TACE序贯联合PMCT治疗原发性肝癌的预后因素分析

  目的  分析影响动脉化疗栓塞术(transarterial chemoemlolization, TACE)序贯联合微波凝固消融(percutaneous micro wave coagulation therapy, PMCT)治疗原发性肝癌预后的主要因素。   方法  本研究收集本科收治的97例接受TACE序贯联合PMCT治疗的原发性肝癌患者。对可能影响预后的各变量进行单因素分析, 再利用多因素Cox逐步回归分析影响预后的主要因素。   结果  本组肝癌患者的1、2、3、5年累积生存率分别为68.2%、43.2%、28.8%、13.4%。单因素分析与预后有关的因素为肿瘤大小、临床分期(BCLC)、Child-Pugh分级、门脉癌栓、动静脉瘘、PMCT治疗次数及体力状况(ECOG评分)。Cox逐步回归多因素分析与预后有关并具有显著意义的因素为肿瘤大小、临床分期、门脉癌栓、PMCT治疗次数及体力状况。   结论  适当重复PMCT治疗可以延长肝癌患者的生存期限。大肝癌、门脉癌栓为预后的危险性因素, 巨块型肝癌及伴门脉主干癌栓患者的中位生存时间明显缩短。      

超声引导经皮射频消融膈下肝肿瘤的安全性研究及疗效观察

  目的   探究超声引导下经皮射频消融对膈下肝肿瘤疗效及安全性。   方法   射频治疗79例共138个肝肿瘤,其中膈下肿瘤组76个,非膈下肿瘤组62个。比较两组并发症、完全消融、局部肿瘤复发发生率。   结果   两组完全消融率分别为92.1%（70/ 76）、98.4%（61/62）,两组比较差异无统计学意义（χ2=2.49,P=0.12）。随访局部肿瘤复发两组分别19.7%（15/76）、6.5%（4/62）,差异有统计学意义（χ2=5.08,P=0.02）;无瘤生存期分别为膈下肿瘤组（21.0±1.4）个月、非膈下肿瘤组（24.7±1.7）个月,差异有统计学意义（χ2=3.84,P=0.05）。10例患者发生并发症,胸水并发症发生率存在差异（χ2=4.52,P=0.034）,无射频治疗相关死亡,无针道转移发生,消融技术成功率为100%。   结论   射频消融是一种安全有效的微创治疗技术。肿瘤位置影响消融效果,膈下肿瘤较肝中央处肿瘤易发生消融区域肿瘤复发,术中麻醉医生的协作有利于消融的顺利完成。      

联合检测术前与术后CEA CA19-9 CA72-4对不同分期胃癌根治术后复发的预测价值

  目的   探讨联合检测术前、术后CEA、CA19-9、CA72-4等肿瘤标志物对不同分期胃癌根治术后复发的预测价值。   方法   回顾性分析北京大学肿瘤医院2002年1月至2007年3月收治的564例胃癌患者的临床资料及血清肿瘤标志物情况。所有患者均未行新辅助治疗,术前、术后均联合检测CEA、CA19-9、CA72-4等肿瘤标志物。分析CEA、CA19-9、CA72-4等肿瘤标志物与胃癌复发的关系。   结果   在Ⅰ、Ⅱ期胃癌患者中,CEA、CA19-9、CA72-4术前阳性的患者术后复发率分别为50.0%、24.1%、22.6%,而术后阳性的患者复发率分别为42.9%、21.7%、14.3%。在Ⅲ期胃癌患者中,CEA、CA19-9、CA72-4术前阳性的患者术后复发率分别为50.0%、55.2%、47.6%,而术后阳性的患者术后复发率分别为75.0%、66.7%、66.7%。多因素分析表明术前CEA增高是Ⅰ、Ⅱ期胃癌复发的独立影响因素,术后CA72-4增高是Ⅲ期胃癌复发的独立影响因素。   结论   对于Ⅰ、Ⅱ期胃癌,术前CEA水平是预测复发较好的因子;对于Ⅲ期胃癌,术后CA72-4水平的预测性较好。      

