Radiofrequency Ablation for Subcapsular Hepatocellular Carcinoma

Background: Limited data from recent studies suggested an increased risk of bleeding complications, needle-track seeding, and local recurrence after radiofrequency ablation (RFA) of subcapsular hepatocellular carcinoma (HCC).Methods: Between May 2001 and October 2002, 80 patients underwent RFA of 104 HCC nodules. Forty-eight patients had subcapsular HCC (group I), whereas the other 32 patients did not have subcapsular HCC (group II). RFA was performed via celiotomy, laparoscopy, or a percutaneous approach. Subcapsular HCCs were ablated by indirect puncture through nontumorous liver, and the needle track was thermocoagulated.Results: There were no significant differences between groups in treatment morbidity (14.6% vs. 15.6%; P = .898), mortality (2.1% vs. 0%; P = 1.000), complete ablation rate after a single session (89.4% vs. 96.9%; P = .392), local recurrence rate (4.3% vs. 12.5%; P = .216), recurrence-free survival (1 year: 60.9% vs. 49.2%; P = .258), or overall survival (1 year: 88.3% vs. 79.4%; P = .441). After a median follow-up of 13 months, no needle-track seeding or intraperitoneal metastasis was observed.Conclusions: This study shows that the results of RFA for subcapsular HCCs are comparable to those of RFA for nonsubcapsular HCCs. Subcapsular HCC should not be considered a contraindication for RFA treatment.     

Acetic acid versus radiofrequency ablation for the treatment of hepatocellular carcinoma: A randomized controlled trial

PurposeThe purpose of this prospective study was to compare the efficacy of percutaneous acetic acid (PAAI) to that of radiofrequency ablation (RFA) in the treatment of small (≤ 5 cm) hepatocellular carcinoma (HCC) using a randomized trial.Material and methodsConsecutive patients with small HCC underwent clinical, biochemical, and imaging evaluation. Those fulfilling the inclusion criteria (Child's A/B cirrhosis, less than 5 HCC nodules, HCC nodules ≤ 5 cm diameter, no extrahepatic disease, patent portal vein, normal coagulation profile with informed consent) were randomly assigned to receive RFA or PAAI. Tumor response and survival rate were estimated. Non-inferiority margin of 10% difference was taken for effectivity of PAAI compared to RFA.ResultsOf the 86 patients screened, 55 patients with 67 HCC nodules were included. There were 40 men and 15 women with a mean age of 54.3 ± 10.5 (SD) years (range: 28–71 years). Of these, 26 patients had PAAI and 29 had RFA. The clinical, demographic and imaging profiles of the two groups were similar. Complete response was non-inferior to RFA [PAAI 75% and RFA 83.3%, difference 8.3% CI (−12.5% to 29.2%)]. Lower limit of this 95% CI (−12.5%) was lower than the 10% non-inferiority margin difference (8.3%). Survival rates were similar at 12 months (PAAI, 81.6% vs. RFA, 71.9%; P = 0.68) and at 30 months (PAAI, 54.4% vs. RFA, 52%; P = 0.50).ConclusionPAAI and RFA have similar efficacy in treating small HCC. PAAI could thus be a cost-effective alternative in situations where RFA is either unavailable or unaffordable.     

Percutaneous thermal ablation of primary and secondary lung tumors: Comparison between microwave and radiofrequency ablation

