, 55.5 years ± 15.0) with solitary HCC with a mean maximum diameter of 9.5 cm ± 2.4 (range, 7.1–13.5 cm) not feasible for surgical resection underwent combined TACE and RFA in a single‐session. Immediately following TACE, RFA was performed under fluoroscopy and CB‐CT guidance. The primary endpoint was overall survival (OS). The secondary endpoints were technical safety and local tumor progression (LTP) rates. OS and time to progression (TTP) were analyzed with the Kaplan–Meier method. Univariate and multivariate analyses were performed to identify prognostic factors affecting OS and TTP.

3 Results

Technical success of combined TACE and RFA in a single‐session was achieved in all patients (100%). On 1‐month follow‐up MRI, complete response (CR) was observed in 76 of 87 patients (87.4 %), partial response (PR) in 8 and stable disease (SD) in 3 patients. The median follow‐up period was 49.5 months (interquartile range, 30.0–70.0 months). The median OS was 39 months (range, 15–86 months). The cumulative OS rates at 1, 3 and 5 years were 100%, 65.5% and 47.5%, respectively. The estimated 1, 3 and 5 year LTP rates were 0 %, 29.9% and 55.2 %, respectively. Univariate and multivariate analyses showed a tumor larger than 10.0 cm (P < 0.05) and presence of portal vein branch invasion (P < 0.05) led to the worst prognosis. No major complications were noted.

4 Conclusions

Combined use of TACE and RFA in single‐session is a safe and effective option in the treatment of patients with solitary large HCC (> 7 cm) not amenable to surgery.     

Consumption of national health insurance medical resources by hepatocellular carcinoma patients treated using radiofrequency ablation therapy

Aim: This study analyzed the health‐care resources consumed in cancer treatment to provide important reference guidance to national governments with regard to their health‐care policy prioritization and efficient health‐care resource allocation. Methods: Researchers used a retrospective observational approach to study medical resources consumed by hospitalized hepatocellular carcinoma (HCC) patients who underwent radiofrequency ablation (RFA) treatment in Taiwan between 2002 and 2006. Results: A systemic analysis of the results showed a mean patient age of 65.3 and average medical costs per patient of US$1403. Higher incidence of HCC was evident in rural areas in Taiwan, however smaller hospitals treated fewer patients diagnosed with HCC due to many patients seeking treatment at larger hospitals, usually in urban areas. Consumption of medical resources at regional hospitals was significantly higher than at medical centers in terms of costs of X‐rays and special materials as well as for the overall cost of treatment (P < 0.001). The average medical costs for hospitalized cancer patients who underwent RFA treatment were lower than for those that received other treatments such as surgical resection, TACE, radiotherapy or chemotherapy. This study further found an upward trend in the number of HCC patients receiving RFA treatments. Conclusion: Taiwan operates a national insurance global budget payment system. Health‐care system budgetary pressures are exacerbated by increases in the costs of cancer treatment. While the cost of RFA for HCC may represent value for money, with cost savings in other treatment areas, it nonetheless places strain on Taiwan NHI global budget payment system.     

Clinical efficacy of metronomic chemotherapy after cool-tip radiofrequency ablation in the treatment of hepatocellular carcinoma

Purpose: Anti-angiogenic agents have shown promise for treating advanced hepatocellular carcinoma (HCC), and the primary mechanism of low-dose metronomic chemotherapy using traditional cytotoxic drugs is anti-angiogenic. This study evaluated the efficacy of metronomic capecitabine and thalidomide after cool-tip radiofrequency ablation (RFA), relative to RFA alone, for treating patients with HCC. Methods and materials: Patients with HCC were randomly apportioned to a test group (n?=?22) receiving metronomic chemotherapy with capecitabine and thalidomide after RFA, or a control group (n?=?28) receiving RFA only. Serum circulating endothelial cells (CECs) and vascular endothelial growth factor (VEGF) were measured in all patients before and 1 month after RFA treatment. Enhanced computed tomography or ultrasound imaging was performed to evaluate efficacy during 12 months of follow-up. The treatment groups were further stratified as HCC within or outside the Milan criteria for transplantation. Results: One month post-treatment, the tumour response rate (TRR), including complete response and partial response rate, of the test and control groups was statistically similar. At 12 months, the TRR of the test group (68.2%) was significantly higher than that of the control group (35.7%). In the test group, the TRR of patients whose tumour burdens were outside the Milan criteria was significantly higher than that of the control group. One month post-treatment, CECs and VEGF levels of the test group were significantly lower than baseline, while those of the control group were significantly higher. At the end of the 12-month follow-up, there was a progression-free survival (PFS) benefit of 2 months in the test group. Conclusion: Metronomic capecitabine and thalidomide after RFA significantly reduced recurrence of HCC and extended PFS, especially for HCC outside the Milan criteria, perhaps via reduction of serum CECs and VEGF levels and inhibition of tumour angiogenesis.     

