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He K, Xiao Y, Tu S, Li Y, Wu Z, Liu L, Shen W, Bao S, He Y. Efficacy evaluation of postoperative adjuvant transarterial chemoembolization in preventing hepatocellular carcinoma recurrence within the Milan criteria: A multicenter propensity score matching analysis based on pathologic indicators. J Gastrointest Surg 2025; 29:101978. [PMID: 39900235 DOI: 10.1016/j.gassur.2025.101978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 01/13/2025] [Accepted: 01/25/2025] [Indexed: 02/05/2025]
Abstract
BACKGROUND Malignant biologic behaviors, such as microvascular invasion (MVI), satellite nodule formation, and poor differentiation, can appear in the postoperative pathology of early hepatocellular carcinoma (HCC), which often indicates an earlier stage of malignant evolution. This study aimed to evaluate tumor recurrence in patients with HCC meeting the Milan criteria who underwent postoperative adjuvant transarterial chemoembolization (PA-TACE) according to postoperative pathologic indices. METHODS A retrospective study was conducted on 790 patients with HCC meeting the Milan criteria who underwent hepatectomy across 4 medical centers, consisting of 366 patients treated with PA-TACE and 424 patients treated without PA-TACE. To reduce selection bias, propensity score matching (PSM) at a 1:1 ratio was applied, achieving balanced clinical characteristics between the 2 groups. RESULTS Patients who underwent PA-TACE did not experience severe adverse events or toxicity-related deaths. After PSM of each subgroup, it was found that patients with MVI (median time: 37 vs 17 months; P =.010), satellite nodules (median time: Not Applicable [NA] vs 14 months; P =.018), and Edmondson-Steiner grades III and IV (median time: NA vs 13 months; P =.004) who received PA-TACE had higher recurrence-free survival (RFS). However, patients who were MVI negative, satellite nodule negative, and Edmondson-Steiner grades I and II did not benefit from PA-TACE in terms of RFS (all P >.05). Patients who received PA-TACE were more likely to undergo liver transplantation, rehepatectomy, or local ablation after tumor recurrence, whereas those who did not receive PA-TACE were more likely to receive TACE, chemoradiotherapy, or immune-targeted therapy after tumor recurrence (all P<.05). CONCLUSION Postoperative pathologic indicators can guide the selection of PA-TACE for patients with HCC meeting the Milan criteria. Patients with MVI, satellite nodules, and Edmondson-Steiner grades III and IV are more suitable for receiving PA-TACE to improve RFS. PA-TACE may alter the recurrence pattern of tumors, rendering them more localized.
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Affiliation(s)
- Kun He
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital, Zhongshan Hospital Affiliated to Sun Yat-sen University, Zhongshan City, China
| | - Yongqiang Xiao
- Department of General Surgery, Ganjiang New Area People's Hospital, Ganjiang New Area Hospital of the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuju Tu
- Department of Hepatobiliary Surgery, Xiantao First People's Hospital, Xiantao City, China
| | - Youyao Li
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University and The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen City, China
| | - Zhao Wu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Liping Liu
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University and The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen City, China
| | - Wei Shen
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Shiyun Bao
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University and The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen City, China
| | - Yongzhu He
- Division of Hepatobiliary and Pancreas Surgery, Department of General Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University and The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen City, China.
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Sugimoto K, Imajo K, Kuroda H, Murohisa G, Shiozawa K, Sakamaki K, Wada T, Takeuchi H, Endo K, Abe T, Matsui T, Murakami T, Yoneda M, Nakajima A, Kokubu S, Itoi T. Microwave ablation vs. single-needle radiofrequency ablation for the treatment of HCC up to 4 cm: A randomized-controlled trial. JHEP Rep 2025; 7:101269. [PMID: 39802807 PMCID: PMC11719385 DOI: 10.1016/j.jhepr.2024.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 10/25/2024] [Accepted: 11/04/2024] [Indexed: 01/16/2025] Open
Abstract
Background & Aims Radiofrequency ablation (RFA) is the standard treatment for small hepatocellular carcinoma (HCC), specifically for tumors <3 cm in size and numbering fewer than three, excluding surgical candidates. Microwave ablation (MWA) is an innovative approach believed to have theoretical benefits over RFA; however, these advantages are yet to be empirically verified. Therefore, we evaluated and compared the effectiveness of MWA and RFA in managing HCC tumors up to 4 cm in size. Methods In this multicenter randomized controlled trial conducted across five centers in Japan, eligible participants had up to 4 tumors, each up to 4 cm in size, and were not considered for surgery. Patients were randomly assigned to undergo MWA or RFA. The primary outcome was the rate of local tumor progression (LTP), whereas secondary outcomes included overall survival (OS) and intra- and extrahepatic recurrence-free survival (RFS) at the end of the 2-year follow up. Results In total, 240 participants were screened from July 12, 2018, to December 7, 2021. Four participants were excluded: three did not meet inclusion criteria, and one died from an unknown cause during treatment. Consequently, 119 (130 lesions) and 117 (136 lesions) participants were treated with MWA and RFA, respectively. The proportion of lesions with LTP at the 2-year follow up was significantly lower in the MWA group (20 [16.4%] lesions) than in the RFA group (38 [30.4%] lesions) (risk ratio, 0.54; p = 0.007). OS and both intra- and extrahepatic RFS did not significantly differ between groups. Conclusions MWA is more effective than RFA in reducing local tumor progression for HCC tumors up to 4 cm. However, no differences were observed in OS and RFS. Impact and implications While some randomized control trials (RCTs) have compared the efficacy of microwave ablation (MWA) and radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC), the superiority of MWA over RFA remains unverified despite its theoretical benefit. This study is the first to demonstrate the utility of MWA over single-needle RFA for patients with HCC, with a significant difference between the two groups in the proportion of lesions with local tumor progression after a 2-year follow up. Moreover, the two techniques were safe, with only two severe complications reported in the entire study cohort. Given that an RCT differs slightly from daily clinical situations, practical and anatomical criteria for selecting the optimal technique on a lesion-by-lesion basis are required.
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Affiliation(s)
- Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kento Imajo
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan
| | - Hidekatsu Kuroda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Go Murohisa
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Kazue Shiozawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kentaro Sakamaki
- Faculty of Health Data Science, Juntendo University, Tokyo, Japan
| | - Takuya Wada
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hirohito Takeuchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kei Endo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Tamami Abe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takashi Matsui
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Takahiro Murakami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Masato Yoneda
- Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan
| | - Shigehiro Kokubu
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Rebillard E, De Abreu N, Buchard B, Muti L, Boulin M, Pereira B, Magnin B, Abergel A. AFP-DIAM Score to Predict Survival in Patients with Hepatocellular Carcinoma Before TACE: A French Multicenter Study. Dig Dis Sci 2024; 69:4259-4267. [PMID: 39322806 DOI: 10.1007/s10620-024-08639-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/05/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is recommended as a palliative treatment for patients of the B stage of the Barcelona Clinic Liver Cancer (BCLC) classification. AIMS To identify clinical, biological, and radiological predictors of survival in patients undergoing TACE and develop a pre-therapeutic prognostic score. METHODS 191 adult cirrhotic patients treated for HCC with TACE at the University Hospital (UH) of Clermont-Ferrand (France) from 2007-2017 were retrospectively included. We investigated the impact of baseline liver function, patient characteristics, and tumor burden on overall survival and developed a prognostic score. RESULTS Patients had a median age of 66 years and 126 patients were Child A. The AFP-DIAM score distinguishes two groups with a significant difference in survival time (median OS 28.3 months in patients with a score = 0 versus 17.7 months in patients with a score > 0). AFP-DIAM was validated on an external cohort, is well calibrated, and has the best discrimination capacity (C-index) as compared to NIACE, HAP, STATE, and SIX TO TWELVE. AFP-DIAM and SIX TO TWELVE are the more easy-to-use scores. When AFP-DIAM and the SIX TO TWELVE scores were tested in the same statistical model, results confirmed a better AFP-DIAM performance. CONCLUSIONS The AFP-DIAM is an easy-to-use score which allows to distinguish two groups with different prognosis before the first TACE session. Its use could provide further support to BCLC system to guide the therapeutic strategy of patients with HCC.
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Affiliation(s)
- Estelle Rebillard
- Médecine Digestive et Hépato-Biliaire, Centre Hospitalier Universitaire de Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France
| | - Nicolas De Abreu
- Radiologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Benjamin Buchard
- Médecine Digestive et Hépato-Biliaire, Centre Hospitalier Universitaire de Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France
| | - Léon Muti
- Médecine Digestive et Hépato-Biliaire, Centre Hospitalier Universitaire de Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France
| | - Mathieu Boulin
- Pharmacie, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et Innovation, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Benoit Magnin
- Radiologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Armand Abergel
- Médecine Digestive et Hépato-Biliaire, Centre Hospitalier Universitaire de Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France.
- Radiologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
- Pharmacie, Centre Hospitalier Universitaire de Dijon, Dijon, France.
- Direction de la Recherche Clinique et Innovation, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
- Université Clermont Auvergne, CHU, CNRS, Clermont Auvergne INP, Institut Pascal, 63000, Clermont-Ferrand, France.
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Wang F, Qin Y, Wang ZM, Yan CY, He Y, Liu D, Wen L, Zhang D. A Dynamic Online Nomogram Based on Gd-EOB-DTPA-Enhanced MRI and Inflammatory Biomarkers for Preoperative Prediction of Pathological Grade and Stratification in Solitary Hepatocellular Carcinoma: A Multicenter Study. Acad Radiol 2024; 31:4021-4033. [PMID: 38494348 DOI: 10.1016/j.acra.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/24/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is an inflammatory cancer. We aimed to explore whether preoperative inflammation biomarkers compared to the gadoxetic acid disodium (Gd-EOB-DTPA) enhanced MRI can add complementary value for predicting HCC pathological grade, and to develop a dynamic nomogram to predict solitary HCC pathological grade. METHODS 331 patients from the Institution A were divided chronologically into the training cohort (n = 231) and internal validation cohort (n = 100), and recurrence-free survival (RFS) was determined to follow up after surgery. 79 patients from the Institution B served as the external validation cohort. Overall, 410 patients were analyzed as the complete dataset cohort. Least absolute shrinkage and selection operator (LASSO) and multivariate Logistic regression were used to gradually filter features for model construction. The area under the receiver operating characteristic curve (AUC) and decision curve analysis were used to evaluate model's performance. RESULTS Five models of the inflammation, imaging, inflammation+AFP, inflammation+imaging and nomogram were developed. Adding inflammation to imaging model can improve the AUC in training cohort (from 0.802 to 0.869), internal validation cohort (0.827 to 0.870), external validation cohort (0.740 to 0.802) and complete dataset cohort (0.739 to 0.788), and obtain more net benefit. The nomogram had excellent performance for predicting high-grade HCC in four cohorts (AUCs: 0.882 vs. 0.869 vs. 0.829 vs. 0.806) with a good calibration, and accessed at https://predict-solitaryhccgrade.shinyapps.io/DynNomapp/. Additionally, the nomogram obtained an AUC of 0.863 (95% CI 0.797-0.913) for predicting high-grade HCC in the HCC≤ 3 cm. Kaplan-Meier survival curves demonstrated that the nomogram owned excellent stratification for HCC grade (P < 0.0001). CONCLUSION This easy-to-use dynamic online nomogram hold promise for use as a noninvasive tool in prediction HCC grade with high accuracy and robustness.
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Affiliation(s)
- Fei Wang
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Yuan Qin
- Department of Radiology, Chongqing University Three Gorges Hospital, No.165, Xincheng Road, Wanzhou District, Chongqing 404031, China
| | - Zheng Ming Wang
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Chun Yue Yan
- Department of gynaecology and obstetrics, Luzhou People's Hospital, No.316, Jiugu Avenue, Jiangyang District, Luzhou 646000, China
| | - Ying He
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Dan Liu
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Li Wen
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China
| | - Dong Zhang
- Department of Radiology, XinQiao Hospital of Army Medical University, No.83, Xinqiao Central Street, Shapingba District, Chongqing 400037, China.