PurposeThe purpose of this study was to retrospectively compare microwave (MWA) and radiofrequency (RFA) ablation in the percutaneous treatment of primary and secondary lung tumors.Material and methodsA total of 115 patients with a total of 160 lung tumors (primary, n = 41; secondary, n = 119) were retrospectively included. There were 56 men and 59 women with a mean age of 67.8 ± 12.7 (SD) years (range: 42–89 years) who underwent either MWA (61 patients; 79 tumors) or RFA (54 patients; 81 tumors). The primary study endpoints were local recurrence during follow-up and the incidence of complications during and following thermal ablation. The MWA and RFA groups were compared in terms of treatment efficacy and complication rates.ResultsDemographics were similar in the two groups. Mean tumor diameter was smaller in RFA group (13.1 ± 5.1 [SD] mm; range: 4–27 mm) than in MWA group (17.1 ± 8.3 [SD] mm; range: 5–36 mm) (P < 0.001). Ablation volumes at one month were 24.1 ± 21.7 (SD) cm³ (range: 2–97.8 cm³) in RFA group and 30.2 ± 35.9 (SD) cm³ (range: 1.9–243.8 cm³) in MWA group (P = 0.195). During a mean overall follow-up duration of 488 ± 407 (SD) days (range: 30–1508 days), 9/160 tumors (5.6%) developed local recurrence: six (6/79; 7.6%) in the RFA group and three (3/81; 3.7%) in the MWA group (P = 0.32). Pneumothoraces were more frequent in the RFA group (32/79; 40.5%) than in the MWA group (20/81; 24.7%) (P = 0.049). The mean length of hospital stay was 4.5 ± 3.7 (SD) days (range: 1–25 days) in the RFA group and 4.7 ± 4.6 (SD) days (range: 2–25 days) in the MWA group (P = 0.76).ConclusionsMWA favorably compares with RFA and can be considered as an effective and safe thermal ablation technique for lung tumors, especially in situations where RFA has limited efficacy.     

肝纤维化血清学模型预测HBV相关肝细胞癌经肝动脉化疗栓塞序贯射频消融后复发

目的探讨肝纤维化血清学模型预测早期乙型肝炎病毒(HBV)相关肝细胞癌(HCC)经导管肝动脉化疗栓塞(TACE)序贯射频消融(RFA)后复发的价值。方法回顾性分析45例经TACE序贯RFA治疗的早期HBV相关HCC患者,采用术前实验室指标构建评估肝纤维化的S指数、天冬氨酸转氨酶与血小板比值指数(APRI)、白蛋白与总胆红素比值指数(ALBI)及谷氨酰转移酶与血小板比值指数(GPRI)4种血清学模型;以受试者工作特征(ROC)曲线评价模型预测HCC复发的效能,以COX比例风险模型分析HCC复发危险因素。结果治疗后随访期间14例HCC复发,复发与未复发患者间S指数、APRI、ALBI、GPR差异均有统计学意义(P均0.05)。S指数预测复发的效果最优,其曲线下面积(AUC)为0.853,敏感度和特异度分别为92.90%和77.40%,预测截断值为0.49;S指数0.49是HCC复发的独立危险因素(P0.05)。结论肝纤维化血清学S指数与经TACE序贯RFA治疗的HCC患者肿瘤复发相关;对S指数0.49的高危复发HCC患者应密切随访。     

Trough Levels of Everolimus Are Associated With Recurrence Rates of Hepatocellular Carcinoma After Liver Transplantation

Purpose

Everolimus, a mammalian target of rapamycin inhibitor, may have a protective role on hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT), but data regarding the impact of its trough serum levels on HCC recurrence are missing.

