Transarterial Chemoembolization Combined with Either Radiofrequency or Microwave Ablation in Management of Hepatocellular Carcinoma

Introduction: Local ablative therapy and trans arterial chemoembolization (TACE) are applied to ablate non resectable hepatocellular carcinoma (HCC). Combination of both techniques has proven to be more effective. We aimed to study combined ablation techniques and assess survival benefit comparing TACE with radiofrequency (RFA) versus TACE with microwave (MWA) techniques. Methods: We retrospectively studied 22 patients who were ablated using TACE-RFA and 45 with TACE-MWA. All were classified as Child A-B and lesions did not exceed 5 cm in diameter. TACE was followed within two weeks by either RFA or MWA. We recorded total and partial ablation rates and complication rates. Survival analysis was then performed. Results: TACE-MWA showed a higher tendency to provide complete response rates than TACE-RFA (P 0.06). This was particularly evident with lesions sized 3-5 cm (P 0.01). Rates of complications showed no significant difference between the groups. Overall median survival was 27 months. The overall actuarial probability of survival was 80.1% at 1 year, 55% at 2 years, and 36.3% at 3 years. The recurrence free survival at 1 year, 2years and 3 years for the TACE-RFA group was 70%, 42% and 14% respectively and for TACE-MWA group 81.2%, 65.1% and 65.1% without any significant difference (P 0.1). In relation to the size of focal lesions, no statistically significant difference in the survival rates was detected between the groups. Conclusion: TACE-MWA led to better response rates than TACE-RFA with tumors 3-5 cm, with no difference in survival rates.     

Efficacy and Safety of Microwave Ablation (MWA) for Hepatocellular Carcinoma (HCC) in Difficult Anatomical Sites in Egyptian Patients with Liver Cirrhosis

Background and aim: Imaging guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) hasbecome a widely used method over recent years. Tumors close to the diaphragm, gastrointestinal tract, gallbladder,pancreas, hepatic hilum and major bile duct or vessels are generally considered relative contraindications for microwaveablation. This study was conducted to assess the effectiveness and safety of ultrasonography-guided MWA in treatingpatients with HCC in difficult anatomical sites in comparison to those in conventional sites. Patients and methods:Eighty-eight patients were included and divided into two groups: the study group of 44 with 46 lesions lying <5mmfrom the diaphragm, hepatic capsule, gall bladder (GB) or large vessel; and the control group of 44 patients with50 lesions in non-risky sites. Each lesion was ablated using an ultrasound guided microwave probe using a detailedprotocol. Results: Most of the patients were males, with a mean age of 57.8 years. In the study group, two patientshad lesions adjacent to the GB, twelve were perivascular and 32 were subcapsular. The overall successful ablationrates were 84.8% and 92% in the study and control groups, respectively. Within the study group, ablation rates were100%, 75% and 87.5% for lesions close to the GB, perivascular lesions and subcapsular lesions, respectively. Onepatient developed a subcutaneous abscess, with good outcome after proper treatment. Fever, pain and asymptomaticpleural effusion were reported after ablation without statistically significant difference between the groups or amongsubgroups. In conclusion: MWA for HCC in difficult anatomical sites is as effective and safe as for ordinary sites.     

Efficacy of Transarterial Chemoembolization Combined with Radiofrequency Ablation in Treatment of Hepatocellular Carcinoma

Purpose: To evaluate efficacy of transarterial chemoembolization (TACE) combined with radiofrequencyablation (RFA) in treatment of patients with hepatocellular carcinoma. Materials and Methods: During January2009 to March 2012, 80 patients with hepatocellular carcinoma underwent TACE, with or without RFA. Alfafetoprotein(AFP) was checked before and after procedure. CT scans were obtained one month after TACE or RFAfor all patients to evaluate tumor changes. Complete response+partial response+stable disease (CR+PR+SD)/nwere used to assess the disease control rate (DCR). Survival at 3, 6 and 12 months was compared in both groups.Results: AFP levels in TACE + RFA group dropped rapidly, becoming obviously lower than that of the TACEgroup. In the TACE + RFA group DCR was 93.8%, while only 76.8% in the TACE group. The treatment effectbetween the two groups was statistically significant (P<0.05) by Ridit analysis. 1 year survival rate in the TACE+ RFA group was 92.5%, significantly higher than that of the TACE group at 77.5% (P<0.05). Conclusions:TACE and RFA as combined therapy method for patients with middle and terminal stage HCC gives full playto synergy between the two and improves the therapeutic effect.     