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Hung HC, Lai Y, Lee JC, Wang YC, Cheng CH, Wu TH, Wu TJ, Chou HS, Chan KM, Lee WC, Lee CF. Optimal treatment strategy and prognostic analysis of salvage liver transplantation for patients with early hepatocellular carcinoma recurrence after hepatectomy. Hepatol Res 2024; 54:838-850. [PMID: 38451566 DOI: 10.1111/hepr.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 03/08/2024]
Abstract
AIM We aimed to investigate the prognostic factors for salvage liver transplant in patients with early hepatocellular carcinoma recurrence after hepatectomy. METHODS This retrospective analysis included 53 patients who underwent salvage living-donor liver transplantation between January 2007 and January 2018. There were 24 and 29 patients in the early (recurrence ≤24 months after primary liver resection) and the late recurrence groups, respectively. RESULTS In the multivariate Cox regression model, pre-liver transplant downstaging therapy, early recurrence (ER) after primary liver resection , and recurrence-to-liver-transplant ≥12 months were independent risks to predict recurrent hepatocellular carcinoma recurrence after salvage living-donor liver transplantation. Compared with the late recurrence group, the ER group showed lower disease-free survival rates (p < 0.001); however, the overall survival rates did not differ between the two groups (p = 0.355). The 1-, 3-, and 5-year disease-free survival rates were 83.3%, 70.6%, and 66.2%, and 96.0%, 91.6%, and 91.6% in the early and late recurrence groups, respectively. When stratified by recurrence-to-liver transplant time and pre-liver transplant downstaging therapy in the ER group, disease-free survival and overall survival rates were significantly different. CONCLUSION ER after primary liver resection with advanced tumor status and a longer period of recurrence-to-liver-transplant (≥12 months) have a negative impact on salvage liver transplant. Our findings provide novel recommendations for treatment strategies and eligibility for salvage liver transplant candidates.
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Affiliation(s)
- Hao-Chien Hung
- Division of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Yin Lai
- Division of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jin-Chiao Lee
- Division of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Chao Wang
- Division of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Hsien Cheng
- Division of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsung-Han Wu
- Division of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Ting-Jung Wu
- Division of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Hong-Shiue Chou
- Division of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Kun-Ming Chan
- Division of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Division of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Chen-Fang Lee
- Division of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Chang-Gung University College of Medicine, Taoyuan, Taiwan
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Xia F, Zhang Q, Xia G, Ndhlovu E, Chen X, Huang Z, Zhang B, Zhu P. A pathologic scoring system for predicting postoperative prognosis in patients with ruptured hepatocellular carcinoma. Asian J Surg 2024; 47:3015-3025. [PMID: 38326117 DOI: 10.1016/j.asjsur.2024.01.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/14/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND The accuracy of pathological factors to predict the prognosis of patients with ruptured hepatocellular carcinoma (rHCC) is unclear. We aimed to develop and validate a novel scoring system based on pathological factors to predict the postoperative survival of patients with rHCC. METHOD Patients with rHCC who underwent hepatectomy were recruited from three hospitals and allocated to the training (n = 221) and validation (n = 194) cohorts. A new scoring system, namely the MSE (microvascular invasion-satellite foci-Edmondson Steiner) score, was established based on three pathological factors using univariate and multivariate Cox proportional hazards regression analyses, including microvascular invasion, satellite foci, and differentiation grade. Finally, patients were stratified into three groups based on their risk of prognosis (low, intermediate, or high) according to their MSE score. We also constructed MSE score-based nomograms. The performance of the nomograms was assessed by receiver operating characteristic and calibration curve analyses and validated using the validation cohort. RESULTS Three pathological factors were significantly correlated with overall survival (OS) and recurrence-free survival (RFS), three of which were included in the MSE score. The score can clearly stratify rHCC patients after hepatectomy (P < 0.05). And we established nomograms based on the MSE score (MSE score, Barcelona Clinic Liver Cancer stage, and alpha-fetoprotein concentration) to predict postoperative OS and RFS in patients with rHCC. The nomograms showed good discrimination, with C-indices over 0.760 for OS and RFS at 1, 3, and 5 years, respectively. The calibration curve showed excellent nomogram calibration, which was also verified in the validation cohort. CONCLUSION The clinical MSE score were accurate in predicting OS and RFS in patients with rHCC with resectable lesions after hepatectomy.
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Affiliation(s)
- Feng Xia
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiao Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Zhongshan People's Hospital Affiliated to Guangdong Medical University, Guangdong, China
| | - Guobing Xia
- Department of Hepatobiliary and Pancreatic Surgery, Huangshi Central Hospital of Edong Healthcare Group, Hubei Polytechnic University.Huangshi, Hubei, China
| | - Elijah Ndhlovu
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoping Chen
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhiyuan Huang
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Bixiang Zhang
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Peng Zhu
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Bai T, Tang ZH, Wang XB, Chen J, Ye JZ, Lu SL, Wei M, Wu FX, Li LQ. Radiotherapy is superior to transarterial chemoembolization as adjuvant therapy after narrow-margin hepatectomy in patients with hepatocellular carcinoma: A single-center prospective randomized study. Langenbecks Arch Surg 2024; 409:97. [PMID: 38488934 DOI: 10.1007/s00423-024-03249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/01/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND This study was recruited to compare the efficacy and safety of radiotherapy (RT) and transarterial chemoembolization (TACE) as postoperative adjuvant therapy after narrow-margin hepatectomy in hepatocellular carcinoma (HCC) patients. METHODS This single-center prospective randomized study was conducted in the Cancer Hospital, Guang Xi Medical University, Nanning. A total of 72 patients who received treatment in this hospital between August 2017 and July 2019 were included and randomly allocated to TACE group (n = 48) and RT group (n = 24). Next, overall survival (OS) and progression-free survival (PFS) rates, recurrence patterns, financial burden, and safety were evaluated. RESULTS The difference between the RT and TACE groups was not significant in one-, three-, and five-year OS (87.5%, 79.0%, and 62.5% vs. 93.8%, 75.9%, and 63.4%, respectively, P = 0.071) and PFS rates (79.0%, 54.2%, and 22.6% vs. 75.0%, 47.9%, and 32.6%, respectively, P = 0.071). Compared to the TACE group, the RT group had significantly lower intrahepatic recurrence rate (20.8% vs. 52.1%, P = 0.011), higher extrahepatic recurrence rate (37.5% vs. 14.6%, P = 0.034), and no marginal and diffuse recurrences (0% vs. 16.7%, P < 0.05). The mean overall treatment cost was higher (¥62,550.59 ± 4397.27 vs. ¥40,732.56 ± 9210.54, P < 0.01), the hospital stay (15.1 ± 3.7 vs. 11.8 ± 4.1 days, P < 0.01) was longer, and the overall treatment stay (13.3 ± 5.3 vs. 41.29 ± 12.4 days, P < 0.01) was shorter in the TACE group than in the RT group. Besides, both groups did not exhibit significant differences in the frequency and severity of adverse events. CONCLUSION Both adjuvant TACE and RT can better the OS and PFS of patients with HCC. However, RT has a significantly better performance than TACE in terms of improving intrahepatic recurrence rate, treatment cost and hospital stay.
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Affiliation(s)
- Tao Bai
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Zhi-Hong Tang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Xiao-Bo Wang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Jie Chen
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Jia-Zhou Ye
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Shao-Long Lu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Meng Wei
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Fei-Xiang Wu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China.
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor(Guangxi Medical University), Nanning, Guangxi, China.
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China.
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Kim NR, Rho SY, Navarro J, An C, Han DH, Choi JS, Kim MJ, Choi GH. Additional nodules detected using EOB-MRI in patients with resectable single hepatocellular carcinoma: an implication for active treatment strategy. JOURNAL OF LIVER CANCER 2024; 24:92-101. [PMID: 38351675 PMCID: PMC10990668 DOI: 10.17998/jlc.2024.01.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND/AIM Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOBMRI) further enhances the identification of additional hepatic nodules compared with computed tomography (CT) alone; however, the optimal treatment for such additional nodules remains unclear. We investigated the long-term oncological effect of aggressive treatment strategies for additional lesions identified using EOB-MRI in patients with hepatocellular carcinoma (HCC). METHODS Data from 522 patients diagnosed with solitary HCC using CT between January 2008 and December 2012 were retrospectively reviewed. Propensity score-matched (PSM) analysis was used to compare the oncologic outcomes between patients with solitary HCC and those with additional nodules on EOB-MRI after aggressive treatment (resection or radiofrequency ablation [RFA]). RESULTS Among the 383 patients included, 59 had additional nodules identified using EOB-MRI. Compared with patients with solitary HCC, those with additional nodules on EOB-MRI had elevated total bilirubin, aspartate transaminase, and alanine transaminase; had a lower platelet count, higher MELD score, and highly associated with liver cirrhosis (P<0.05). Regarding long-term outcomes, 59 patients with solitary HCC and those with additional nodules after PSM were compared. Disease-free survival (DFS) and overall survival (OS) were comparable between the two groups (DFS, 60.4 vs. 44.3 months, P=0.071; OS, 82.8 vs. 84.8 months, P=0.986). CONCLUSION The aggressive treatment approach, either resection or RFA, for patients with additional nodules identified on EOBMRI was associated with long-term survival comparable with that for solitary HCC. However, further studies are required to confirm these findings.
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Affiliation(s)
- Na Reum Kim
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seoung Yoon Rho
- Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Jonathan Navarro
- Division of Surgical Oncology, Department of Surgery, Vicente Sotto Memorial Medical Center, Cebu, Philippines
| | - Chansik An
- Department of Radiology, CHA University Bundang Medical Center, Seongnam, Korea
| | - Dai Hoon Han
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sub Choi
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Jin Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Gi Hong Choi
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Tanaka T, Ide T, Itoh K, Kai K, Noshiro H. Laparoscopic liver resection for local recurrence after carbon‑ion radiotherapy for hepatocellular carcinoma: A case report. Oncol Lett 2024; 27:78. [PMID: 38192671 PMCID: PMC10773218 DOI: 10.3892/ol.2023.14211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024] Open
Abstract
Numerous potentially curative treatments have become available for patients with hepatocellular carcinoma (HCC) on the basis of the individual patient and tumor characteristics. Carbon-ion radiotherapy (C-ion RT) is a novel treatment option to reduce the physical burden in patients with HCC. However, the long-term outcomes and the clinical and pathological features of locoregional recurrence after initial C-ion RT are unclear. The present study reports the case of a patient who underwent a curative laparoscopic liver resection for the local recurrence of HCC after C-ion RT. A 73-year-old man was diagnosed with chronic hepatitis C and achieved a sustained virological response. During subsequent surveillance, a solitary HCC of 2.3 cm in diameter appeared in liver segment 7 (S7). While surgical resection was considered the best option, the patient chose C-ion RT as the initial HCC treatment. Although C-ion RT appeared to be successful for the primary lesion, enhanced computed tomography revealed that a hypervascular tumor had reappeared in the same area 16 months later. As HCC recurrence was suspected, several different examinations were performed. Computed tomography and magnetic resonance imaging showed that the recurrent tumor had irregular margins, and communication was suspected with the intrahepatic portal vein. A laparoscopic partial liver resection of S7 was planned. Histopathological examination of the excised specimen revealed proliferation of viable moderately to poorly differentiated HCC, with marked invasive growth and numerous portal vein infiltrations. To the best of our knowledge, this is the first report of surgery for locally recurrent HCC after C-ion RT. Oncological outcomes following C-ion RT for HCC remain unclear. Notably, there are cases of unusual recurrence with massive vascular invasion after C-ion RT. In the present case, the histological features were confirmed after C-ion RT for HCC. This case may raise concerns about the true efficacy of C-ion RT and warns against the easy choice of C-ion RT in spite of a resectable HCC.