肝癌射频消融术后复发危险因素分析及术前预测评分

目的探讨肝细胞癌(HCC)患者射频消融术(RFA)术后复发的独立危险因素并建立术前预测评分。方法回顾性分析2016年6月至2019年9月中山大学附属中山医院收治的RFA治疗的168例HCC患者资料,应用X-tile软件确定术前循环肿瘤细胞(CTC)最佳的截断值并进行分组,分析术前不同CTC值与各临床因素之间的关系。采用Cox回归模型分析RFA术后复发的独立危险因素,按每项独立危险因素赋值为1分组成预测评分,分为低危组(0~2分)、中危组(3分)及高危组(4~5分),并运用Kaplan-Meier法绘制累积复发曲线,统计各组累积复发率。结果168例患者中男性151例,女性17例,年龄(58.33±9.53)岁。在CTC的检测中,131例肝癌患者CTC≥1个/3.2 ml(77.98%),范围为0~20个/3.2ml。X-tile软件确定HCC患者术前CTC临界值为2个/3.2ml,故CTC≤2个/3.2ml为阴性组(93例),CTC>2个/3.2ml为阳性组(75例)。分析术前CTC与各术前临床参数的关系,发现CTC与肿瘤结节数目、肿瘤最大径及甲胎蛋白(AFP)相关(P<0.05)。多因素分析显示,CTC阳性[HR(95%CI):1.990(1.332~2.974)]、AFP>20 ng/ml[HR(95%CI):1.659(1.111~2.477)]、异常凝血酶原(PIVKA-II)>40 mAU/ml[HR(95%CI):1.580(1.022~2.443)]、肿瘤结节数目≥2个[HR(95%CI):1.568(1.057~2.326)]、肿瘤最大径>30 mm[HR(95%CI):1.544(1.007~2.369)]均是HCC患者RFA术后复发的独立危险因素(P<0.05);三组患者6个月、12个月、18个月的累积复发率低危组为14.9%、35.6%、56.4%,中危组为38.9%、70.5%、85.0%,高危组为64.5%、84.5%、100%,三者患者累积复发曲线对比,差异有统计学意义(P<0.05)。结论术前CTC阳性、AFP>20 ng/ml、PIVKA-II>40 mAU/ml、肿瘤结节数目≥2个、肿瘤最大径>30 mm是HCC患者RFA术后复发的独立危险因素,基于此构建的术前预测评分,对指导临床实践治疗策略具有重要意义。     

125I粒子植入与射频消融对TACE术后AFP阳性中晚期肝细胞癌干预效果的对比分析

目的对比分析125I粒子植入或射频消融(RFA)对TACE术后甲胎蛋白(AFP)阳性中晚期原发性肝细胞癌(HCC)患者的干预效果。方法回顾性分析79例TACE术后AFP阳性的中晚期原发性HCC患者,其中41例接受125I粒子植入(A组),38例接受RFA(B组)。分别于治疗后1、3、6个月评价治疗效果,并检测血清AFP。结果术后1个月,2组治疗有效率差异无统计学意义(P=0.122);术后3、6个月A组治疗有效率均高于B组(P均<0.05)。A、B组术前及术后1个月血清AFP差异均无统计学意义(P均>0.05),术后3、6个月A组AFP均低于B组(P均<0.05)。结论125 I粒子植入治疗TACE术后AFP阳性中晚期HCC临床效果优于RFA,且降低AFP效果更显著。     

Ablación por radiofrecuencia del lecho quirúrgico tras tumorectomía en cirugía conservadora del cáncer de mama

IntroductionObtaining tumor-free margins during breast conservative surgery (BCS) is essential to avoid local recurrence and frequently requires reoperation. Radiofrequency ablation (RFA) of surgical margins after lumpectomy seems to be a helpful tool to avoid reoperations, but evidence is insufficient. This study analyzes the efficacy and safety of RFA after BCS to obtain free surgical margins.MethodsNon-randomized experimental study performed in an intervention group of 40 patients assigned to receive RFA after lumpectomy and successive resection of surgical margins, and a historical control group of 40 patients treated with BCS alone. In the intervention group, the RFA effect on tumor cell viability in the surgical margins was analyzed. Also, reoperation rate, complications and cosmetic results were compared in both groups.ResultsA total of 240 excised margins were analyzed after RFA, obtaining a high number of tumor-free margins. Compared to the control group, the reoperation rate decreased significantly (0% vs 12%; P = .02), without differences in terms of postoperative complications (10% vs 5%; P = .67) or cosmetic results (excellent or good 92.5% vs 95%; P = .3).ConclusionsRFA after lumpectomy is a reliable, safe and successful procedure to obtain tumor-free surgical margins and to decrease the reoperation rate without affecting complications or compromising cosmetic results.     