Percutaneous Radiofrequency Ablation Guided by Contrastenhanced Ultrasound in Treatment of Metastatic Hepatocellular Carcinoma after Liver Transplantation

This study evaluated the advantages and applications of contrast-enhanced ultrasound (CEUS)-supportedpercutaneous radiofrequency ablation (RFA) in the treatment of metastatic hepatocellular carcinoma after livertransplantation, based on clinical details. CEUS-supported percutaneous RFA was adopted to treat 12 patientswith hepatic metastatic carcinomas after liver transplantation. The diameters of the metastatic carcinomas variedfrom 1 cm to 5 cm, and the foci were discovered after 3 months to 12 months. Each focus was diagnosed andlocalised by CEUS for RFA once or twice. Curative effects were evaluated by CEUS or contrast-enhanced CTafter the treatment. The re-examination results at 2 weeks post-treatment showed that the foci of 11 patients wereablated completely, whereas one patient with the largest focus required retreatment by RFA because of a partialresidue. No local recurrence was found one month later in the re-examination. CEUS-supported percutaneousRFA in the treatment of hepatic metastatic carcinoma after liver transplantation has the advantages of accuratelocalisation, good efficacy, easy operation, and minimal invasion without any complications. Therefore, it canbe recommended as the preferred therapy for hepatic metastatic carcinoma after liver transplantation.     

肝动脉化疗栓塞联合射频消融治疗中晚期肝癌的临床疗效

目的探讨肝动脉化疗栓塞（TACE）联合射频消融（RFA）治疗中晚期肝癌的临床疗效。方法62例具有介入治疗指征的中晚期肝癌患者随机均分为2组,对照组31例单独行TACE治疗,观察组31例行TACE联合RFA治疗。比较观察2组的临床疗效及AFP水平。结果观察组总有效率为87．1％,高于对照组的51．6％（P〈0．05）。观察组术后AFP水平明显低于对照组（P〈0．05）。随访24个月各时期的生存率观察组均明显高于对照组（P〈0．05）。结论TACE联合RFA治疗中晚期肝癌安全、可靠,可提高患者生存率,延长患者生存时间,疗效优于单独应用TACE。     

人工腹水辅助超声引导射频消融治疗膈顶部原发性肝癌

目的 探讨人工腹水辅助超声引导射频消融（radiofrequency ablation, RFA）治疗膈顶部肝细胞癌（hepatocellular carcinoma, HCC）的可行性、安全性及临床应用价值。方法 回顾性分析2010年1月至2012年12月间于广西医科大学第一附属医院行人工腹水辅助超声引导RFA治疗膈顶部HCC的22例患者25个病灶的临床资料,参照Seldinger穿刺技术并进行改进,用5-F动脉鞘管置入肝与腹膜之间的膈顶部建立人工腹水,使得膈顶部肿瘤显示清楚或穿刺路径完全暴露。并对人工腹水辅助下射频消融治疗的成功率、安全性进行分析。结果 本组88.0%（22/25）病例成功建立人工腹水,膈顶部病灶位置及范围得以完全显示并显示穿刺路径。所有患者注入的人工腹水均于术后3天内完全自行吸收。本组未发生腹腔内出血、腹膜炎、血胸、气胸等严重的并发症,无手术相关死亡病例。术后一月增强CT/MR随访复查提示所有病灶消融完全,无肿瘤局部残留。结论 建立人工腹水后可使得原位于超声盲区无法进行RFA治疗的膈顶部肿瘤得以清楚显示,拓宽了RFA治疗适应证;人工腹水辅助超声引导射频消融治疗膈顶部HCC安全、简易、可行,有较高临床应用价值。     