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Affiliation(s)
- Tomokazu Tanaka
- Department of Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Takao Ide
- Department of Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Kotaro Itoh
- Department of Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Keita Kai
- Department of Pathology, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
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Long H, Zhou X, Zhang X, Ye J, Huang T, Cong L, Xie X, Huang G. 3D fusion is superior to 2D point-to-point contrast-enhanced US to evaluate the ablative margin after RFA for hepatocellular carcinoma. Eur Radiol 2024; 34:1247-1257. [PMID: 37572191 DOI: 10.1007/s00330-023-10023-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 06/04/2023] [Accepted: 06/12/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE To compare the efficiency of three-dimensional (3D) and two-dimensional (2D) contrast-enhanced ultrasound (CEUS)-derived techniques in evaluating the ablative margin (AM) after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). METHODS In total, 98 patients with 98 HCCs were enrolled. The 2D CEUS point-to-point imaging (2D CEUS-PI) was conducted by comparing the pre- and post-RFA 2D CEUS images manually, and the 3D CEUS fusion imaging (3D CEUS-FI) was conducted by fusing the pre- and post-RFA 3D CEUS images automatically. These two techniques were compared in distinguishing an adequate AM ≥ 5 mm. Risk factors for local tumor progression (LTP) after RFA were analyzed by the Kaplan-Meier method with log-rank test. RESULTS The mean registration time of 3D CEUS-FI and 2D CEUS-PI was 5.0 and 9.3 min, respectively (p < 0.0001). The kappa coefficient was 0.680 for agreement between 2D CEUS-PI and 3D CEUS-FI in the evaluation of AM (p < 0.0001). Tumors with AM < 5 mm by 2D CEUS-PI were all identified as AM < 5 mm by 3D CEUS-FI. Nonetheless, 16 (26%) tumors identified as AM ≥ 5 mm by 2D CEUS-PI were re-classified as AM < 5 mm by 3D CEUS-FI. During a median follow-up time of 31.2 months (range, 3.2-66.0 months), LTP was identified in 8 tumors. The estimated 1-/2-/3-year cumulative incidence of LTP was 4.4%, 8.1%, and 10.3%, respectively. Higher estimated cumulative incidence of LTP was identified in tumors with AM < 5 mm by 2D CEUS-PI (at 3-year, 27.2% vs 0%; p < 0.001), and by 3D CEUS-FI (at 3-year, 20.7% vs 0%; p = 0.004). CONCLUSION 3D CEUS-FI excelled in the evaluation of AM when compared with 2D CEUS-PI. With equivalent efficacy in the prediction of LTP, 3D CEUS-FI was superior to 2D CEUS-PI for its automatic and time-saving procedure. CLINICAL RELEVANCE STATEMENT 3D CEUS fusion imaging may serve as an effective tool in evaluating ablative margin and predicting local tumor progression after RFA in HCC. KEY POINTS • Both 2D and 3D CEUS-derived techniques could evaluate ablative margin (AM) after RFA for hepatocellular carcinoma. • 3D CEUS fusion imaging was more precise in the evaluation of AM compared to 2D CEUS point-to-point imaging, with advantages of its automatic and time-saving procedure. • An inadequate AM < 5 mm evaluated by CEUS-derived techniques was the only risk factor of LTP after RFA for hepatocellular carcinoma (p < 0.001 for 2D CEUS point-to-point imaging, and p = 0.004 for 3D CEUS fusion imaging).
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Affiliation(s)
- Haiyi Long
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhong Shan Road 2, Guangzhou, 510080, China
| | - Xiaoyu Zhou
- Department of Ultrasound, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Xiaoer Zhang
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhong Shan Road 2, Guangzhou, 510080, China
| | - Jieyi Ye
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Foshan First People's Hospital, 81 Lingnan North Road, Foshan, 528000, Guangdong, China
| | - Tongyi Huang
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhong Shan Road 2, Guangzhou, 510080, China
| | - Longfei Cong
- Medical Imaging System Division, Shenzhen Mindray Bio-Medical Electronics Co. Ltd, Shenzhen, China
| | - Xiaoyan Xie
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhong Shan Road 2, Guangzhou, 510080, China.
| | - Guangliang Huang
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhong Shan Road 2, Guangzhou, 510080, China.
- Department of Medical Ultrasonics, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-Sen University, Guangxi, China.
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Ferrell LD, Kakar S, Terracciano LM, Wee A. Tumours and Tumour-Like Lesions. MACSWEEN'S PATHOLOGY OF THE LIVER 2024:842-946. [DOI: 10.1016/b978-0-7020-8228-3.00013-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Wu C, Du X, Zhang Y, Zhu L, Chen J, Chen Y, Wei Y, Liu Y. Five machine learning-based radiomics models for preoperative prediction of histological grade in hepatocellular carcinoma. J Cancer Res Clin Oncol 2023; 149:15103-15112. [PMID: 37624395 DOI: 10.1007/s00432-023-05327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE To compare the efficacy of radiomics models via five machine learning algorithms in predicting the histological grade of hepatocellular carcinoma (HCC) before surgery and to develop the most stable model to classify high-risk HCC patients. METHODS Contrast-enhanced computed tomography (CECT) images of 175 HCC patients before surgery were analysed, and radiomics features were extracted from CECT images (including arterial and portal phases). Five machine learning models, including Bayes, random forest (RF), k-nearest neighbors (KNN), logistic regression (LR), and support vector machine (SVM), were applied to establish the model. The stability of the five models was weighed by the relative standard deviation (RSD), and the lowest RSD value was chosen as the most stable model to predict the histological grade of HCC. The area under the curve (AUC) and Delong tests were devoted to assessing the predictive efficacy of the models. RESULTS High-grade HCC accounted for 28.57% (50/175) of the 175 patients. The RSD value of AUC via the RF machine learning model was the lowest (2.3%), followed by Bayes (3.2%), KNN (6.4%), SVM (8.7%) and LR (31.3%). In addition, the RF model (AUC = 0.995) was better than the other four models in the training set (p < 0.05), as well as obtained good predictive performance in the test set (AUC = 0.837). CONCLUSION Among the five machine learning models, the RF-based radiomics model was the most stable and performed excellently in identifying high histological grade of HCC.
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Affiliation(s)
- Cuiyun Wu
- Cancer Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital),, Hangzhou Medical College, 158 Shangtang Road, Hangzhou, Zhejiang, China
| | - Xingyue Du
- Bengbu Medical College, Bengbu, Anhui, China
| | - Yang Zhang
- Cancer Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital),, Hangzhou Medical College, 158 Shangtang Road, Hangzhou, Zhejiang, China
| | - Li Zhu
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Junfa Chen
- Cancer Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital),, Hangzhou Medical College, 158 Shangtang Road, Hangzhou, Zhejiang, China
| | - Yuan Chen
- Cancer Center, Department of Pathology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yuguo Wei
- Precision Health Institution, General Electric Healthcare, Hangzhou, Zhejiang, China
| | - Yang Liu
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Gwon DI, Kim GH, Chu HH, Kim JH, Ko GY, Yoon HK. Local Recurrence following Radiological Complete Response in Patients Treated with Subsegmental Balloon-Occluded Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:4991. [PMID: 37894358 PMCID: PMC10605316 DOI: 10.3390/cancers15204991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
The aim of this study was to determine the local recurrence (LR) rate and identify factors associated with LR in patients who achieve a radiological complete response (CR) after undergoing balloon-occluded transcatheter arterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC). From November 2017 to September 2021, 60 patients (44 men, 16 women; mean age, 63.5 years; range, 39-82 years) with 72 HCCs (mean diameter, 31 mm; range, 10-50 mm) who underwent subsegmental B-TACE were included in this retrospective study. Radiological and clinical evaluation of oily subsegmentectomy, defined as radiological CR of the HCC and peritumoral parenchymal necrosis, was performed. The CR rate was 97.2% (70 of 72 HCCs) at first follow-up (mean, 41 days; range, 14-110 days). Overall, 13 HCCs (19.7%) demonstrated LR at a mean of 29.8 months (range, 3-63 months) and cumulative LR rates were 1.5% 14.2% 21%, 21%, and 21% at 6, 12, 24, 36, and 48 months, respectively. In 28 (38.9%) of 72 HCCs, oily subsegmentectomy was achieved, tumor markers were normalized, and LR did not occur. The oily subsegmentectomy-positive group had a significantly lower LR rate than the oily subsegmentectomy-negative group (p = 0.001). Age ≥65 years (adjusted hazard ration (HR), 0.124; 95% confidence interval (CI), 0.037-0.412; p < 0.001) and peripheral location (adjusted HR, 0.112; 95% CI, 0.046-0.272; p < 0.001) were independent predictive factors of LR. Subsegmental B-TACE can be an effective method with a high initial CR rate and low LR incidence. Oily subsegmentectomy can be considered as an index of successful treatment because it did not demonstrate any LR.
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Affiliation(s)
- Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea; (G.H.K.); (H.H.C.); (J.H.K.); (G.-Y.K.); (H.-K.Y.)
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Shimizu R, Ida Y, Kitano M. Predicting Outcome after Percutaneous Ablation for Early-Stage Hepatocellular Carcinoma Using Various Imaging Modalities. Diagnostics (Basel) 2023; 13:3058. [PMID: 37835800 PMCID: PMC10572637 DOI: 10.3390/diagnostics13193058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Percutaneous ablation is a low-invasive, repeatable, and curative local treatment that is now recommended for early-stage hepatocellular carcinoma (HCC) that is not suitable for surgical resection. Poorly differentiated HCC has high-grade malignancy potential. Microvascular invasion is frequently seen, even in tumors smaller than 3 cm in diameter, and prognosis is poor after percutaneous ablation. Biopsy has a high risk of complications such as bleeding and dissemination; therefore, it has limitations in determining HCC tumor malignancy prior to treatment. Advances in diagnostic imaging have enabled non-invasive diagnosis of tumor malignancy. We describe the usefulness of ultrasonography, computed tomography, magnetic resonance imaging, and 18F-fluorodeoxyglucose positron emission tomography for predicting outcome after percutaneous ablation for HCC.
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Affiliation(s)
- Ryo Shimizu
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
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15
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Jeon HJ, Eun HS, Kwon IS, Lee BS, Lee ES, Rou WS, Sung JK, Moon HS, Kang SH, Lee HS, Kim SH, Chun K, Kim SH. Outcomes of laparoscopic radiofrequency ablation versus percutaneous radiofrequency ablation for hepatocellular carcinoma. Surg Endosc 2023:10.1007/s00464-023-09956-1. [PMID: 36947227 DOI: 10.1007/s00464-023-09956-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 02/12/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Few studies have compared the therapeutic outcomes in patients with HCC who underwent laparoscopic radiofrequency ablation (LRFA) versus percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma (HCC). Therefore, this study compared the recurrence and survival outcomes of the two RFA methods in patients with HCC. METHODS Recurrence and overall survival outcomes were evaluated in 307 patients who underwent LRFA (n = 151) or PRFA (n = 156) as a treatment method for de novo HCC. Inverse probability of treatment weighting (IPTW) analysis was performed to reduce the impact of treatment selection bias. RESULTS There were no significant differences in major baseline characteristics between the LRFA and PRFA groups. However, the proportion of cirrhotic patients was higher in the LRFA group, whereas the LRFA group had more tumors and a more advanced tumor-node-metastasis stage. Moreover, the mean tumor size was significantly larger in the LRFA group than in the PRFA group. In a multivariate analysis, serum albumin level, more than three tumors, and the RFA method were identified as significant predictors of recurrence-free survival. Moreover, for the overall survival of HCC patients, serum albumin levels, days of hospital stay during RFA, and the RFA method were independent predictors. In the IPTW-adjusted analysis, the LRFA group showed significantly higher recurrence-free survival and overall survival. CONCLUSIONS Our study revealed that compared with PRFA, LRFA was associated with longer recurrence-free survival and favorable overall survival in patients with HCC. Therefore, LRFA should be considered the primary therapy in patients with HCC eligible for RFA.