射频消融治疗复发性肝细胞癌疗效分析

目的探讨射频消融对肝细胞癌(HCC)手术切除后复发病例再治疗的效果,比较不同复发时间的疗效差别。方法以行超声引导经皮射频消融(RFA)治疗的手术切除后复发性肝细胞癌(RHCC)患者(RHCC组)和同期行RFA治疗的首发HCC患者(首发HCC组)为研究对象。(1)RHCC组42例患者,男34例,女8例,平均年龄(58±10)岁;复发灶大小1.5~6.6cm,平均(3.8±1.4)cm。RFA治疗前5例伴肝外转移。肝功能A级21例,B级19例,C级2例。手术切除距肝内初次复发时间为1~96个月,平均22.8个月。术后1年内肿瘤复发者20例40灶(RHCC近期组),术后1年以上复发者22例37灶(RHCC远期组)。(2)首发HCC组148例患者,男117例,女31例,平均年龄59岁。肿瘤大小1.2~7.0cm,平均(4.0±1.4)cm。RFA治疗后1个月采用增强CT检查评价消融成功率;比较RHCC近期组、RHCC远期组和首发HCC组的治疗效果、复发转移情况及生存期。结果首发HCC组RFA成功率为87.2%(129例),局部复发率为16.2%(24例),另位复发率为37.8%(56例),平均生存期为(39.0±2.1)个月;RHCC近期组、远期组RFA成功率分别为85.0%和95.5%(P>0.05),局部复发率分别为15.0%和13.6%(P>0.05),另位复发率为60.0%和18·2%(P=0.005),平均生存期为(15.4±2.3)个月和(39.5±4.5)个月(P<0.005)。与首发HCC组相比,RHCC远期组消融成功率与局部复发率均无显著性差异(P>0.05),RHCC近期组生存期低于首发HCC组(P<0.05)。RHCC远期组1例患者治疗后出血,经射频止血、输血等保守治疗缓解。结论RFA治疗RHCC的预后及疗效与复发的时间相关;对于术后远期复发者,行RFA治疗可获得同首发HCC相似的生存期,而手术后近期复发者疗效相对较差。     

Minimally invasive surgery versus percutaneous radio frequency ablation for the treatment of single small (≤3 cm) hepatocellular carcinoma: a case–control study

Background

Patients with single small hepatocellular carcinoma (HCC) can be managed by surgical resection or radio frequency ablation (RFA), with similar recurrence and survival rates. Recently, minimally invasive surgery (MIS) has been introduced in liver surgery, and the advantage/drawback balance between surgery and RFA needs reassessment.

Methods

Patients with Child-Pugh class A or B cirrhosis, and with single 1–3 cm HCC, undergoing MIS (laparoscopic or robot-assisted) or RFA from July 1998 to December 2012 were compared.

Results

Overall, 45 patients underwent MIS, and 60 underwent RFA. Groups were not statistically different regarding type of underlying liver disease, HCC size, and AFP. However, RFA patients showed worse liver synthetic function with lower albumin and higher bilirubin serum levels, and higher ASA scores. Patients with HCC in segments 2–6 were more often treated by MIS. The incidence of complications was similar between groups (RFA: 6/60, 10 % vs. MIS: 5/45, 11 %, p = 0.854), and there was no measurable difference in the rate of procedure-related blood transfusions (RFA: 1/60, 1.7 % vs. MIS: 3/45, 6.7 %, p = 0.185). Local recurrence was only detected after RFA (11.7 %, p = 0.056, log-rank). Overall survival was higher in the MIS group (p = 0.042), with median survivals of 100 ± 13.5 versus 68 ± 15.9 months.

Conclusion

The present data need further validation. Selected patients with single ≤3-cm HCCs can be safely treated by MIS, without increased risk of perioperative complication, and with a lower risk of local recurrence. MIS should be especially favoured in patients with peripheral HCCs in segments 2–6, and/or when a histological assessment is desirable.