无水酒精注射联合射频消融治疗射频消融困难部位的肝癌

目的:探讨无水酒精注射联合射频消融治疗射频消融困难部位肝癌的疗效.方法:回顾性分析靠近结肠、胆囊、大中血管、膈肌等存在射频困难区肝癌患者31例,在采用射频治疗后残余病灶行无水酒精补充治疗,评价病灶坏死率及术后并发症.结果:31例患者的47个病灶当中共有33个病灶位于射频困难部位,肿瘤完全坏死率为72.7%(24/33).无腹腔内出血,胆囊穿孔,结肠穿孔等严重并发症出现.结论:射频困难部位的肝癌病灶采用射频补充无水酒精注射治疗效果良好,未见严重的射频或酒精注射相关并发症发生,可在肝癌的综合治疗中推广应用.     

Cost Effectiveness Analysis of Radiofrequency Ablation (RFA) Versus Stereotactic Body Radiotherapy (SBRT) for Early Stage Renal Cell Carcinoma (RCC)

ObjectivesTo conduct a cost-effectiveness analysis of stereotactic body radiotherapy (SBRT) versus radiofrequency ablation (RFA) in the non-surgical management of early stage renal cell carcinoma (RCC) according to Consolidated Health Economic Evaluation Reporting Standards (CHEERS) criteria in the Canadian healthcare system.MethodsA Markov state transition model was constructed for initial local treatment with RFA or SBRT for early stage, kidney confined, medically inoperable RCC in a hypothetical cohort. Incremental cost effectiveness ratios (ICER) were then calculated to compare the two treatments. The analysis was conducted over 5-year time horizon from the perspective of a publicly funded health system in Canada. Secondary analyses were conducted to assess the effect of small versus large size (< 4 cm vs. > 4 cm) RCC on ICERs. Multiple one-way deterministic sensitivity analysis were conducted. Discounting of 1.5% per year was applied.ResultsOver 5 years, SBRT economically dominated RFA with a gain of 4.103 quality-adjusted life years (QALYs) and a cost of $16,097, compared with 3.607 QALYs at a cost of $18,324 for RFA. The ICER was $4490 CAD less per QALY for SBRT in the base case analysis (BCE). In patients with small tumors (T1a), SBRT compared with RFA was more effective and marginally more costly, resulting in an ICER of $2207 CAD per QALY gained, while for larger tumors (T1b), SBRT was less costly and more effective than RFA, resulting in an ICER of -$22904. Sensitivity analysis demonstrated significant variability in the cost-effectiveness of SBRT versus RFA when parameters were varied, with rates of distant metastasis following RFA or SBRT having the greatest implications on ICERs.ConclusionOverall, SBRT used as a primary treatment for RCC shows promising effectiveness at an overall reduction in cost compared with RFA in the Canadian healthcare system. The use of SBRT appears to be cost-effective for larger tumors as well as smaller tumors. The validity of these conclusions are highly sensitive to the accuracy of local and distant progression rates reported in previous studies, and may be adjusted as the available data on SBRT and RFA continues to evolve and mature.     

Predictors of Complete Response in Patients with Hepatocellular Carcinoma Treated with Trans-Arterial Radioembolization