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Affiliation(s)
- Hong Jae Jeon
- Department of Gastroenterology, Chungnam National University Sejong Hospital, 20, Bodeum 7-ro, Sejong-si, 30099, Republic of Korea
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Hyuk Soo Eun
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Byung Seok Lee
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Eaum Seok Lee
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Woo Sun Rou
- Department of Gastroenterology, Chungnam National University Sejong Hospital, 20, Bodeum 7-ro, Sejong-si, 30099, Republic of Korea
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Jae Kyu Sung
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Hee Seok Moon
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Sun Hyung Kang
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Hyun Seok Lee
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Seok-Hwan Kim
- Department of Surgery, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Surgery, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Kwangsik Chun
- Department of Surgery, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
- Department of Surgery, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
| | - Seok Hyun Kim
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
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Hu X, Li C, Wang Q, Wu X, Chen Z, Xia F, Cai P, Zhang L, Fan Y, Ma K. Development and External Validation of a Radiomics Model Derived from Preoperative Gadoxetic Acid-Enhanced MRI for Predicting Histopathologic Grade of Hepatocellular Carcinoma. Diagnostics (Basel) 2023; 13:diagnostics13030413. [PMID: 36766518 PMCID: PMC9914153 DOI: 10.3390/diagnostics13030413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Histopathologic grade of hepatocellular carcinoma (HCC) is an important predictor of early recurrence and poor prognosis after curative treatments. This study aims to develop a radiomics model based on preoperative gadoxetic acid-enhanced MRI for predicting HCC histopathologic grade and to validate its predictive performance in an independent external cohort. Clinical and imaging data of 403 consecutive HCC patients were retrospectively collected from two hospitals (265 and 138, respectively). Patients were categorized into poorly differentiated HCC and non-poorly differentiated HCC groups. A total of 851 radiomics features were extracted from the segmented tumor at the hepatobiliary phase images. Three classifiers, logistic regression (LR), support vector machine, and Adaboost were adopted for modeling. The areas under the curve of the three models were 0.70, 0.67, and 0.61, respectively, in the external test cohort. Alpha-fetoprotein (AFP) was the only significant clinicopathological variable associated with HCC grading (odds ratio: 2.75). When combining AFP, the LR+AFP model showed the best performance, with an AUC of 0.71 (95%CI: 0.59-0.82) in the external test cohort. A radiomics model based on gadoxetic acid-enhanced MRI was constructed in this study to discriminate HCC with different histopathologic grades. Its good performance indicates a promise in the preoperative prediction of HCC differentiation levels.
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Affiliation(s)
- Xiaojun Hu
- The Department of General Surgery & Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Department of Hepatobiliary Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou 510920, China
| | - Changfeng Li
- Institution of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Qiang Wang
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14152 Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital Huddinge, 14186 Stockholm, Sweden
| | - Xueyun Wu
- The Department of General Surgery & Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Zhiyu Chen
- Institution of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Feng Xia
- Institution of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Ping Cai
- Department of Radiology, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Leida Zhang
- Institution of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Yingfang Fan
- The Department of General Surgery & Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Correspondence: (Y.F.); (K.M.); Tel.: +86-20-62782567 (Y.F.); +86-15-213-249-505 (K.M.)
| | - Kuansheng Ma
- Institution of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing 400038, China
- Correspondence: (Y.F.); (K.M.); Tel.: +86-20-62782567 (Y.F.); +86-15-213-249-505 (K.M.)
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Du F, Zhang L, Zhang Y, Fan H, Ren L. Efficacy and safety of no-touch radiofrequency ablation for small hepatocellular carcinoma-a systematic review and single-arm meta-analysis. Clin Res Hepatol Gastroenterol 2023; 47:102069. [PMID: 36513251 DOI: 10.1016/j.clinre.2022.102069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to report the efficacy and safety of no-touch radiofrequency ablation (NT-RFA) in the treatment of small hepatocellular carcinoma (HCC). METHODS We systematically searched for eligible studies in PubMed, Embase and Cochrane library until June 1, 2022. Random effect model was applied to synthesize the pooled proportions of local tumor progression-free survival (LTP), recurrence-free survival (RFS) and overall survival (OS) respectively, as well as adverse events, for small HCC treated by NT-RFA. RESULTS Of the 10 included studies, 3 of them reported local tumor recurrence. One reported local tumor recurrence at 19 months (range, 12-24), and 2 studies had no tumor recurrence with 24-months of follow-up. The 1- and 2-year LTP pooled proportions were 99.3% (95%CI, 97.5-100) and 97.8% (95%CI, 94.6-99.6) respectively, and two studies reported a 3-year LTP rate of 96.4% (204/212, 36/37). The 1-yearRFS rates was 91.3% (95%CI, 84.1-98.4), 2-year was 86.4% (95%CI, 75.3-97.5). The 1-, 2- and 3- year OS rates were 92.4% (95%CI, 82.8-92.7), 84.1% (95%CI, 74.7-93.6) and 81.8% (116/181, 33/36) respectively, and only one study reported a 5-year OS rate of 47.0% (85/181). The ablative success rate of the HCC nodules was 96.6% (95%CI, 91.3-99.5) and the proportions of mild and severe adverse events following ablation were 18.3% (95%CI, 8.1-41.6) and 5.0%, respectively. CONCLUSION NT-RFA provides safely very high rate of sustained local control for the treatment of HCC up to 5 cm.
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Affiliation(s)
- Fei Du
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China
| | - Lingkai Zhang
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China; Graduate School of Qinghai University, Xining 810000, China
| | - Yongxuan Zhang
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China; Graduate School of Qinghai University, Xining 810000, China
| | - Haining Fan
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China
| | - Li Ren
- Department of Hepatobiliary-Pancreatic surgery, Affiliated Hospital of Qinghai University, Xining 810000, China.
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18
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Han YE, Cho Y, Kim MJ, Park BJ, Sung DJ, Han NY, Sim KC, Park YS, Park BN. Hepatocellular carcinoma pathologic grade prediction using radiomics and machine learning models of gadoxetic acid-enhanced MRI: a two-center study. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:244-256. [PMID: 36131163 DOI: 10.1007/s00261-022-03679-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To develop a radiomics-based hepatocellular carcinoma (HCC) grade classifier model based on data from gadoxetic acid-enhanced MRI. METHODS This retrospective study included 137 patients who underwent hepatectomy for a single HCC and gadoxetic acid-enhanced MRI within 60 days before surgery. HCC grade was categorized as low or high (modified Edmondson-Steiner grade I-II vs. III-IV). We used the hepatobiliary phase (HBP), portal venous phase, T2-weighted image(T2WI), and T1-weighted image(T1WI). From the volume of interest in HCC, 833 radiomic features were extracted. Radiomic and clinical features were selected using a random forest regressor, and the classification model was trained and validated using a random forest classifier and tenfold stratified cross-validation. Eight models were developed using the radiomic features alone or by combining the radiomic and clinical features. Models were validated with internal enrolled data (internal validation) and a dataset (28 patients) at a separate institution (external validation). The area under the curve (AUC) of the validation results was compared using the DeLong test. RESULTS In internal and external validation, the HBP radiomics-only model showed the highest AUC (internal 0.80 ± 0.09, external 0.70 ± 0.09). In external validation, all models showed lower AUC than those for internal validation, while the T2WI and T1WI models failed to predict the HCC grade (AUC 0.30-0.58) in contrast to the internal validation results (AUC 0.67-0.78). CONCLUSION The radiomics-based machine learning model from gadoxetic acid-enhanced liver MRI could distinguish between low- and high-grade HCCs. The radiomics-only HBP model showed the best AUC among the eight models, good performance in internal validation, and fair performance in external validation.
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Affiliation(s)
- Yeo Eun Han
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Yongwon Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.,AI Center, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Min Ju Kim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Beom Jin Park
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Deuk Jae Sung
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Na Yeon Han
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Ki Choon Sim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Bit Na Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
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Xu L, Dai F, Wang P, Li L, Zhang M, Xu M. Novel postoperative nomograms for predicting individual prognoses of hepatitis B-related hepatocellular carcinoma with cirrhosis. BMC Surg 2022; 22:339. [PMID: 36100893 PMCID: PMC9472365 DOI: 10.1186/s12893-022-01789-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Liver cirrhosis is a well-known risk factor for carcinogenesis of hepatocellular carcinoma (HCC). The aim of the present study was to construct individual prognostic models for HCC with cirrhosis.
Methods
The clinical differences between HCC patients with and without cirrhosis were compared using a large cohort of 1003 cases. The patients with cirrhosis were randomly divided into a training cohort and a validation cohort in a ratio of 2:1. Univariate and multivariate analyses were performed to reveal the independent risk factors for recurrence-free survival (RFS) and overall survival (OS) in HCC patients with cirrhosis. These factors were subsequently used to construct nomograms.
Results
Multivariate analyses revealed that five clinical variables (hepatitis B e antigen (HBeAg) positivity, alpha-fetoprotein (AFP) level, tumour diameter, microvascular invasion (MVI), and satellite lesions) and seven variables (HBeAg positivity, AFP level, tumour diameter, MVI, satellite lesions, gamma-glutamyl transpeptidase level, and histological differentiation) were significantly associated with RFS and OS, respectively. The C-indices of the nomograms for RFS and OS were 0.739 (P < 0.001) and 0.789 (P < 0.001), respectively, in the training cohort, and 0.752 (P < 0.001) and 0.813 (P < 0.001), respectively, in the validation cohort. The C-indices of the nomograms were significantly higher than those of conventional staging systems (P < 0.001). The calibration plots showed optimal consistence between the nomogram-predicted and observed prognoses.
Conclusions
The nomograms developed in the present study showed good performance in predicting the prognoses of HCC patients with hepatitis B virus-associated cirrhosis.
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20
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Li C, Ouyang W, Yang T. The association of microvascular invasion with satellite nodule, tumor multiplicity, tumor encapsulation and resection margin of hepatocellular carcinoma. J Hepatol 2022; 77:890-891. [PMID: 35421425 DOI: 10.1016/j.jhep.2022.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Chao Li
- Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China; Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China; Graduate School, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Wei Ouyang
- Graduate School, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Tian Yang
- Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China; Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China; Eastern Hepatobiliary Clinical Research Institute, Third Affiliated Hospital of Navy Medical University, Shanghai, China.
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21
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Effect of the normal liver mean dose on intrahepatic recurrence in patients with hepatocellular carcinoma after receiving liver stereotactic body radiation therapy. Transl Oncol 2022; 25:101492. [PMID: 35944415 PMCID: PMC9365976 DOI: 10.1016/j.tranon.2022.101492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022] Open
Abstract
The normal liver mean dosage is rarely studied in its association with metastasis related survival. Higher normal liver mean dosage was related to a better intra-hepatic progression free survival. No associations were found between normal liver mean dose with Local control rate, Overall Survival, Distant Metastasis Free Survival, Progression Free Survival. Background and purpose This study aims to evaluate whether dosimetric parameters affect the intrahepatic out-field recurrence or distant metastasis-free survival following the stereotactic body radiation therapy (SBRT) in patients with hepatocellular carcinoma (HCC). Materials and methods A total of 76 patients with HCC who were treated with SBRT from January 2015 to May 2020 were included in this retrospective study. The main clinical endpoints considered were intrahepatic out-field free survival (OutFFS) and distant metastasis-free survival (DMFS). The target parameters and the liver were documented including tumor diameters, gross tumor volume (GTV), Liver minus GTV volume (LGV), and Liver minus GTV mean dose (LGD). Multivariable Cox regression with forward stepwise selection was performed to identify independent risk factors for OutFFS and DMFS. Maximally selected rank statistics were used to determine the most informative cut-off value for age and LGD. Results The median follow-up was 28.2 months (range, 7.7–74.5 months). LGD higher than 12.54 Gy [HR, 0.861(0.747–0.993); p = 0.040] and age greater than 67-year-old [HR, 0.966(0.937–0.997); p = 0.030] are two independent predictors of OutFFS, previous TACE treatment [HR, 0.117(0.015–0.891); p = 0.038] was an independent predictor of DMFS. Conclusions The results of this study suggested that the higher the dose received by the normal liver (greater than 12.54 Gy) the better the intrahepatic out-field recurrence-free survival (RFS) rate. Further study is warranted to confirm and to better understand this phenomenon.