肝癌根治术后早期肝内复发危险因素分析

[目的]探讨原发性肝癌(以下简称肝癌)根治性切除术后早期复发的影响因素.[方法]回顾性分析105例肝癌根治性切除术的病例,研究肿瘤、宿主、治疗等因素与术后早期肝内复发关系.[结果]105例病例中早期肝内复发47例.多因素分析表明肿瘤大小、门静脉分支受侵、术前AFP≥100ng/L是早期复发的独立危险因素.复发高危组2年复发率为56.70%,1、3、5年生存率分别为83.58%、62.65%、21.48%:复发低危组2年复发率为23.70%,1、3、5年生存率分别为86.38%、69.94%、47.85%.二组差异有显著性(P《0.05).[结论]肿瘤大小、门静脉分支受侵、术前AFP≥100ng/ml是影响病人术后早期肝内复发的重要因素.     

超声造影与增强CT对肝癌射频消融效果的一致性评价

  目的  对超声造影与增强CT对肝癌射频消融术后评价效果一致性进行分析。  方法  对35例患者共68个肿瘤病灶进行超声或CT引导下射频消融治疗,术后同时定期进行增强CT以及超声造影检查评价射频消融效果,分析超声造影以及增强CT在肿瘤完全消融率、残留率,复发率、准确性以及超声造影与增强CT一致性。  结果  68个病灶中,超声造影评价肿瘤总体完全消融率以及残留率分别为84%及16%,增强CT分别为90%及10%,二者之间比较差异无统计学意义(χ2=0.576 3,P=0.447 8),具有很高的一致性(K=0.882 9,Sk=0.120 4),68个病灶中24个月内共有13个病灶为复发病灶,超声造影对复发病灶检出率为92%(12/ 13),与增强CT 100%(13/13)之间比较差异无统计意义(P>0.05)。以增强CT作为判断RFA后肿瘤残留及复发的金标准,超声造影对68个肿瘤病灶总体诊断准确性为92%(63/68),5个病灶判断不一致。  结论  超声造影在肝癌射频消融效果评价中与增强CT具有很高准确性及一致性,能为肿瘤射频消融术后治疗提供可靠诊断依据。      

53例肝细胞癌患者根治性切除术后辅助肝动脉化疗栓塞的生存分析

  目的   探讨肝细胞癌根治性切除术后辅助肝动脉化疗栓塞对无瘤生存率及累积生存率的影响。   方法   收集53例肝细胞癌根治性切除术后辅助TACE治疗患者和64例单纯行肝细胞癌根治术后患者的临床资料,采用回顾性研究的方法,对其治疗的1、2、3、5无瘤生存率和累积生存率进行对比分析,从而探讨肝细胞癌根治性切除术后辅助TACE治疗对无瘤生存率及累积生存率的影响。   结果   术后+TACE组1、2、3、5年的无瘤生存率和累积生存率分别为84.9%、60.4%、39.6%、18.9%和98.1%、86.8%、69.8%、47.2%,单纯手术组1、2、3、5年的无瘤生存率和累积生存率分别为70.3%、43.8%、21.9%、12.5%和87.5%、71.9%、50.0%、31.3%,两组的无瘤生存率和累积生存率差异均有统计学意义。Cox回归结果显示术后+TACE治疗是影响患者无瘤生存率和累积生存率的独立影响因素。   结论   肝细胞癌根治性切除术后辅助TACE治疗可提高患者的无瘤生存率和累积生存率,术后辅助TACE治疗是影响患者术后无瘤生存率和累积生存率的独立影响因素。      

射频治疗肝癌术后复发的相关因素

射频消融治疗肝癌已经成为目前治疗肝癌的主要非手术方法之一，但术后较高的复发率受到关注。本文根据近年来的文献，对射频毁损术后复发的危险因素做一综述。结果显示，肿瘤直径〉3cm、肿瘤位置临近大血管或肝脏包膜下、不足够的治疗范围、以及术者经验缺乏是使局部复发率升高的危险因素，而血清甲胎蛋白水平高、术前肝功能分级差、肿瘤病理分期晚等因素是肝内远处复发的危险因素。     