Background: Trans-arterial radioembolization (TARE) has shown promising results in treating hepatocellular carcinoma (HCC). We identified independent predictors of radiological complete response (CR) in patients with intrahepatic HCC who were treated with TARE. Methods: Patients with intrahepatic HCC treated with TARE between 2011 and 2017 were recruited. CR was defined according to the modified Response Evaluation Criteria in Solid Tumors. Cox regression analysis was used to determine independent predictors of CR. Results: The median age of study participants (83 men and 19 women) was 64.3 years. The mean survival after TARE was 55.5 months, and 21 (20.6%) patients died during the study period. Patients who achieved CR (14 patients, 13.7%) had significantly higher serum albumin level (median 4.1 vs. 3.9 g/dL), lower total bilirubin level (median 0.6 vs. 0.7 mg/dL), lower aspartate aminotransferase level (median 30.0 vs. 43.0 IU/L), lower alkaline phosphatase level (median 79.0 vs. 103.0 IU/L), lower alpha-fetoprotein level (median 12.7 vs. 39.9 ng/mL), lower des-gamma-carboxyprothrombin level (median 575.5 vs. 2772.0 mAU/mL), lower model for end-stage liver disease (MELD) score (median 6.0 vs. 7.0), and smaller maximal tumor diameter (median 6.3 vs. 9.0 cm) compared to those who did not achieve CR (all p < 0.005). Multivariate Cox regression analysis showed that lower MELD score (hazard ratio (HR) = 0.436, p = 0.015) and maximal tumor size < 9 cm (HR = 11.180, p = 0.020) were independent predictors of an increased probability of radiological CR after TARE. Conclusions: Low MELD score and small maximal tumor size were independently associated with an increased probability of CR after TARE in patients with intrahepatic HCC.     

Prognostic Value of Serum AFP,AFP-L3, and GP73 in Monitoring Short-term Treatment Response and Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation

Purpose: Alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), and Golgiprotein 73 (GP73) levels have been widely used as tumor markers for the diagnosis of hepatocellular carcinoma(HCC). The aim of this study was to investigate whether these tumor markers could be used to monitor short-termtreatment response and recurrence of HCC in patients undergoing radiofrequency ablation (RFA). Methods:Between July 2012 and July 2013, 53 consecutive patients with newly diagnosed HCC were prospectively enrolledin this study. Among these, 32 patients underwent RFA, after which they were followed up prospectively at theFirst Hospital of Jilin University in China. Results: AFP, AFP-L3, and GP-73 values pre-RFA were not associatedwith tumor size, whereas AFP and GP-73 levels tended to be associated with tumor number, the presence ofvascular invasion, deterioration of liver function, advanced-stage disease, and a poor performance status. GP-73levels were dramatically elevated in the patients with hepatitis C-associated HCC. Neither pre-RFA nor 1-monthpost-RFA tumor marker values were associated with short-term outcome. The short-term recurrence rate ofAFP-positive patients measured 1 month post-RFA was obviously higher than that of AFP-negative patients.Conclusions: AFP and GP-73 values were associated with clinical variables representing tumor growth andinvasiveness, and the AFP value measured 1 month post-RFA was a strong predictor of short-term recurrencein patients with HCC.     

无水酒精注射联合射频消融治疗射频消融困难部位的肝癌

目的：探讨无水酒精注射联合射频消融治疗射频消融困难部位肝癌的疗效。方法：回顾性分析靠近结肠、胆囊、大中血管、膈肌等存在射频困难区肝癌患者31例,在采用射频治疗后残余病灶行无水酒精补充治疗,评价病灶坏死率及术后并发症。结果：31例患者的47个病灶当中共有33个病灶位于射频困难部位,肿瘤完全坏死率为72.7%（24/33）。无腹腔内出血,胆囊穿孔,结肠穿孔等严重并发症出现。结论：射频困难部位的肝癌病灶采用射频补充无水酒精注射治疗效果良好,未见严重的射频或酒精注射相关并发症发生,可在肝癌的综合治疗中推广应用。     

TACE联合射频消融在肝癌肝动静脉分流治疗中的临床应用

[目的]评价肝动脉化疗栓塞术（TACE）联合冷循环射频消融术（RFA）治疗原发性肝癌肝动静脉分流的疗效。[方法]伴有肝动静脉分流的原发性肝癌25例，行TACE联合RFA，术后1个月行CT及DSA检查。[结果]13例快速型肝动静脉分流仍然存在，5例中速型肝动静脉瘘分流量减少，7例慢速型肝动静脉瘘消失。[结论]TACE联合RFA治疗肝癌肝动静脉分流，对慢速型肝动静脉分流有治疗作用，对中速型分流有一定帮助，对快速型分流无治疗意义。     

Quality of Life after Transcatheter Arterial Chemoembolization Combined with Radiofrequency Ablation in Patients with Unresectable Hepatocellular Carcinoma Compared with Transcatheter Arterial Chemoembolization alone