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22
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Cheng CH, Lai Y, Hung HC, Lee JC, Wang YC, Wu TH, Lee CF, Wu TJ, Chou HS, Chan KM, Lee WC. Recurrence Patterns After Hepatectomy With Very Narrow Resection Margins for Hepatocellular Carcinoma. Front Surg 2022; 9:926728. [PMID: 35910466 PMCID: PMC9330627 DOI: 10.3389/fsurg.2022.926728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background The extent of hepatic resection In HCC depends on the remnant liver reserve or the proximity of the tumor to major vessels. In this study, we evaluated the effects of very close resection margins on postoperative recurrence. Methods Consecutive LR for HCC between 2003 and 2009 were studied. Patients were divided into groups with very narrow (≤1 mm) or wider (>1 mm) resection margins. Propensity score matching (PSM) was used to balance demographic, surgical, and pathological factors. Results 983 patients were included in the study. After PSM, 173 patients were analyzed in each group. 5-year tumor recurrence and survival rates were comparable. Most recurrences were multiple intrahepatic. Section margin recurrences were similar in both groups. By multivariate analysis, tumor size >5 cm was associated with a very narrow resection margin, whereas low platelet count and tumor macrovascular invasion were significant factors related to tumor recurrence. Conclusions Patients with very narrow surgical margins showed outcomes comparable to those with wider surgical margins. Most recurrences were multiple intrahepatic and associated with the degree of portal hypertension and adverse tumor biology. Although wide surgical margins should be aimed whenever possible, a narrow tumor-free margin resection still represents an effective therapeutic strategy.
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Affiliation(s)
- Chih-Hsien Cheng
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yin Lai
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hao-Chien Hung
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jin-Chiao Lee
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Chao Wang
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsung-Han Wu
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chen-Fang Lee
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ting-Jung Wu
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hong-Shiue Chou
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kun-Ming Chan
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Correspondence: Wei-Chen Lee
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23
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Zhang S, Zhong BY, Zhang L, Wang WS, Ni CF. Transarterial chemoembolization failure/refractoriness: A scientific concept or pseudo-proposition. World J Gastrointest Surg 2022; 14:528-537. [PMID: 35979416 PMCID: PMC9258238 DOI: 10.4240/wjgs.v14.i6.528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/08/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
Multi-session transarterial chemoembolization (TACE) is usually needed for the treatment of intermediate-stage hepatocellular carcinoma (HCC), but it may not always have a positive influence on prognosis due to high heterogeneity of HCC. To avoid ineffective repeated TACE, the concept of TACE failure/refractoriness has been proposed by several organizations and is being addressed using tyrosine kinase inhibitors. The concept of TACE failure/refractoriness is controversial due to ambiguous definitions and low evidence-based data. To date, only a few studies have examined the rationality concerning the definition of TACE failure/refractoriness, although the concept has been introduced and applied in many TACE-related clinical trials. This review focuses on some of the issues related to different versions of TACE failure/refractoriness, the rationality of related definitions, and the feasibility of continuing TACE after so-called failure/refractoriness based on published evidence. A suggestion to re-define TAEC failure/refractoriness is also put forward.
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Affiliation(s)
- Shen Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Bin-Yan Zhong
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Lei Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Wan-Sheng Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Cai-Fang Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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24
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Fang T, Long G, Mi X, Su W, Mo L, Zhou L. Splenic Volume, an Easy-To-Use Predictor of HCC Late Recurrence for HCC Patients After Hepatectomy. Front Oncol 2022; 12:876668. [PMID: 35686100 PMCID: PMC9172205 DOI: 10.3389/fonc.2022.876668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/25/2022] [Indexed: 01/27/2023] Open
Abstract
Purpose The high recurrence rate of hepatocellular carcinoma (HCC) has a poor impact on the quality of life and survival time of patients. Especially for late recurrence, poor data are available in analysis. We aim to evaluate whether the splenic volume (SV) measured from preoperative CT images could predict late recurrence in HCC patients after hepatectomy. Patients and Methods A cohort of 300 HCC patients hospitalized at Xiangya Hospital of Central South University between January 2015 and June 2018 was retrospectively analyzed. The SV was calculated by using automated volumetry software from preoperative CT images. A total of 300 HCC patients were separated into the early recurrence cohort (n=167), the late recurrence cohort (n=39), and the no recurrence cohort (n=94) according to whether there is a recurrence and the recurrence time. Univariate and multivariate Cox analyses were performed to identify the independent risk factors of both early and late recurrence. Results AFP, Microvascular invasion (MVI), satellitosis, and BCLC staging were independent risk factors of HCC early recurrence. Splenic volume (HR=1.003, 95%CI:1.001-1.005, P<0.001) was the only predictor of HCC late recurrence. Based on X-tile software, 133 non-early recurrence patients were divided into two groups according to SV: low SV (<165ml, n=45) and high SV (≥165ml, n= 88). The low SV group had a significantly better RFS compared with the high SV group (P=0.015). Nomogram was built on the base of SV to get the probability of 3-year RFS, 4-year RFS, and 5-year RFS. Conclusion In our study, we drew a conclusion that splenic volume was the only predictor of HCC late recurrence because of its association with portal hypertension and liver cirrhosis. High splenic volume often indicated a worse recurrence.
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Affiliation(s)
- Tongdi Fang
- Department of General Surgery, The Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Guo Long
- Department of General Surgery, The Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xingyu Mi
- Department of General Surgery, The Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wenxin Su
- Department of General Surgery, The Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lei Mo
- Department of General Surgery, The Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ledu Zhou
- Department of General Surgery, The Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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25
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Hendriks P, Rietbergen DDD, van Erkel AR, Coenraad MJ, Arntz MJ, Bennink RJ, Braat AE, Crobach ASLP, van Delden OM, van der Hulle T, Klümpen HJ, van der Meer RW, Nijsen JFW, van Rijswijk CSP, Roosen J, Ruijter BN, Smit F, Stam MK, Takkenberg RB, Tushuizen ME, van Velden FHP, de Geus-Oei LF, Burgmans MC. Study Protocol: Adjuvant Holmium-166 Radioembolization After Radiofrequency Ablation in Early-Stage Hepatocellular Carcinoma Patients-A Dose-Finding Study (HORA EST HCC Trial). Cardiovasc Intervent Radiol 2022; 45:1057-1063. [PMID: 35618860 PMCID: PMC9307549 DOI: 10.1007/s00270-022-03162-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/23/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE To investigate the biodistribution of holmium-166 microspheres (166Ho-MS) when administered after radiofrequency ablation (RFA) of early-stage hepatocellular carcinoma (HCC). The aim is to establish a perfused liver administration dose that results in a tumoricidal dose of holmium-166 on the hyperaemic zone around the ablation necrosis (i.e. target volume). MATERIALS AND METHODS This is a multicentre, prospective, dose-escalation study in HCC patients with a solitary lesion 2-5 cm, or a maximum of 3 lesions of ≤ 3 cm each. The day after RFA patients undergo angiography and cone-beam CT (CBCT) with (super)selective infusion of technetium-99 m labelled microalbumin aggregates (99mTc-MAA). The perfused liver volume is segmented from the CBCT and 166Ho-MS is administered to this treatment volume 5-10 days later. The dose of holmium-166 is escalated in a maximum of 3 patient cohorts (60 Gy, 90 Gy and 120 Gy) until the endpoint is reached. SPECT/CT is used to determine the biodistribution of holmium-166. The endpoint is met when a dose of ≥ 120 Gy has been reached on the target volume in 9/10 patients of a cohort. Secondary endpoints include toxicity, local recurrence, disease-free and overall survival. DISCUSSION This study aims to find the optimal administration dose of adjuvant radioembolization with 166Ho-MS after RFA. Ultimately, the goal is to bring the efficacy of thermal ablation up to par with surgical resection for early-stage HCC patients. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03437382.
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Affiliation(s)
- Pim Hendriks
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Daphne D D Rietbergen
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Arian R van Erkel
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark J Arntz
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roel J Bennink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Andries E Braat
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - A Stijn L P Crobach
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Otto M van Delden
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom van der Hulle
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Rutger W van der Meer
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - J Frank W Nijsen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carla S P van Rijswijk
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Joey Roosen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastian N Ruijter
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits Smit
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Mette K Stam
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Floris H P van Velden
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Mark C Burgmans
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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Guo Y, Ren Y, Dong X, Kan X, Zheng C. An Overview of Hepatocellular Carcinoma After Insufficient Radiofrequency Ablation. J Hepatocell Carcinoma 2022; 9:343-355. [PMID: 35502292 PMCID: PMC9056053 DOI: 10.2147/jhc.s358539] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/04/2022] [Indexed: 12/13/2022] Open
Abstract
Radiofrequency ablation (RFA) is a commonly used treatment for hepatocellular carcinoma (HCC), however, various complex conditions in clinical practice may lead to insufficient radiofrequency ablation (IRFA), allowing residual HCC to survive. In clinical practice and laboratory models, IRFA plays an important role in rapid tumor progression. Therefore, targeting the residual HCC and avoiding IRFA were worthwhile methods. A deeper understanding of IRFA is required; IRFA contributes to the improvement of proliferative activity, migration rates, and invasive capacity, and this may be due to the involvement of multiple complex processes or proteins, including epithelial mesenchymal transitions (EMTs), cancer stem cells (CSCs), autophagy, heat shock proteins (HSPs), changes of non-tumor cells and extracellular matrix, altered immune microenvironment, hypoxia-inducible factors (HIFs), growth factors, epigenetic alterations, and metabolic reprogramming. We focus on the processes of the above mechanisms and possible therapeutic approach, with a review of the literature. Additionally, we recapitulated the construction methods of various experimental models of IRFA (in vivo and in vitro).
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Affiliation(s)
- Yusheng Guo
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, People’s Republic of China
| | - Yanqiao Ren
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, People’s Republic of China
| | - Xiangjun Dong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, People’s Republic of China
| | - Xuefeng Kan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, People’s Republic of China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, People’s Republic of China
- Correspondence: Chuansheng Zheng, Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China, Tel/Fax +86-27-85726290, Email
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Li X, Han X, Li L, Su C, Sun J, Zhan C, Feng D, Cheng W. Dynamic Contrast-Enhanced Ultrasonography with Sonazoid for Diagnosis of Microvascular Invasion in Hepatocellular Carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:575-581. [PMID: 34933756 DOI: 10.1016/j.ultrasmedbio.2021.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 06/14/2023]
Abstract
The aim of the present study was to investigate the imaging features observed in pre-operative Sonazoid contrast-enhanced ultrasound (SZ-CEUS) and the correlations with the presence of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients. In this single-center retrospective study, 31 patients with surgically and histopathologically confirmed HCC lesions were included. Patients were classified according to the presence of MVI into the MVI-positive group (n = 15) and MVI-negative group (n = 16). The CEUS examinations were performed within 2 or 3 d before surgery. Features, including tumor necrosis and ultrasound contrast agent (UCA) distribution characteristics in the arterial phase (AP), tumor types (single nodular [SN] or non-single nodular [non-SN]) in the post-vascular phase (PVP), wash-in time, wash-in slope, time to peak (TTP) and peak intensity (PI), were assessed. Univariate analysis revealed statistically significant differences between the two groups with respect to tumor necrosis (p = 0.002), inhomogeneous distribution of contrast agent in the AP (p = 0.001) and non-SN type in the PVP (p < 0.001). There was no significant difference in the quantitative parameters. Multivariate analysis revealed that non-SN type in the PVP was a significant independent risk factor for MVI of HCC (odds ratio = 30.51, 95% confidence interval [CI]: 2.335-398.731, p = 0.009). The area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 0.873, 93.3%, 81.3%, 82.4% and 92.9%, respectively. Thus, SZ-CEUS can provide useful information for the diagnosis of MVI in HCC.