超声引导下经皮激光消融与射频消融治疗微小肝细胞癌的疗效对比

目的：通过与超声引导下经皮射频消融（RFA）比较,观察超声引导下经皮激光消融（LA）治疗微小肝细胞癌（HCC）的临床疗效。方法回顾性分析54例微小 HCC 患者的临床资料,按照治疗方法的不同将其分为 LA 组（n ＝27）和 RFA 组（n ＝27）。LA 组患者接受超声引导下 LA 治疗,RFA 组接受超声引导下 RFA 治疗,观察近期疗效及不良反应,随访患者的肿瘤局部控制率和无进展生存期（PFS）。结果LA 组和 RFA 组患者治疗后的总有效率分别为81．48％、77．78％,差异无统计学意义（χ2＝0．11,P ＝0．74）;两组患者1年肿瘤局部控制率分别为77．78％、51．85％,差异有统计学意义（χ2＝14．74,P ＝0．00）;两组患者中位 PFS 分别为（12．52±6．57）个月和（8．67±5．13）个月,差异有统计学意义（χ2＝4．70,P ＝0．03）。LA 组和 RFA 组治疗后出现的不良反应如穿刺区域疼痛（40．74％∶33．33％;χ2＝0．32,P ＝0．57）、腹腔出血（7．41％∶11．11％;P ＝0．64）、胆道出血（0∶3．70％;P ＝0．31）、胆漏（7．41％∶14．81％;P ＝0．39）、腹腔感染（3．70％∶11．11％;P ＝0．30）的差异均无统计学意义。结论与 RFA 比较,LA 可提高微小 HCC 患者的肿瘤局部控制率,并延长患者的 PFS,具有一定的临床应用价值和前景。     

射频消融联合肝动脉化疗栓塞对原发性肝癌基因表达及生存期的影响

目的:分析射频消融联合肝动脉化疗栓塞对原发性肝癌基因表达及生存期的影响。方法:选择2013年1月至2014年6月在我院接受治疗的原发性肝癌患者90例作为研究对象,根据随机数表法将所选对象分为观察组和对照组,每组均为45例。观察组患者给予射频消融联合肝动脉化疗栓塞,对照组给予单独肝动脉化疗栓塞。观察两组患者治疗后近期疗效、肿瘤坏死情况、远期疗效、肝癌组织中促凋亡基因以及凋亡抑制基因情况。结果:观察组患者治疗后近期疗效（84.44%）优于对照组患者（46.67%）,比较差异有统计学意义（P＜0.05）;观察组肿瘤完全坏死率（86.67%）高于对照组（26.67%）,观察组肿瘤不完全坏死率和部分坏死率（8.89%、4.44%）低于对照组（31.11%、42.22%）,比较差异有统计学意义（P＜0.05）;观察组和对照组治疗后1年生存率差异无统计学意义（P＞0.05）;观察组治疗后2、3年生存率（66.67%、53.33%）显著高于对照组（42.22%、26.67%）,比较差异具有统计学意义（P＜0.05）;观察组治疗后肝癌组织中促凋亡基因MTS1、Caspase-3及 Bax的mRNA含量（213.08±27.86、226.89±31.54、249.42±31.51）均显著高于对照组（100.09±11.74、100.13±14.25、101.38±14.65）,比较差异有统计学意义（P＜0.05）;观察组肝癌组织中凋亡抑制基因PLK1、Bcl-2及Survivin的mRNA含量（21.46±3.43、33.41±5.07、29.02±3.85）均低于对照组（101.52±11.82、100.73±14.16、100.49±17.63）,比较差异有统计学意义（P＜0.05）。结论:射频消融联合肝动脉化疗栓塞治疗原发性肝癌患者的近远期疗效显著,可提高肿瘤坏死率,促进肝癌细胞凋亡,延长患者生存期。