Aim: The aim of this study was to assess quality of life (QoL) in patients with unresectable hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) compared to TACE plus radiofrequency ablation (RFA) done at the same sitting, and to assess tumor therapy response after these 2 palliative interventions. Methods: 73 patients with unresectable HCC (BCLC-B) were included. Patients with tumor ≤ 5 cm were subjected to TACE (N = 45) while patients with tumors > 5 cm were subjected to TACE followed immediately by RFA (N = 28). QoL was evaluated with two validated questionnaires (EORTC QLQ-30 and EORTC HCC18). These questionnaires were filled out before intervention, 2 weeks and 2 months after intervention. Pre/post interventional changes were analyzed. The modified response evaluation criteria in solid tumor (mRECIST) were employed for the evaluation of therapeutic efficacy. Results: Baseline global health status/QoL was significantly higher in TACE group (64.1%) compared to TACE-RFA group (51.2%). Two weeks after intervention: the absolute decrease in global health state was higher in TACE-RFA (- 12.1%) compared to TACE (- 6.3%, p = 0.411). Less impairment was found in TACE group compared to TACE-RFA group for physical/social functioning, fatigue and pain but it was statistically insignificant. Two months after intervention; TACE-RFA group showed significant improvement in global health score, social and physical functioning scores, as well as significant improvement in pain and fatigue compared to TACE group. The therapeutic efficacy of TACE-RFA was better than TACE alone: complete remission, partial remission, stable disease and progressive disease were 17.9%, 32.1%, 42.9% and 7.1% Vs11.1%, 22.2%, 48.9% and 17.8%, respectively). Conclusion: Neither TACE nor TACE-RFA showed a significant decrease in QoL in patients with unresectable HCC two weeks after intervention. However, two months after intervention; TACE-RFA showed significant improvement in global health score compared to TACE monotherapy. TACE-RFA appeared safe, effective and more favorable than TACE monotherapy.     

Clinical Application of Transcatheter ArterialChemoembolization Combined with Synchronous C-armCone-Beam CT Guided Radiofrequency Ablation in treatmentof Large Hepatocellular Carcinoma

Objective: This work aimed to evaluate the safety and clinical efficacy of transcatheter arterialchemoembolization (TACE) combined with c-arm cone-beam CT guided synchronous radiofrequency ablation(RFA) in treatment of large hepatocellular carcinoma (HCC). Methods: 21 patients with large HCC were studiedfrom January 2010 to March 2012. TACE combined with synchronous C-arm cone-beam CT guided RFA wereperformed on a total of 25 lesions. Conventional imaging examination (CEUS, enhanced CT or MRI) and AFPdetection were regularly conducted to evaluate the technical success rate of combined treatment, complications,treatment response, time without disease recurrence and survival rate. Results: The technical success rate ofcombined treatment was 100%, without any significant complication. After 1 month, there were 19 cases withcomplete response and 2 cases with partial response, with an complete response rate of 90.4% (19/21) and aclinical effective rate of 100% (21/21). The complete response rates of single nodular lesions (100%, 17/17) wassignificantly higher than that of multiple nodular lesions (50%, 2/4) (P < 0. 05). During 2 to 28 months of followup,in 19 cases with complete response, the average time without disease recurrence was 10.8 ± 6 months. Thetotal survival rates of 6, 12 and 18 months in 21 patients were 100%, respectively. Conclusion: TACE combinedwith synchronous C-arm CT guided RFA is safe and effective for treatment of large HCC. The treatment efficacyfor single nodular lesion is better than that for multiple nodular lesions.     