经皮消融治疗微小肝癌的疗效和预后因素分析

目的 评估经皮消融微小肝癌的疗效并进行预后因素分析.方法 2003年7月至2006年10月,对单个结节直径≤2 cm的33例微小肝癌行超声引导经皮消融,视肿瘤所在部位分别采用水冷式低杆温微波消融或多极无水酒精消融,每个肿瘤治疗一次.结果 肿瘤完全消融率为93.9%,局部复发率9.1%,远处复发率33 3%,1年、2年和3年无瘤生存率63.4%、63 4%和63.4%,总生存率84.5%、76.6%和71.2%.单因素分析显示甲胎蛋白基线水平与无瘤生存率显著相关,甲胎蛋白、治疗后远处复发与总生存率显著相关.多因素相关分析显示高甲胎蛋白水平和远处复发是显著影响总生存率的独立危险因子.结论 经皮消融对微小肝癌长期疗效良好,病人的甲胎蛋白基线水平和治疗后远处复发是影响预后的主要因素.     

Ki-67在T1期非肌层浸润性膀胱癌中的表达及意义

  目的   检测Ki-67在T1期非肌层浸润性膀胱癌（non-muscle invasive bladder cancer,NMIBC）组织中的表达,并探讨其与肿瘤复发和进展的关系。   方法   回顾性分析2011年6月至2013年10月天津医科大学肿瘤医院102例T1期NMIBC患者的临床病理资料,利用免疫组织化学方法检测组织中Ki-67的表达,分析Ki-67表达与患者临床病理特征的关系,探讨其对T1期NMIBC复发和进展的影响。   结果   中位随访时间43（24~57）个月,102例T1期NMIBC患者中20例（19.6%）复发,12例（11.8%）进展,32例（31.4%）Ki-67表达≥25%。Ki-67表达与肿瘤分级相关（P < 0.05）,与患者性别、年龄、肿瘤数目、肿瘤大小等无相关性（P > 0.05）。单因素分析结果显示,Ki-67表达与T1期NMIBC的复发无相关性（P > 0.05）,Ki-67表达、肿瘤分级、肿瘤数目和既往复发率是影响T1期NMIBC进展的危险因素（P < 0.05）,Cox风险回归模型多因素分析结果显示,Ki-67高表达（P=0.043）和既往复发率（P=0.018）是影响T1期NMIBC进展的独立危险因素。   结论   Ki-67表达是T1期NMIBC的独立预后因素,检测Ki-67表达有助于预测其进展风险,为采取及时有效治疗提供依据。      

29例血管外皮瘤临床疗效分析

  目的   血管外皮瘤是一种罕见的软组织肿瘤, 本研究旨在分析血管外皮瘤的综合治疗方法和预后。   方法   回顾性分析1966年4月至2011年8月天津医科大学附属肿瘤医院收治的29例血管外皮瘤患者的临床资料。中位年龄为42岁(7个月~75岁), 其中男19例, 女10例。原发病灶总数为31个, 中位大小为5.2 cm×4.6 cm。   结果   29例患者中位生存期51个月(5~252个月)。1年、3年、5年及10年生存率分别为93.1%、76.5%、67.5%和52.5%。辅助放疗组与未行辅助放疗组1年、5年、10年生存率分别为100%、87.5%、69.3%和89.5%、56.8%、34.1%。全组共11例局部复发(44%), 中位局部复发时间为9.5个月(4~120个月)。术后辅助放疗组较未行辅助放疗组局部复发率低(P=0.042), 但远处转移率没有差别(P=0.673)。术后辅助化疗未能降低远处转移率及延长总生存期。   结论   术后辅助放疗能降低血管外皮瘤局部复发率并可延长生存期。      