     

Oncological Outcomes of Hepatic Resection vs Transplantation for Localized Hepatocellular Carcinoma

BackgroundScarce data are available comparing outcomes of hepatic resection vs orthotopic liver transplantation (OLT) for localized hepatocellular carcinoma (HCC) patients both meeting and exceeding the Milan criteria. This study compared the clinical and oncological outcomes of patients undergoing hepatic resection vs transplantation localized HCC.MethodBetween January 2005 and February 2017, clinical and oncological outcomes of patients who underwent liver resection (n = 38) vs OLT (n = 28) for localized HCC were compared using a prospectively maintained database.ResultsA total of 66 patients (with a median age of 62) who met the study criteria were analyzed. Comparable postoperative complications (13.2% vs 28.6%, P = .45) and perioperative mortality rates (7.9% vs 10.7%, P = .2) were noted for the resection vs OLT groups. While Child-Pugh Class A patients were more prevalent in the resection group (78.9% vs 7.1%, P = .0001), the rate of patients who met the Milan criteria was higher in the OLT group (89.3% vs 34.25, P = .0001). Recurrence rates were 36.8% in the resection group and 3.6% in the OLT group at the end of the median follow-up period (32 vs 39 months, respectively). The HCC-related mortality rate was significantly higher in the resection group (39.5% vs 10.7%, P = .034).However, a subgroup analysis of patients who met the Milan criteria revealed similar rates of recurrence and HCC-related mortality (15.4% vs 8%, P = .63). Based on logistic regression analysis, number of tumors (P = .034, odds ratio: 2.1) and “resection”-type surgery (P = .008, odds ratio: 20.2) were independently associated with recurrence.ConclusionCompared to liver transplantation, hepatic resection for localized hepatocellular carcinoma is associated with a higher rate of recurrence and disease-related mortality.     

经肝动脉介入治疗在预防原发性肝细胞癌术后复发中的应用价值

目的探讨经肝动脉介入治疗（TAIT）对原发性肝细胞癌（HCC）术后复发的影响。方法将206例原发HCC外科切除术后患者分成两组,对研究组128例术后行补充TAIT治疗,对照组78例术后未行补充治疗。对可能影响原发HCC术后复发的观察指标进行统计学处理,同时对比分析两组患者术后0.5、1、2、3年的累计复发率。结果两组间临床与病理资料差异无统计学意义（P均〉0.05）。研究组0.5、1、2、3年的累计复发率分别为15.62%（20/128）、37.50%（48/128）、71.88%（92/128）、87.50%（112/128）,对照组分别为30.77%（24/78）、56.41%（44/78）、76.92%（60/78）、92.31%（72/78）,两组0.5、1年累计复发率差异有统计学意义（P均〈0.05）。结论 HCC术后给予补充TAIT治疗可降低其近期复发率,延长患者生存时间。     

Hepatocellular carcinoma: Can it be considered a controversial indication for liver transplantation in centers with high rates of hepatitis C?