肝细胞癌腹腔镜射频消融治疗前后活检组织端粒酶活性检测对治疗效果评价的意义

目的 :探讨肝细胞癌腹腔镜射频消融(LRFA)治疗前后活检组织端粒酶活性检测对治疗效果评价的价值。 方法 :2001年8月至2004年10月,34例肝细胞癌合并肝硬化患者在全麻下行LRFA治疗。其中男性27例,女性7例,平均年龄49.9±11.7岁。平均肿瘤直径4.0±1.0cm。肿瘤均位于肝脏表面、肝左外叶或临近胆囊等空腔脏器。LRFA治疗前后,分别对瘤体行腹腔镜超声检查及活检,所得微量组织采用ELISA-TRAP法行端粒酶活性检测及病理学检查。 结果 :所有病例均顺利完成LRFA治疗。RFA治疗前,病理学诊断阳性率为100%(34/34),端粒酶活性阳性率为91.2%(31/34);RFA治疗后,病理学检查均未发现肿瘤细胞,端粒酶活性阳性率26.5%(9/34)。术后1个月螺旋CT增强扫描提示肿瘤完全坏死率达100%。随访7～40个月(中位21个月),9例RFA治疗后端粒酶表达阳性的患者中,8例射频治疗部位复发;而25例RFA治疗后端粒酶表达阴性的患者中,2例发现肝内新病灶。 结论 :肝细胞癌合并肝硬化患者LRFA治疗后,活检组织端粒酶活性检测对LRFA治疗效果的评价及预后具有一定的参考价值。     

超声引导微波凝固治疗肝癌前后血清转化生长因子β1的变化及意义

 目的　探讨超声引导微波凝固治疗肝癌前后血清转化生长因子 β1(transforminggrowthfactor β1,TGF β1)的变化及意义。 方法　采用ELISA法检测 18例原发性肝癌患者微波凝固治疗前、治疗后1周、1月后血清TGF β1水平 ,以 2 0例健康者为对照。 结果　以正常对照组血清TGF β1 x +2sd(2 7.2 μg/L)为阈值 ,18例肝癌患者中 13例TGF β1为阳性 (72 .2 % ) ,5例为阴性。肝癌微波治疗后 1周血清TGF β1为6 5 .1± 12 .3μg/L ,较治疗前明显升高 (P <0 .0 1) ,4周时大多数患者 (11/ 13)血清TGF β1降至低于治疗前水平 ,与治疗前差异显著 (P <0 .0 5 ) ,2例患者由于发生腹腔内转移而TGF β1持续升高。结论　肝癌微波凝固治疗前后血清TGF β1的检测对于术前肝癌的诊断及术后肿瘤的复发转移有一定的诊断价值。     

CT引导下射频消融治疗中晚期非小细胞肺癌的近期疗效观察

背景与目的 近年来,射频消融术(Radio-Frequency Ablation,RFA)作为一种新的局部治疗手段运用于肺部肿瘤的治疗.取得了很好的临床效果.本文探讨CT引导下射频消融治疗中晚期肺癌的临床价值.方法 对66例中晚期非小细胞肺癌的68个病灶(其中2例病人各治疗2个病灶)在三维重建CT引导下进行射频消融治疗,观察近期疗效.结果 66例病人经CT引导下射频消融,即刻及1个月复查CT提示病灶阴影增大.而64个病灶CT值降低,占94.1%,4个病灶CT值增加,占5.9%.1个月复查SPECT提示T/N降低至正常值以下的患者占82.4%(56/68).治疗后3个月CT扫描显示在68个肿瘤中,没有肿瘤完全消失(CR)者,肿瘤缩小者(PR)73.5%(50/68),肿瘤无变化者(SD)2.9%(2/68),肿瘤增大者(PD)8.8%(6/68),6例增大的病灶进行了第2次消融;3个月复查SPECT提示T/N降低至正常值以下的患者占79.496(54/68).无严重并发症,无围手术期死亡.结论 CT6[导下射频消融治疗中晚期非小细胞肺癌安全可行,近期疗效明显.     