Effectiveness of hepatic resection for early-stage hepatocellular carcinoma in cirrhotic patients: subgroup analysis according to Milan criteria

BACKGROUND: The aim of this study was to determine the long-term post-resection outcomes for cirrhotic patients with early-stage hepatocellular carcinoma (HCC). METHODS: A total of 217 < or = 65-year-old cirrhotic patients who underwent hepatic resection were divided into four groups in accordance with the Milan criteria: Group 1, those who met the Milan criteria (n = 130); Group 2A, those with a solitary tumor > 5 cm in size (n = 12); Group 2B, those with 2 or 3 tumors > 3 cm in size (n = 35); and Group 2C, those with > or = 4 tumors (n = 33). Overall and recurrence-free survival were compared between the groups. RESULTS: At 1, 3, 5 and 10 years, overall survival rates were 91, 67, 45 and 12%, and recurrence-free survival rates were 62, 26, 16 and 0%, respectively. Independent prognostic factors for overall survival were age, blood transfusion, tumor number, tumor size and microscopic vascular invasion; and for recurrence they were hepatitis C infection, tumor number, tumor size, microscopic vascular invasion and histological tumor grade. Group 1 patients had significantly better survival (5-year survival rate, 56%) than those of other groups (5-year survival rate, around 30%). The median tumor-free survival time was significantly shorter in Groups 2B and 2C (0.7 years and 0.6 years, respectively) than in Groups 1 and 2A. CONCLUSIONS: Hepatic resection can confer a considerable overall survival benefit for cirrhotic patients with HCC who meet the Milan criteria. For patients with HCC who do not meet the criteria, however, hepatic resection has limited efficacy. We suggest that application of non-surgical therapy or expansion of the indications for liver transplantation may be warranted for such patient subsets.     

Radiofrequency ablation using a multiple-electrode switching system for hepatocellular carcinoma within the Milan criteria: long-term results

Purpose: To assess the long-term outcome of 516 consecutive patients treated with multiple-electrode switching system (MESS) radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) that met the Milan criteria.

Materials and methods: We performed 522 MESS RFAs on 516 patients from December 2006 to June 2011. A total of 956 tumours that met the Milan criteria with an average diameter of 2.64?cm (range, 0.9–4.6?cm) were treated with MESS RFA. Ultrasonic contrast and serum α-fetoprotein (AFP) were measured every 2?months during the first postoperative year and every 4?months thereafter. Enhanced computed tomography was performed every 6?months. Survival was estimated using the Kaplan–Meier method. Follow-up was censored at 60?months. Multivariate analysis was performed using the Cox proportional hazards model.

Results: For the 956 HCC tumours, the complete ablation rate with MESS was 98.83% (510/516). During a median of 34 months (IQR, 23–52?months) of follow-up, 171 patients died and 4 were lost to follow-up (15, 30, 38 and 42?months). The cumulative incidence of local tumour progression at 1, 3 and 5?years was 0.39%, 4.96% and 6.66%, respectively, and the 1-, 3- and 5-year overall survival was 99.42%, 83.97% and 68.42%, respectively. Tumour size >30?mm was the only parameter that was predictive of local tumour progression (p?14?s, serum AFP levels >200?ng/mL and tumour abutting vessel diameter <5?mm. The complication rate was 1.74%.

Conclusion: MESS RFA is a safe and effective method for HCC treatment. This approach results in a high local progression-free survival for HCC tumours that meet the Milan criteria.     