Hepatocellular carcinoma (HCC) is still considered a controversial indication for liver transplantation (LT), mainly because of long waiting times and underlying viral cirrhosis. The goal was to evaluate the outcome of LT in 104 patients with HCC and cirrhosis, mainly hepatitis C virus (HCV)–related, in a center with a short waiting time (median, 105 days). Four groups were formed according to the HCC and HCV status: HCV positive with HCC (group 1, n = 81), HCV negative with HCC (group 2, n = 23), HCV positive without HCC (group 3, n = 200), and HCV negative without HCC (group 4, n = 207). Predictive factors of tumor recurrence were demographics, tumor related (size or number of nodules, capsule, bilobar involvement, vascular or lymphatic invasion, clinical and pathologic TNM staging, pre-LT percutaneous ultrasound-guided ethanol injection or transarterial chemoembolization, α-fetoprotein levels), donor and surgery related, and year of transplantation. The same variables and “tumor recurrence (yes/no)” were applied to evaluate the effect on survival. The median follow up was 29 months (range, 0 to 104 months). Patient survival was 70% at 1 year and 59% at 5 years for group 1, 87% at 1 year and 77% at 5 years for group 2, 81% at 1 year and 64% at 5 years for group 3, and 88% at 1 year and 77% at 5 years for group 4 (P = .013). Survival was significantly lower in patients with HCC than in those without (74% and 63% versus 85% and 70%, at 1 and 5 years, respectively; P = .05). The causes of death in those with and without HCC were tumor recurrence (24%) and recurrent HCV (8%) versus sepsis (34%) and recurrent HCV (14%). HCC recurrence occurred in 12 patients (11.5%) at a median of 14 months (range, 3 to 60 months) with a probability increasing from 8% at 1 year to 16% at 5 years. In patients with HCC, tumor recurrence was associated with vascular invasion (P = .0004) by multivariate analysis; variables predictive of survival were donor old age (P = .01), viral-related etiology (P = .02), and tumor recurrence (P = .001). Although LT still remains an adequate indication for HCC in centers with high prevalence of HCV infection and short waiting times, both tumor and HCV-related recurrent diseases hamper significantly the outcomes of these patients. (Liver Transpl 2002;8:1020-1027.)     

Endoscopic versus Open Radiofrequency Ablation for Treatment of Small Hepatocellular Carcinoma

Background

Surgical radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is associated with superior oncological outcome in comparison with percutaneous RFA. The present study aimed to retrospectively evaluate the relative perioperative safety and postoperative outcome of the laparoscopic or thoracoscopic approach versus the open approach to RFA for small HCC.

Methods

A retrospective analysis was performed in 55 consecutive patients who underwent open (n = 32) or laparoscopic/thoracoscopic (LTS) RFA (n = 23) for primary unresectable HCC between January 2005 and December 2010. Baseline characteristics, survival/recurrence rates, and complications after treatment were compared between the two groups.

Results

There was a trend showing that LTS RFA was performed for tumors located in the anterior segment (e.g., segments III, V, VIII). The LTS RFA group had a significantly lower intraoperative blood loss, shorter operative time, and shorter postoperative hospital stay, compared with the open RFA group. No major postoperative complications occurred in patients who underwent LTS RFA. No significant differences in overall survival, recurrence-free survival and local recurrence rates were observed between the two groups.

Conclusions

In consideration of operative invasiveness and postoperative recovery, LTS RFA is superior to the open approach in patients with small HCC. Moreover, the surgical outcome did not differ between the two approaches. Laparoscopic/thorascopic RFA can be considered to be a useful procedure for ablation therapy.     

中晚期原发性肝癌患者TACE术后早期复发危险因素

目的观察中晚期原发性肝癌(HCC)患者TACE术后早期复发危险因素。方法对42例中晚期原发性HCC患者行TACE治疗,术后随访6个月,对比分析早期复发与未复发患者之间的差异。结果术后6个月中,23例HCC早期复发(复发组),19例未复发(无复发组)。复发组白蛋白35 g/L者占比低于未复发组(P0.05),甲胎蛋白(AFP)400 ng/ml者占比及谷氨酰基转移酶(ALT)水平均高于未复发组(P均0.05)。未复发组肿瘤病理分化程度较高(P0.05),复发组瘤灶相对较多、肿瘤最大径较大,ADC值和包膜完整比例低于未复发组(P均0.05)。多因素Logistic回归分析结果显示,AFP400 ng/ml者占比(OR=3.313,P=0.041)、肿瘤分化程度(OR=1.463,P=0.038)、瘤灶数量(OR=2.216,P=0.028)及肿瘤ADC值(OR=0.025,P=0.003)是TACE术后HCC早期复发的独立危险因素。结论 TACE术后中晚期HCC早期复发与AFP、肿瘤分化程度、瘤灶数量及ADC值独立相关。     