Clinical Significance of Joint Detection of Serum VEGF,SIL-2R and HGF in Patients with Primary Hepatocellular Carcinoma before and after Percutaneous Microwave Coagulation Therapy

Objective: To investigate the changes of serum vascular endothelial growth factor (VEGF), solubleinterleukin-2 receptor (SIL-2R) and hepatocyte growth factor (HGF) contents in patients with primaryhepatocellular carcinoma (HCC) before and after percutaneous microwave coagulation therapy (PMCT) anddetermine their clinical significance. Materials and Methods: Fasting venous blood (3 mL) from 81 patientswith primary HCC diagnosed by pathology was collected in the mornings 1 day before PMCT, and 1 day, 7days and 1 month after PMCT, and then the serum was separated and stored in -70℃. The contents of VEGF,SIL-2R and HGF were detected by enzyme linked immunosorbent assay (ELISA). Results: The serum VEGF,SIL–2R and HGF contents in 81 patients with primary HCC had obviously dynamic changes before and afterPMCT. By comparison to 1 day after PMCT with pre-operation, there was no statistical significance regardingVEGF and SIL–2R contents (P>0.05), but HGF content showed significant difference (P<0.01). Compared withpre-operation, VEGF, SIL-2R and HGF contents 7 days and 1 month after PMCT all manifested significantdifferences (P<0.01). By comparison to 7 days with 1 month after PMCT, there was no statistical significanceregarding the VEGF content (P>0.05), whereas SIL-2R and HGF contents showed significant change (P<0.01).Conclusions: The contents of serum VEGF, SIL-2R and HGF have obviously dynamic changes in primary HCCbefore and after PMCT, and their joint detection is expected to be an effective hematologic evaluation index ofPMCT for primary HCC.     

Radiofrequency ablation of hepatocellular carcinoma in elderly patients fitting the Milan criteria: A single centre with 13 years experience

Purpose: The aim of this study was to evaluate the safety and outcomes of radiofrequency ablation (RFA) in treating elderly patients with hepatocellular carcinoma (HCC).

Patients and methods: This was a retrospective analysis of 391 patients with HCC fitting the Milan criteria and treated with RFA for the first time from 1999 to 2012 at the Southwest Hospital, China. The patients were divided into two groups, an elderly group (age ≥70 years, n?=?102) and a non-elderly group (age <70 years, n?=?289). Long-term outcomes were assessed on all patients and survival rates were calculated.

Results: The overall survival rates of the two groups differed significantly. The recurrence-free survival rates of the two groups did not differ significantly. There was no significant difference between the two groups. Excluding comorbid diseases related deaths, the overall survival rates of the two groups did not differ significantly.

Conclusions: The safety and outcomes of RFA in treating early HCC were similar among elderly and non-elderly patients. Co-morbid diseases, such as cardiovascular disease and respiratory disease, rather than HCC or liver diseases, contributed to the relatively low overall survival rate found in elderly patients.     

Rate and Predictive Factors for Sustained Complete Response after Selective Transarterial Chemoembolization (TACE) in Patients with Hepatocellular Carcinoma

Background: To determine the effectiveness and performance of selective conventional transarterialchemoembolization (TACE) and analyze the potential predictive factors of sustained complete response (CR) forpatients with hepatocellular carcinoma (HCC). Materials and Methods: Total of 52 patients with HCC (33 males,19 females; mean age 64.0 ± 9.6 years) who underwent 81 sessions of selective TACE between November 2015 andMarch 2017 at Songklanagarind hospital were reviewed. The Kaplan-Meier method was used to describe CR rates atvarious time points. Univariate and multivariate logistic regression models were performed to determine the predictivefactors for sustained CR at six months. Results: The CR rates after selective TACE at 1, 4, 6, 9 and 12 months were87%, 81%, 62%, 40% and 31%, respectively. Univariate and multivariate analyses demonstrated that alpha fetoproteinlevel <100ng/ml, a tumor size in summation ≤ 30 mm, ≤ 2 sessions of selective TACE and unilobar involvement had asignificantly higher odds of sustaining complete response at six months (p =0.018, 0.031, 0.032, and 0.044, respectively).Conclusions: Selective TACE has a good therapeutic results and can sustained complete response in selected HCCpatients. Serum AFP≤ 100 ng/ml, a few sessions of selective TACE, tumor size in summation ≤ 30 mm and unilobarinvolvement were favorable predictive factors for sustained complete response of HCC patients.