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Affiliation(s)
- Xintong Li
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Xue Han
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Lei Li
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Chang Su
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Jianmin Sun
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Chao Zhan
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Di Feng
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Wen Cheng
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China.
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Wu YL, Zhai Y, Li M, Cai JQ, Ma P, Wang LM, Wu XH, Wang XD, Wu F, Zeng Q, Chen B, Li YX, Wu JX, Feng Q. Long-Term Outcome of Centrally Located Hepatocellular Carcinomas Treated by Radical Resection Combined With Intraoperative Electron Radiotherapy (IOERT). Front Oncol 2022; 12:773301. [PMID: 35223467 PMCID: PMC8874208 DOI: 10.3389/fonc.2022.773301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/07/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose To explore the feasibility and safety of centrally located hepatocellular carcinoma (CL-HCC) treated by narrow-margin resection combined with intraoperative electron radiotherapy (IOERT). Methods and Materials From November 2009 to November 2016, 37 consecutive patients were treated with IOERT as adjuvant treatment during narrow-margin resection for CL-HCC. Long-term outcomes, adverse events for surgery, and acute and chronic toxicities were analyzed. Results The median follow-up was 57.82 months (range, 3.75-111.41 months). A total dose of 15 Gy (range 12 to 17Gy) (prescribed at the 90% isodose) was delivered with a 0.9cm (range 0.8-1.2 cm) median treatment depth targeting the narrow-margin. The 1-year, 3-year and 5-year OS rates were 91.39%, 88.34% and 88.34%, respectively. The 1-year, 3-year and 5-year DFS rates were 80.81%, 68.59% and 54.17%, respectively. In the univariate analysis, none of the treatment characteristics were predictive of overall survival. Fifteen (40.5%) patients suffered from a recurrence event. No patient had marginal recurrence. The 1-year, 3-year and 5-year intrahepatic recurrence rates were 19.75%, 25.92% and 39.58%, respectively. The 1-year, 3-year and 5-year extrahepatic recurrence rates were 2.7%, 5.95% and 9.87%, respectively. There was no 30-day surgical-related death. Three patients had grade 4, and 28 patients had grade 3 alanine aminotransferase (ALT) levels, and seven patients had grade 4, and 30 patients had grade 3 aspartate transaminase (AST) levels. All of them returned to normal within four months. There was no acute radiation-induced liver injury during follow-up. There were no acute or chronic toxicities associated with IOERT. Conclusion IOERT for narrow-margin CL-HCC may achieve good long-term survival outcomes, without significantly increasing acute and chronic toxicities. An IOERT dose of 15Gy may be the safest and most feasible. IOERT might be considered as an adjuvant therapy for CL-HCC patients with a narrow-margin.
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Affiliation(s)
- Yan-Ling Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Yirui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Minghui Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Jian-Qiang Cai
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Pan Ma
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Li-Ming Wang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Xiu-Hong Wu
- Department of Operating Room, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Xiao-Dan Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Fan Wu
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Qiang Zeng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Jian-Xiong Wu
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
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Mao Y, Wang J, Zhu Y, Chen J, Mao L, Kong W, Qiu Y, Wu X, Guan Y, He J. Gd-EOB-DTPA-enhanced MRI radiomic features for predicting histological grade of hepatocellular carcinoma. Hepatobiliary Surg Nutr 2022; 11:13-24. [PMID: 35284527 DOI: 10.21037/hbsn-19-870] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/11/2020] [Indexed: 01/03/2023]
Abstract
Background Prediction models for the histological grade of hepatocellular carcinoma (HCC) remain unsatisfactory. The purpose of this study is to develop preoperative models to predict histological grade of HCC based on gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) radiomics. And to compare the performance between artificial neural network (ANN) and logistic regression model. Methods A total of 122 HCCs were randomly assigned to the training set (n=85) and the test set (n=37). There were 242 radiomic features extracted from volumetric of interest (VOI) of arterial and hepatobiliary phases images. The radiomic features and clinical parameters [gender, age, alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), alanine aminotransferase (ALT), aspartate transaminase (AST)] were selected by permutation test and decision tree. ANN of arterial phase (ANN-AP), logistic regression model of arterial phase (LR-AP), ANN of hepatobiliary phase (ANN-HBP), logistic regression mode of hepatobiliary phase (LR-HBP), ANN of combined arterial and hepatobiliary phases (ANN-AP + HBP), and logistic regression model of combined arterial and hepatobiliary phases (LR-AP + HBP) were built to predict HCC histological grade. Those prediction models were assessed and compared. Results ANN-AP and LR-AP were composed by AST and radiomic features based on arterial phase. ANN-HBP and LR-HBP were composed by AFP and radiomic features based on hepatobiliary phase. ANN-AP + HBP and LR-AP + HBP were composed by AST and radiomic features based on arterial and hepatobiliary phases. The prediction models could distinguish between high-grade tumors [Edmondson-Steiner (E-S) grade III and IV] and low-grade tumors (E-S grade I and II) in both training set and test set. In the test set, the AUCs of ANN-AP, LR-AP, ANN-HBP, LR-HBP, ANN-AP + HBP and LR-AP + HBP were 0.889, 0.777, 0.941, 0.819, 0.944 and 0.792 respectively. The ANN-HBP was significantly superior to LR-HBP (P=0.001). And the ANN-AP + HBP was significantly superior to LR-AP + HBP (P=0.007). Conclusions Prediction models consisting of clinical parameters and Gd-EOB-DTPA-enhanced MRI radiomic features (based on arterial phase, hepatobiliary phase, and combined arterial and hepatobiliary phases) could distinguish between high-grade HCCs and low-grade HCCs. And the ANN was superior to logistic regression model in predicting histological grade of HCC.
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Affiliation(s)
- Yingfan Mao
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jincheng Wang
- Department of Hepatobiliary Surgery, Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, China
| | - Yong Zhu
- Department of Radiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jun Chen
- Department of Pathology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Liang Mao
- Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Weiwei Kong
- Department of Oncology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yudong Qiu
- Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaoyan Wu
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yue Guan
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Centonze L, De Carlis R, Vella I, Carbonaro L, Incarbone N, Palmieri L, Sgrazzutti C, Ficarelli A, Valsecchi MG, Dello Iacono U, Lauterio A, Bernasconi D, Vanzulli A, De Carlis L. From LI-RADS Classification to HCC Pathology: A Retrospective Single-Institution Analysis of Clinico-Pathological Features Affecting Oncological Outcomes after Curative Surgery. Diagnostics (Basel) 2022; 12:160. [PMID: 35054327 PMCID: PMC8775107 DOI: 10.3390/diagnostics12010160] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 02/08/2023] Open
Abstract
Background: The latest Liver Imaging Reporting and Data System (LI-RADS) classification by the American College of Radiology has been recently endorsed in the American Association for the Study of Liver Disease (AASLD) guidelines for Hepatocellular carcinoma (HCC) management. Although the LI-RADS protocol has been developed as a diagnostic algorithm, there is some evidence concerning a possible correlation between different LI-RADS classes and specific pathological features of HCC. We aimed to investigate such radiological/pathological correlation and the possible prognostic implication of LI-RADS on a retrospective cohort of HCC patients undergoing surgical resection. Methods: We performed a retrospective analysis of the pathological characteristics of resected HCC, exploring their distribution among different LI-RADS classes and analyzing the risk factors for recurrence-free, overall and cancer-specific survival Results: LI-RADS-5 (LR-5) nodules showed a higher prevalence of microvascular invasion (MVI), satellitosis and capsule infiltration, as well as higher median values of alpha-fetoprotein (αFP) compared to LI-RADS-3/4 (LR-3/4) nodules. MVI, αFP, satellitosis and margin-positive (R1) resection resulted as independent risk factors for recurrence-free survival, while LI-RADS class did not exert any significant impact. Focusing on overall survival, we identified patient age, Eastern Cooperative Oncology Group performance status (ECOG-PS), Model for End Stage Liver Disease (MELD) score, αFP, MVI, satellitosis and R1 resection as independent risk factors for survival, without any impact of LI-RADS classification. Last, MELD score, log10αFP, satellitosis and R1 resection resulted as independent risk factors for cancer-specific survival, while LI-RADS class did not exert any significant impact. Conclusions: Our results suggest an association of LR-5 class with unfavorable pathological characteristics of resected HCC; tumor histology and underlying patient characteristics such as age, ECOG-PS and liver disease severity exert a significant impact on postoperative oncological outcomes.
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Affiliation(s)
- Leonardo Centonze
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20161 Milan, Italy; (R.D.C.); (I.V.); (N.I.); (L.P.); (A.F.); (A.L.); (L.D.C.)
| | - Riccardo De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20161 Milan, Italy; (R.D.C.); (I.V.); (N.I.); (L.P.); (A.F.); (A.L.); (L.D.C.)
| | - Ivan Vella
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20161 Milan, Italy; (R.D.C.); (I.V.); (N.I.); (L.P.); (A.F.); (A.L.); (L.D.C.)
| | - Luca Carbonaro
- Department of Diagnostic and Interventional Radiology, Niguarda Ca’ Granda Hospital, 20161 Milan, Italy; (L.C.); (C.S.); (U.D.I.); (A.V.)
| | - Niccolò Incarbone
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20161 Milan, Italy; (R.D.C.); (I.V.); (N.I.); (L.P.); (A.F.); (A.L.); (L.D.C.)
| | - Livia Palmieri
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20161 Milan, Italy; (R.D.C.); (I.V.); (N.I.); (L.P.); (A.F.); (A.L.); (L.D.C.)
| | - Cristiano Sgrazzutti
- Department of Diagnostic and Interventional Radiology, Niguarda Ca’ Granda Hospital, 20161 Milan, Italy; (L.C.); (C.S.); (U.D.I.); (A.V.)
| | - Alberto Ficarelli
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20161 Milan, Italy; (R.D.C.); (I.V.); (N.I.); (L.P.); (A.F.); (A.L.); (L.D.C.)
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre—B4, School of Medicine and Surgery, University of Milan-Bicocca, 20126 Milan, Italy; (M.G.V.); (D.B.)
| | - Umberto Dello Iacono
- Department of Diagnostic and Interventional Radiology, Niguarda Ca’ Granda Hospital, 20161 Milan, Italy; (L.C.); (C.S.); (U.D.I.); (A.V.)
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20161 Milan, Italy; (R.D.C.); (I.V.); (N.I.); (L.P.); (A.F.); (A.L.); (L.D.C.)
| | - Davide Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre—B4, School of Medicine and Surgery, University of Milan-Bicocca, 20126 Milan, Italy; (M.G.V.); (D.B.)
| | - Angelo Vanzulli
- Department of Diagnostic and Interventional Radiology, Niguarda Ca’ Granda Hospital, 20161 Milan, Italy; (L.C.); (C.S.); (U.D.I.); (A.V.)
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20161 Milan, Italy; (R.D.C.); (I.V.); (N.I.); (L.P.); (A.F.); (A.L.); (L.D.C.)