肝癌术后复发高危患者行TACE的意义

目的 探讨预防性经皮肝动脉化疗栓塞(transeatheter arterial chemoembolization,TACE)在防治高危患者术后复发中的意义.方法 回顾性分析54例有癌栓、子灶或合并多发结节、术后高AFP高危肝细胞癌患者,所有患者由同组手术医师手术,达到根治性切除手术要求.42例患者术后1～2月复查肝功能达到Child A级、肝炎病毒复制被控制在1000 copies/ml以下的高危患者行TACE术做为目标组.12例同样接受根治性手术治疗的高危患者因其他原因未接受TACE治疗做为对照组.通过2年的随访,比较2组的复发率,以了解术后TACE与高危患者复发的关系.结果 接受预防性TACE者术后1年肝内复发率(19.O%)明显低于未接受者(50%);术后2年复发率同样明显低于未接受者(52.3%vs 83.3%).对不同时间段复发率进行分析,随着时间延长TACE组复发率逐渐增高接近对照组.结论 对于肝癌高危复发患者术后进行预防性TACE有助于减少术后近期肿瘤复发率.     

弥散加权成像联合动态增强MRI预测肝细胞癌经TACE联合射频消融治疗后复发

目的 观察弥散加权成像（DWI）联合动态增强MRI预测肝细胞癌（HCC）经TACE联合射频消融治疗后复发的价值。方法 回顾性分析80例接受TACE联合射频消融治疗的HCC患者,均于治疗前10天和治疗后20、60及90天接受腹部DWI及动态增强MR检查;计算DWI联合动态增强MRI预测TACE联合射频消融治疗后20天HCC复发的敏感度、特异度及准确率;绘制受试者工作特征（ROC）曲线,评估以表观弥散系数（ADC）值预测TACE联合射频消融治疗后20天HCC复发的效能。结果 参照改良实体瘤疗效评价标准,将47例HCC患者纳入稳定组、33例归为进展组。TACE联合射频消融治疗后20天,稳定组HCC病灶DWI多呈不均匀信号、ADC图呈高信号、增强扫描未见强化,进展组病灶多呈DWI高信号、ADC图低信号、增强扫描轻度强化。DWI联合动态增强MRI预测TACE联合射频消融治疗后20天HCC复发的敏感度、特异度及准确率分别为97.75%（87/89）、92.31%（24/26）及96.52%（111/115）。以ADC值预测TACE联合射频消融治疗后20天HCC复发的曲线下面积为0.82;以ADC=1.42×10^-3 mm²/s为截断值,预测的敏感度及特异度分别为72.13%及82.25%。结论 DWI联合动态增强MRI用于预测TACE联合射频消融治疗后HCC复发具有一定价值;ADC值可作为有效预测指标。     

Sequential treatment by polidocanol and radiofrequency ablation of large benign partially cystic thyroid nodules with solid components: Efficacy and safety

PurposeThe purpose of this study was to retrospectively evaluate the efficacy and safety of a sequential treatment including percutaneous polidocanol sclerotherapy and radiofrequency ablation (RFA) in terms of volume reduction and complication rate in large, benign, partially cystic thyroid nodules with solid components.Materials and methodFrom April 2017 to April 2019, 46 patients with 47 large benign partially cystic thyroid nodules underwent sequential treatment. There were 14 men and 32 women with a mean age of 49.9 ± 11.5 (SD) years (range: 18–75 years). The volume of initial nodules was 12.7 ± 12.3 (SD) mL (range: 2.16–75.62 mL). Volume reduction after percutaneous polidocanol sclerotherapy and further RFA was evaluated respectively. Patients had clinical and ultrasound evaluations at a follow-up time of 12.1 ± 5.3 (SD) months (range: 1.5–23.9 months). Technical success and complications were accessed retrospectively.ResultsAfter unsatisfying results with polidocanol sclerotherapy alone the 46 patients with 47 large benign partially cystic thyroid nodules had further RFA. Mean volume reduction of 47 nodules was 90.5 ± 11.3 (SD) % (range: 43.9–99.3%) one month after RFA, 94.9 ± 6.2 (SD) % (range: 66.9–99.5%) three months after RFA, and 95.8 ± 5.5 (SD) % (range: 71.0–99.8%) six months after RFA. No recurrence or nodule enlargement after RFA was observed at the last follow-up. The complication rate of RFA was 12.5% (8/46 patients), with minor complications only.ConclusionsThe sequential treatment regimen, including percutaneous polidocanol sclerotherapy and RFA, is an appropriate and safe treatment strategy for large benign partially cystic thyroid nodules with solid components.     