Postoperative adjuvant transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond the Milan criteria: a retrospective analysis

Objective: To clarify the value of postoperative adjuvant transcatheter arterial chemoembolization (TACE) for resectable multiple hepatocellular carcinoma beyond the Milan criteria. Background: Patients with multiple HCC have been shown to have a worse survival after a partial hepatectomy (PH) because of the high incidence of intrahepatic tumor recurrence. Postoperative adjuvant TACE is an optional strategy for HCC patients with a high recurrence risk. Its effects and range of applications are debatable. Methods: This retrospective study enrolled 135 HCC patients with resectable multiple hepatocellular carcinoma beyond the Milan criteria, and those patients underwent a hepatectomy with/without postoperative adjuvant TACE from Jan. 2004 to Dec. 2008. The patients were divided to the PH cohort or the PH+TACE cohort. The prognosis measures were the disease-free survival (DFS) and overall survival (OS) from the date of treatment. Univariate and multivariate analyses were used to assess the prognostic factors associated with DFS and OS, using the Cox proportional hazards model. Results: The 1-, 2-, and 5-year DFS and OS for the PH+TACE group differed significantly from the PH group (p = 0.004, p = 0.002, respectively). Multivariate analysis revealed that the significant independent risk factors associated with the DFS and OS were postoperative TACE treatment (p = 0.002, p = 0.001, respectively) and the number of tumors (p = 0.006, p = 0.037, respectively). Conclusions: Our results show that postoperative adjuvant treatment resulted in delayed intrahepatic recurrence and better survival for patients with resectable multiple hepatocellular carcinoma beyond the Milan criteria. Postoperative adjuvant TACE should be regarded as a common strategy for patients with resectable multiple HCC beyond the Milan criteria.     

经肝动脉化疗栓塞联合射频消融治疗原发性肝细胞癌合并门静脉癌栓的预后影响因素分析

背景与目的：经肝动脉化疗栓塞（transcatheter arterial chemoembolization,TACE)是否为治疗原发性肝细胞癌（hepatocellular carcinoma,HCC）合并门静脉癌栓（portal vein tumor thrombus,PVTT）的绝对禁忌,目前尚无定论。该研究旨在探讨TACE联合射频消融（radiofrequency ablation,RFA）治疗HCC合并PVTT的预后影响因素。方法：回顾性分析2011年1月1日—2013年12月31日于郑州大学附属肿瘤医院行TACE联合RFA治疗的HCC合并PVTT的157例患者的临床资料及随访数据,单因素及多因素Cox回归分析人口学资料、实验室指标及临床资料与生存时间和肿瘤转移复发情况的关系。结果：多因素Cox回归结果显示,在调整和控制其他因素后,血清白蛋白（albumin,ALB）水平为TACE联合RFA治疗后HCC合并PVTT患者3年生存及降低肿瘤复发转移风险的保护性因素,术前甲胎蛋白（alpha-fetoprotein,AFP）、丙氨酸转氨酶（alanine aminotransferase,ALT）、天门冬氨酸转氨酶（aspartate transaminase,AST）水平、门静脉癌栓部位及肝功能Child Pugh分级为患者3年生存的独立危险因素;AFP、AST水平及门静脉癌栓部位为肿瘤复发转移的独立危险因素。结论：TACE联合RFA并非治疗HCC合并PVTT的绝对禁忌,在治疗前对患者进行相关因素评估有助于更好地选择治疗方法和时机,从而提高HCC治疗水平。     

Living donor liver transplantation for the patient with hepatocellular carcinoma

Since 1989, over 3,000 living donor liver transplantation (LDLTx) were performed in Japan. Among them, LDLTx for advanced hepatocellular carcinoma (HCC) with severe liver cirrhosis have recently increased. LDLTx for HCC has been offered only when liver function was severely impaired, or HCC became uncontrollable by other modalities such as hepatic resection or ablation therapies, which often exceeded the Milan criteria. One-and 3-year survivals were 84.6% and 73.3%, respectively. When exceeding the Milan criteria, tumor size over 5 cm, vascular invasion, grade of histologic differentiation of HCC, and high PIVKA-II over 300 mAU/ml were independent risk factors for HCC recurrence. Prevention of HCC or hepatitis C recurrence after transplantation should be resolved to improve graft and patient survival.     