- School of Medicine and Surgery, University of Milan-Bicocca, 20126 Milan, Italy
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Cao S, Zou Y, Lyu T, Fan Z, Guan H, Song L, Tong X, Wang J. Long-term outcomes of combined transarterial chemoembolization and radiofrequency ablation versus RFA monotherapy for single hepatocellular carcinoma ≤3 cm: emphasis on local tumor progression. Int J Hyperthermia 2021; 39:1-7. [PMID: 34937501 DOI: 10.1080/02656736.2021.1998660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To compare the long-term outcomes of combined transarterial chemoembolization and radiofrequency ablation (TACE-RFA) with radiofrequency ablation (RFA) monotherapy for small (≤3 cm) hepatocellular carcinomas (HCCs). METHODS A total of 248 patients with 329 HCC nodules who underwent TACE-RFA or RFA monotherapy as the only first-line treatment between January 2009 and December 2020 were included in this study. The technical success, complications, survival rate, and local tumor progression (LTP) rate were compared between the two treatments. RESULTS The 1-, 3- and 5-year survival rates were similar between the two groups (98.7%, 93.0% and 75.9% vs 97.4%, 88.0% and 77.4%; p = 0.444). The 1-, 3-, and 5-year cumulative LTP rates were significantly lower in the TACE-RFA group than in the RFA monotherapy group (2.9%, 9.2%, and 13.8% vs. 5.2%, 17.0%, and 21.0%; p = 0.043). Subgroup analyses suggested that TACE-RFA showed significantly lower LTP rates than RFA monotherapy for small HCC with tumor size>2cm (p = 0.008), subphrenic location (p = 0.021), and perivessel (p = 0.030). Furthermore, HCC with well-defined lipiodol deposition in the TACE-RFA group showed better local tumor control than the small HCC in the RFA monotherapy group (p = 0.013). There was no significant difference in the technical success rates (p = 0.064) and complication rates (p = 0.952) between the two groups. CONCLUSIONS TACE-RFA is superior to RFA monotherapy in providing local tumor control for small HCC with tumor size 2-3 cm in diameter, subphrenic location, perivessel and HCCs with well-defined lipiodol deposition by TACE before RFA.
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Affiliation(s)
- Shoujin Cao
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Yinghua Zou
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Tianshi Lyu
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Zeyang Fan
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Haitao Guan
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Li Song
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Xiaoqiang Tong
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Jian Wang
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
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Comparison of local recurrence in transcatheter arterial chemoembolization of hepatocellular carcinoma with or without accumulation of iodized oil beyond corona enhancement area: Short-term results. Radiol Oncol 2021; 56:69-75. [PMID: 34957733 PMCID: PMC8884859 DOI: 10.2478/raon-2021-0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/01/2021] [Indexed: 12/21/2022] Open
Abstract
Background Local tumor recurrence of hepatocellular carcinoma (HCC) often occurs in blood drainage areas. Corona enhancement is determined by computed tomography during hepatic arteriography (CTHA) and is considered to represent the blood drainage area. This study aimed to investigate the relationship between embolization of corona enhancement area and local tumor recurrence of patients with HCC who underwent transcatheter arterial chemoembolization (TACE). Patients and methods The study retrospectively selected 53 patients with 60 HCC nodules that showed corona enhancement area on late-phase CTHA and showed homogenous accumulation of iodized oil throughout the nodule on non-contrast-enhanced CT performed immediately after TACE. We divided the nodules into two groups, according to whether the accumulation of iodized oil covered the entire corona enhancement area (group A) or not (group B). Local tumor recurrence was compared between the two groups. Results The cumulative local tumor recurrence rates for group A (n = 36) were 2.8%, 2.8%, 8.3% at 3, 6, and 12 months, respectively, whereas the recurrence rates for group B (n = 24) were 20.8%, 45.8%, 75% at 3, 6, and 12 months, respectively. The cumulative local tumor recurrence rates for group A were significantly lower than those for group B (hazard ratio, 0.079; 95% confidence interval, 0.026–0.24; p < 0.001). Conclusions The results of the study suggest that the corona enhancement area may be an accurate safety margin in TACE which should be performed until the embolic area covers the entire corona enhancement area.
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Combined transarterial chemoembolization and radiofrequency ablation for subphrenic versus nonsubphrenic hepatocellular carcinoma: a propensity score matched study. Abdom Radiol (NY) 2021; 46:5735-5745. [PMID: 34581928 DOI: 10.1007/s00261-021-03291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare therapeutic outcomes of combined transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) treatment for small hepatocellular carcinoma (HCC) in subphrenic versus nonsubphrenic locations by propensity score matching. METHODS This retrospective study included 293 patients with single HCC (≤ 3 cm) ineligible for ultrasound-guided RFA who received iodized oil TACE and subsequent RFA between June 2010 and January 2017. The patients were divided into two groups according to the tumor location: subphrenic (n = 99) and nonsubphrenic (n = 194). Subphrenic HCC was defined as a tumor abutting the diaphragm. Local tumor progression (LTP) and overall survival (OS) rates were compared by propensity score matching. Procedure-related complications were also assessed. RESULTS Matching yielded 93 matched pairs of patients. In the matched cohorts, cumulative 1-, 3-, and 5-year LTP rates were 5.4%, 12.1%, and 12.1% in the subphrenic group and 1.1%, 7.5%, and 8.6% in the nonsubphrenic group, respectively, with no significant differences (p = 0.278). Corresponding OS rates were 100%, 80.2%, and 71.3% in the subphrenic group and 97.9%, 88.1%, and 75.6% in the nonsubphrenic group, respectively, with no significant differences (p = 0.308). The subphrenic location was not a significant risk factor for LTP and OS in multivariate analysis. There were no significant differences in complication rates between the two groups (p > 0.05). CONCLUSION The therapeutic outcomes of combined TACE and RFA for small subphrenic HCC were similar to those for nonsubphrenic HCC. The combination therapy seems to be an effective and safe method in treating small subphrenic HCC.
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Gu D, Guo D, Yuan C, Wei J, Wang Z, Zheng H, Tian J. Multi-scale patches convolutional neural network predicting the histological grade of hepatocellular carcinoma. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:2584-2587. [PMID: 34891782 DOI: 10.1109/embc46164.2021.9630413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Preoperative predicting histological grade of hepatocellular carcinoma (HCC) is a crucial issue for the evaluation of patient prognosis and determining clinical treatment strategies. Previous studies have shown the potential of preoperative medical imaging in HCC grading diagnosis, however, there still remain challenges. In this work, we proposed a multi-scale 2D dense connected convolutional neural network (MS-DenseNet) for the classification of grade. This architecture consisted of three CNN branches to extract features of CT image patches in different scale. Then the outputs for each CNN branch were concatenated to the final fully connected layer. Our network was developed and evaluated on 455 HCC patients from two different centers. For data augmentation, more than 2000 patches for each scale were cropped from transverse section 2D region of interest on these patients. Besides, three-channel inputs including original CT image, tumor region and peritumoral component provided complementary knowledge. Experimental results demonstrated that the proposed method achieved encouraging prediction performance with AUC of 0.798 in testing dataset.Clinical Relevance-The proposed MS-DenseNet yielded an encouraging prediction performance for HCC histological grade and might assist the clinical diagnosis and decision making of HCC patients.
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Fowler KJ, Burgoyne A, Fraum TJ, Hosseini M, Ichikawa S, Kim S, Kitao A, Lee JM, Paradis V, Taouli B, Theise ND, Vilgrain V, Wang J, Sirlin CB, Chernyak V. Pathologic, Molecular, and Prognostic Radiologic Features of Hepatocellular Carcinoma. Radiographics 2021; 41:1611-1631. [PMID: 34597222 DOI: 10.1148/rg.2021210009] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is a malignancy with variable biologic aggressiveness based on the tumor grade, presence or absence of vascular invasion, and pathologic and molecular classification. Knowledge and understanding of the prognostic implications of different pathologic and molecular phenotypes of HCC are emerging, with therapeutics that promise to provide improved outcomes in what otherwise remains a lethal cancer. Imaging has a central role in diagnosis of HCC. However, to date, the imaging algorithms do not incorporate prognostic features or subclassification of HCC according to its biologic aggressiveness. Emerging data suggest that some imaging features and further radiologic, pathologic, or radiologic-molecular phenotypes may allow prediction of the prognosis of patients with HCC. An invited commentary by Bashir is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Kathryn J Fowler
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Adam Burgoyne
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Tyler J Fraum
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Mojgan Hosseini
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Shintaro Ichikawa
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Sooah Kim
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Azusa Kitao
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Jeong Min Lee
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Valérie Paradis
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Bachir Taouli
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Neil D Theise
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Valérie Vilgrain
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Jin Wang
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Claude B Sirlin
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Victoria Chernyak
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
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Liu W, Rong D, Zhu J, Xiao Y, Zhang L, Deng Y, Chen J, Yin M, Venkatesh SK, Ehman RL, Wang J. Diagnostic accuracy of 3D magnetic resonance elastography for assessing histologic grade of hepatocellular carcinoma: comparison of three methods for positioning region of interest. Abdom Radiol (NY) 2021; 46:4601-4609. [PMID: 34085091 DOI: 10.1007/s00261-021-03150-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess the influence of region of interest (ROI) placement on the predictive value of 3D MRE in differentiating the histologic grade of HCC. METHODS 85 patients with pathologically confirmed HCCs were analyzed using 3D MRE imaging, two radiologists measured the tumor stiffness with three different ROI positioning methods. Intraclass correlation coefficient (ICC) was expressed in terms of inter- and intra-observer agreements. Kruskal-Wallis rank test or one-way ANOVA was used to compare the difference in MRE stiffness across the three-ROI positioning methods. Receiver operating characteristic curve analysis (ROC) was performed, and the area under curve (AUC) was measured to evaluate the diagnostic performance. RESULTS There were 64 (75%) well-or-moderately differentiated HCCs and 21(25%) poorly differentiated HCCs included finally. Almost excellent inter- and intra-observer agreements (all ICC > 0.82) were observed for all three-ROI methods, the volumetric method has the highest values (inter-observer ICC 0.967, intra-observer ICC 0.919, 0.926, respectively). The mean stiffnesses of poorly differentiated HCC obtained by two readers were significantly higher than well-or-moderately differentiated HCC with volumetric method (7.07 ± 1.57 Kpa, 5.00 ± 1.49 Kpa, and 6.85 ± 1.49 Kpa, 4.94 ± 1.48 Kpa, respectively) and three-ROI method (6.14 ± 1.71 Kpa, 4.91 ± 1.56 Kpa and 5.94 ± 1.61 Kpa, 4.84 ± 1.54 Kpa, respectively) but not on single-ROI method (p > 0.005), for the diagnostic performance, the highest area under the curve (AUC) with a value of 0.837, 0.812 by using the volumetric method, followed by the three-ROI method (0.713, 0.754) and single-ROI method. CONCLUSION Different ROI positioning methods significantly affect HCC tumor stiffness measurements. The whole tumor volumetric analysis is superior to ROI-based methods for predicting the grade of HCC.
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Affiliation(s)
- Weimin Liu
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, Guangdong, 510630, People's Republic Of China
| | - Dailin Rong
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, Guangdong, 510630, People's Republic Of China
| | - Jie Zhu
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, Guangdong, 510630, People's Republic Of China
| | - Yuanqiang Xiao
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, Guangdong, 510630, People's Republic Of China
| | - Linqi Zhang
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, Guangdong, 510630, People's Republic Of China
| | - Ying Deng
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, Guangdong, 510630, People's Republic Of China
| | - Jun Chen
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Meng Yin
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jin Wang
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, Guangdong, 510630, People's Republic Of China.