Radiofrequency ablation of liver tumors: a systematic review

OBJECTIVES: To systematically review radiofrequency ablation (RFA) for treating liver tumors. DATA SOURCES: Databases were searched in July 2003. STUDY SELECTION: Studies comparing RFA with other therapies for hepatocellular carcinoma (HCC) and colorectal liver metastases (CLM) plus selected case series for CLM. DATA EXTRACTION: One researcher used standardized data extraction tables developed before the study, and these were checked by a second researcher. DATA SYNTHESIS: For HCC, 13 comparative studies were included, 4 of which were randomized, controlled trials. For CLM, 13 studies were included, 2 of which were nonrandomized comparative studies and 11 that were case series. There did not seem to be any distinct differences in the complication rates between RFA and any of the other procedures for treatment of HCC. The local recurrence rate at 2 years showed a statistically significant benefit for RFA over percutaneous ethanol injection for treatment of HCC (6% vs 26%, 1 randomized, controlled trial). Local recurrence was reported to be more common after RFA than after laser-induced thermotherapy, and a higher recurrence rate and a shorter time to recurrence were associated with RFA compared with surgical resection (1 nonrandomized study each). For CLM, the postoperative complication rate ranged from 0% to 33% (3 case series). Survival after diagnosis was shorter in the CLM group treated with RFA than in the surgical resection group (1 nonrandomized study). The CLM local recurrence rate after RFA ranged from 4% to 55% (6 case series). CONCLUSIONS: Radiofrequency ablation may be more effective than other treatments in terms of less recurrence of HCC and may be as safe, although the evidence is scant. There was not enough evidence to determine the safety or efficacy of RFA for treatment of CLM.     

A Retrospective Comparison of Microwave Ablation vs. Radiofrequency Ablation for Colorectal Cancer Hepatic Metastases

Background

Microwave (MWA) and radiofrequency ablation (RFA) are the most commonly used techniques for ablating colorectal-liver metastases (CRLM). The technical and oncologic differences between these modalities are unclear.

Methods

We conducted a matched-cohort analysis of patients undergoing open MWA or RFA for CRLM at a tertiary-care center between 2008 and 2011; the primary endpoint was ablation-site recurrence. Tumors were matched by size, clinical-risk score, and arterial-intrahepatic or systemic chemotherapy use. Outcomes were compared using conditional logistic regression and stratified log-rank test.

Results

We matched 254 tumors (127 per group) from 134 patients. MWA and RFA groups were comparable by age, gender, median number of tumors treated, proximity to major vessels, and postoperative complication rates. Patients in the MWA group had lower ablation-site recurrence rates (6% vs. 20%; P < 0.01). Median follow-up, however, was significantly shorter in the MWA group (18 months [95% confidence interval 17–20] vs. 31 months [95% confidence interval 28–35]; P < 0.001). Kaplan–Meier estimates of ablation-site recurrence at 2 years were significantly lower for the lesions treated with MWA (7% vs. 18%, P: 0.01).

Conclusions

Ablation-site recurrences of CRLM were lower with MWA compared with RFA in this matched cohort analysis. Longer follow-up time in the MWA may increase the recurrence rate; however, actuarial local failure estimations demonstrated better local control with MWA.