Radiofrequency ablation versus surgical resection for hepatocellular carcinoma within the Milan criteria: A study of 281 Western patients

Abstract

Objectives: The aim of this study was to compare survival between radiofrequency ablation (RFA) and surgical resection (SR) in patients with hepatocellular carcinoma (HCC) within Milan criteria. Methods: From January 2004 to December 2013 we consecutively and retrospectively included all patients with first occurrence of HCC within Milan criteria receiving SR or RFA as first-line treatment. The cumulative overall survival (OS) and disease-free survival (DFS) were compared after inverse probability weighting (including confounding factor). Results: A total of 281 patients (RFA 178, SR 103) were enrolled. In multivariate Cox regression RFA and SR were not independent predictors of survival or recurrence. The respective weighted 5 years OS and DFS for patients with propensity scores between 0.1–0.9 in the SR and RFA groups were 54–33% and 60–16.9%, P?=?0.695 and P?=?0.426, respectively. Local tumour progression rate did not differ according to treatment (P?=?0.523). Major complication rate was higher in the SR group, P?=?0.001. Hospitalisation duration was lower in the RFA group (mean 2.19 days, range 2–7) than in the SR group (mean 10.2 days, range 3–30), P?<?0.001. Conclusion: This large Western study has shown that OS and DFS did not differ after RFA (using mainly multipolar devices) and SR, for HCC within the Milan criteria in a European population, with a shorter hospitalisation time and a lower complication rate for RFA.     

Potential predictive factors for microvascular invasion in hepatocellular carcinoma classified within the Milan criteria

Background

Microvascular invasion (mvi) is an important risk factor for recurrent hepatocellular carcinoma (HCC), even after curative liver resection or orthotopic liver transplantation. However, mvi is difficult to detect preoperatively. The aim of this study was to clarify the risk factors of postoperative recurrence and investigate predictive factors of mvi before hepatectomy for HCC classified within the Milan criteria.

Methods

One hundred fifty-nine patients with hepatocellular carcinoma (HCC) classified within the Milan criteria, who underwent hepatectomy, were enrolled in this study. We investigated the risk factors of recurrence. In addition, we divided them into two groups: mvi-negative group and mvi-positive group, based on pathological findings after surgery. We compared the clinicopathological factors between the two groups and determined the risk factors for mvi.

Results

Overall survival rate at 1, 3, and 5 years were 91.6%, 80.5%, and 74.9%, and the recurrence-free survival rate at 1, 3, and 5-years were 72.3%, 51.6%, and 37.2%. Risk factor analysis for tumor recurrence revealed that total bilirubin, albumin, ICGR15, AFP-L3, tumor number, mvi, and tumor stage had a significant predictive value. Multivariate analysis revealed that tumor number and mvi were significant independent risk factors for tumor recurrence. Predictive analysis for risk factors of mvi revealed that multiple tumors and AFP-L3 > 10% were significant independent risk factors for mvi in HCC classified within the Milan criteria.

Conclusions

The mvi was one of the independent risk factors for tumor recurrence in HCC classified within the Milan criteria. Multiple tumors and high AFP-L3 value were independent predictive factors for mvi.

     

Risk Factors for Early Recurrence of HBV-related Hepatocellular Carcinoma Meeting Milan Criteria after Curative Resection

Background: The prognosis of patients with hepatocellular carcinoma (HCC) after curative resection variesgreatly. Few studies had investigated the risk factors for early recurrence (recurrence-free time ≤ 1 year) ofhepatitis B virus (HBV)-related HCCs meeting Milan criteria. Methods: A retrospective analysis was performedon the 224 patients with HCC meeting Milan criteria who underwent curative liver resection in our center betweenFebruary 2007 and March 2012. The overall survival (OS) rate, recurrence-free survival (RFS) rate and riskfactors for early recurrence were analyzed. Results: After a median follow-up of 33.3 months, HCC reoccurredin 105 of 224 patients and 32 died during the period. The 1-, 3- and 5-year OS rates were 97.3%, 81.6% and75.6% respectively, and the 1-, 3- and 5-year RFS rates were 73.2%, 53.7% and 41.6%. Cox regression showedalpha-fetoprotein (AFP) > 800 ng/ml (HR 2.538, 95% CI 1.464-4.401, P=0.001), multiple tumors (HR 2.286, 95%CI 1.123-4.246, P=0.009) and microvascular invasion (HR 2.518, 95% CI 1.475-4.298, P=0.001) to be associatedwith early recurrence (recurrence-free time ≤ 1-year) of HCC meeting Milan criteria. Conclusions: AFP > 800ng/ml, multiple tumors and microvascular invasion are independent risk factors affecting early postoperativerecurrence of HCC. In addition resection appears capable of replacing liver transplantation in some situationswith safety and a better outcome.     

Recurrence-free survival after radiofrequency ablation of hepatocellular carcinoma. A registry report of the impact of risk factors on outcome

BACKGROUND: Despite the high complete necrosis rate of radiofrequency ablation (RFA), tumor recurrence, either local tumor recurrence or new tumor formation, remains a significant problem. Purpose of this study is to evaluate the pattern and risk factors for intrahepatic recurrence after percutaneous RFA for hepatocellular carcinoma (HCC). METHODS: We studied 40 patients with 48 HCCs (< or = 3.5 cm) who were treated with percutaneous RFA. The mean follow-up period was 24.1 +/- 15.7 months. We evaluated the cumulative disease-free survival of overall intrahepatic recurrence, local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Thirty host, tumoral and therapeutic risk factors were reviewed for significant tie-in correlation with recurrence: age; gender; whether RFA was the initial treatment for HCC or not; severity of liver disease; cause of liver cirrhosis; contact of tumor to major hepatic vessels and liver capsule; degree of approximation of tumor to the liver hilum; ablation time; degree of benign pre-ablational enhancement; sufficient safety margin; tumor multinodularity; tumor histological differentiation; tumor segmental location; maximum tumor diameter; degree of tumor pre-ablational enhancement at arterial phase CT, MRI or CT-angiography; and laboratory markers pre- and post-ablation (AFP, PIVKA II, TP, AST, ALT, ALP and TB). RESULTS: The incidence of overall recurrence, LTP and IDR was 65, 23 and 52.5%, respectively. The cumulative disease-free survival rates were 54.6, 74.8 and 78.3% at 1 year, 27.3, 71.9 and 46.3% at 2 years and 20, 71.9 and 29.4 at 3 years, respectively. Univariate and multivariate analysis showed that the significant risk factors for LTP were: tumor size > or = 2.3 cm, insufficient safety margin, multinodular tumor, tumors located at segments 8 and 5, and patient's age > 65 years (P < 0.05). No significant risk factor relationship for IDR could be detected. CONCLUSION: Our results would have clinical implications for advance warning and appropriate management of patients scheduled for RFA. Patients at risk of LTP should be closely monitored in the first year. Furthermore, regular long-term surveillance is essential for early detection and eradication of IDR.     

Transarterial Chemoembolization Monotherapy in Combination with Radiofrequency Ablation or Percutaneous Ethanol Injection for Hepatocellular Carcinoma

Purpose: To evaluate whether combined transarterial chemoembolization (TACE) with radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI) for hepatocellular carcinoma (HCC) have superior efficacy to transarterial chemoembolization (TACE) alone a retrospective review was conducted. Methods: During January 2009 to March 2013, 108 patients with hepatocellular carcinoma underwent TACE or combined therapies (TACERFA or TACEPEI). The long-term survival rates were evaluated in those patients by various statistical analyses. Results: The cumulative survival rates in the combined TACERFA/PEI group were significantly superior to those in the TACE alone group. When the comparison among the groups was restricted to patients with two or three tumors fulfilling the Milan criteria, significantly greater prolongation of survival was observed in the combined TACE RFA/PEI group than in the RFA/PEI alone group. Conclusions: In terms of the effect on the survival period, combined TACE RFA/PEI therapy was more effective than TACE monotherapy, and also more effective than PEI or RFA monotherapy in cases with multiple tumors.