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Gong XQ, Tao YY, Wu Y, Liu N, Yu X, Wang R, Zheng J, Liu N, Huang XH, Li JD, Yang G, Wei XQ, Yang L, Zhang XM. Progress of MRI Radiomics in Hepatocellular Carcinoma. Front Oncol 2021; 11:698373. [PMID: 34616673 PMCID: PMC8488263 DOI: 10.3389/fonc.2021.698373] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/31/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world and the third leading cause of cancer-related death. Although the diagnostic scheme of HCC is currently undergoing refinement, the prognosis of HCC is still not satisfactory. In addition to certain factors, such as tumor size and number and vascular invasion displayed on traditional imaging, some histopathological features and gene expression parameters are also important for the prognosis of HCC patients. However, most parameters are based on postoperative pathological examinations, which cannot help with preoperative decision-making. As a new field, radiomics extracts high-throughput imaging data from different types of images to build models and predict clinical outcomes noninvasively before surgery, rendering it a powerful aid for making personalized treatment decisions preoperatively. OBJECTIVE This study reviewed the workflow of radiomics and the research progress on magnetic resonance imaging (MRI) radiomics in the diagnosis and treatment of HCC. METHODS A literature review was conducted by searching PubMed for search of relevant peer-reviewed articles published from May 2017 to June 2021.The search keywords included HCC, MRI, radiomics, deep learning, artificial intelligence, machine learning, neural network, texture analysis, diagnosis, histopathology, microvascular invasion, surgical resection, radiofrequency, recurrence, relapse, transarterial chemoembolization, targeted therapy, immunotherapy, therapeutic response, and prognosis. RESULTS Radiomics features on MRI can be used as biomarkers to determine the differential diagnosis, histological grade, microvascular invasion status, gene expression status, local and systemic therapeutic responses, and prognosis of HCC patients. CONCLUSION Radiomics is a promising new imaging method. MRI radiomics has high application value in the diagnosis and treatment of HCC.
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Affiliation(s)
- Xue-Qin Gong
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yun-Yun Tao
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yao–Kun Wu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ning Liu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xi Yu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ran Wang
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing Zheng
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Nian Liu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiao-Hua Huang
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing-Dong Li
- Department of Hepatocellular Surgery, Institute of Hepato-Biliary-Intestinal Disease, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Gang Yang
- Department of Hepatocellular Surgery, Institute of Hepato-Biliary-Intestinal Disease, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiao-Qin Wei
- School of Medical Imaging, North Sichuan Medical College, Nanchong, China
| | - Lin Yang
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiao-Ming Zhang
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Zhuang BW, Xie XH, Yang DP, Lin MX, Wang W, Lu MD, Kuang M, Xie XY. Percutaneous thermal ablation of hepatic tumors: local control efficacy and risk factors for artificial ascites failure. Int J Hyperthermia 2021; 38:461-470. [PMID: 33752538 DOI: 10.1080/02656736.2021.1882708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To investigate the risk factors affecting the technical failure of artificial ascites (AA) formation and to evaluate the local control efficacy of percutaneous thermal ablation assisted by the AA for hepatic tumors. METHODS A total of 341 patients with 362 hepatic tumors who underwent thermal ablation assisted by AA were reviewed retrospectively. The technical success of AA, the volume of liquid, and local efficacy after ablation were assessed. Predictive factors for the technical failure of AA formation and local tumor progression (LTP) were analyzed using univariate and multivariate analysis. RESULTS The technical success rate of AA formation was 81.8% (296/362). The amount of fluid was higher when the tumor was located in the left lobe of the liver than when it was located in the right lobe (median 950 ml versus 700 ml, p < 0.001). Previous hepatic resection (OR: 12.63, 95% CI: 2.93-54.45, p < 0.001), ablation (OR: 6.48, 95% CI: 1.36-30.92, p = 0.019) and upper-abdomen surgery (OR: 11.34, 95% CI: 1.96-65.67, p = 0.007) were the independent risk factors of AA failure. In the AA success group, the complete ablation rate was higher and the LTP rate was lower than that in the AA failure group (98.7 versus 92.4%, p = 0.012; 8.8 versus 21.2%, p = 0.004). Multivariate analysis identified AA failure (p = 0.004), tumor size (>3.0 cm) (p = 0.002) and metastatic liver tumor (p = 0.008) as independent risk factors for LTP. CONCLUSION History of hepatic resection, ablation and upper abdomen surgery were significant predictive factors affecting the technical failure of AA formation. Successful introduction of AA before thermal ablation can achieve better local tumor control efficacy.
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Affiliation(s)
- Bo-Wen Zhuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiao-Hua Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Dao-Peng Yang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Man-Xia Lin
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Wei Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ming-de Lu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.,Department of liver Surgery, The Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ming Kuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.,Department of liver Surgery, The Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
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Hirooka M, Koizumi Y, Tanaka T, Sunago K, Nakamura Y, Watanabe T, Yoshida O, Tokumoto Y, Abe M, Hiasa Y. Radiofrequency Ablation Covering the Entire Tumor Blood Drainage Area Improves Survival in Hepatocellular Carcinoma. Hepatol Commun 2021; 5:1300-1309. [PMID: 34278177 PMCID: PMC8279463 DOI: 10.1002/hep4.1703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/29/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
Hepatocellular carcinoma has been considered to disseminate through the tumor blood drainage area. To improve curation rates, treatment should cover this area as it may contain satellite lesions. This retrospective study aimed to investigate whether radiofrequency ablation (RFA) completely covering the blood drainage area can improve the overall and disease-free survival. We enrolled 526 patients who underwent computed tomography during hepatic arteriography following RFA from April 2001 to May 2019. Patients were categorized into a covered group in which the blood drainage area was completely covered by RFA and a noncovered group in which coverage was incomplete. The primary endpoint was the overall survival rate; secondary outcomes included disease-free survival rate, distant intrahepatic and local recurrence rate, and changes in the Child-Pugh score. There were no significant differences in baseline characteristics between the two groups. Cumulative overall survival rates were significantly higher in the covered group than in the noncovered group (hazard ratio, 0.63; 95% confidence interval, 0.48-0.84; P = 0.002). On multivariate Cox proportional hazard model analysis, age <65 years, Child-Pugh class A, and coverage of the entire drainage area were independent protective factors. Child-Pugh worsened in 11 (4.2%) patients in the covered group compared to 18 (6.7%) patients in the noncovered group. Conclusion: RFA covering the complete drainage area improved overall survival without decreasing liver function.
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Affiliation(s)
- Masashi Hirooka
- Department of Gastroenterology and MetabologyEhime University Graduate School of MedicineTouon, EhimeJapan
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Minami Y, Minami T, Ueshima K, Yagyu Y, Tsurusaki M, Okada T, Hori M, Kudo M, Murakami T. Three-Dimensional Radiological Assessment of Ablative Margins in Hepatocellular Carcinoma: Pilot Study of Overlay Fused CT/MRI Imaging with Automatic Registration. Cancers (Basel) 2021; 13:cancers13061460. [PMID: 33806751 PMCID: PMC8004695 DOI: 10.3390/cancers13061460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/06/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We investigate the feasibility of image fusion application for ablative margin assessment in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and possible causes for a wrong initial evaluation of technical success through a side-by-side comparison. METHODS A total of 467 patients with 1100 HCCs who underwent RFA were reviewed retrospectively. Seventeen patients developed local tumor progressions (LTPs) (median size, 1.0 cm) despite initial judgments of successful ablation referring to contrast-enhanced images obtained in the 24 h after ablation. The ablative margins were reevaluated radiologically by overlaying fused images pre- and post-ablation. RESULTS The initial categorizations of the 17 LTPs had been grade A (absolutely curative) (n = 5) and grade B (relatively curative) (n = 12); however, the reevaluation altered the response categories to eight grade C (margin-zero ablation) and nine grade D (existence of residual HCC). LTP occurred in eight patients re-graded as C within 4 to 30.3 months (median, 14.3) and in nine patients re-graded as D within 2.4 to 6.7 months (median, 4.2) (p = 0.006). Periablational hyperemia enhancements concealed all nine HCCs reevaluated as grade D. CONCLUSION Side-by-side comparisons carry a risk of misleading diagnoses for LTP of HCC. Overlay fused imaging technology can be used to evaluate HCC ablative margin with high accuracy.
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Affiliation(s)
- Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
- Correspondence: ; Tel.: +81-72-366-0221 (ext. 3149); Fax: +81-72-367-2880
| | - Tomohiro Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
| | - Kazuomi Ueshima
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
| | - Yukinobu Yagyu
- Department of Radiology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (Y.Y.); (M.T.)
| | - Masakatsu Tsurusaki
- Department of Radiology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (Y.Y.); (M.T.)
| | - Takuya Okada
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; (T.O.); (M.H.); (T.M.)
| | - Masatoshi Hori
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; (T.O.); (M.H.); (T.M.)
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; (T.O.); (M.H.); (T.M.)
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Lee SY, Ou HY, Yu CY, Huang TL, Tsang LLC, Cheng YF. Drug-eluting bead transarterial chemoembolization for hepatocellular carcinoma: does size really matter? ACTA ACUST UNITED AC 2021; 26:230-235. [PMID: 32352922 DOI: 10.5152/dir.2019.19261] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE We aimed to compare the safety and effectiveness of 100-300 μm versus 300-500 μm drug-eluting bead transarterial chemoembolization (DEB-TACE) and to investigate the impact of tumor and feeding artery size on treatment outcome of different particle sizes in the treatment of hepatocellular carcinoma (HCC). METHODS This retrospective cohort study enrolled 234 consecutive patients who underwent TACE using 100-300 μm DEB (Group A, n=75) and 300-500 μm DEB (Group B, n=159) in a tertiary center between August 2012 and March 2017. Initial treatment response and adverse events were assessed using modified Response Evaluation Criteria in Solid Tumors (mRECIST) and National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, respectively. RESULTS A total of 704 HCCs in 234 patients were evaluated. The average index tumor size was 3.8 cm. Multivariate analysis showed that tumor size, lobe involvement, particle size, and tumor location were significant predictive factors of complete response. The overall rate of complete response in groups A and B were 56.0% and 33.3% (P = 0.001), respectively. Group A had higher complete response rate than group B in the subgroup of BCLC B with tumor <3 cm (57.9% vs. 21.1%; P = 0.020) and subgroup of feeding artery ≥0.9 mm (55.2% vs. 30.9%; P = 0.014). There were fewer major complications in group A compared with group B (0% vs. 6.9%, P = 0.018). CONCLUSION TACE with 100-300 μm DEB is associated with better initial treatment response and fewer major complications compared with 300-500 μm. Our study also highlights the impact of tumor characteristics on treatment outcome of different DEB size, which might help to select the optimal sphere size for TACE in the treatment of HCC.
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Affiliation(s)
- Sieh-Yang Lee
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Hsin-You Ou
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Chun-Yen Yu
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Tung-Liang Huang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Leo Leung-Chit Tsang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Yu-Fan Cheng
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
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Wang F, Ma J, Wu L, Li N, Luo R, Wei G, Yang J. Percutaneous cryoablation of subcapsular hepatocellular carcinoma: a retrospective study of 57 cases. ACTA ACUST UNITED AC 2020; 26:34-39. [PMID: 31650975 DOI: 10.5152/dir.2019.18543] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aims to evaluate the safety and effectiveness of the percutaneous cryoablation for subcapsular hepatocellular carcinoma (HCC). METHODS A total of 57 patients with subcapsular (<1 cm form the liver edge) HCCs (68 lesions), who were treated with CT-guided percutaneous cryoablation in the Department of Interventional Radiology of our hospital between July 1, 2016 and September 1, 2018, were retrospectively included. Complete ablation rate, local tumor progression (LTP) and treatment-related complications were evaluated. Furthermore, the degree of intraoperative and postoperative pain was measured with the visual analog scale (VAS), and laboratory findings were compared before and after the procedure. RESULTS All patients successfully completed the treatment. The mean follow-up period was 12.8 months (range, 3-27 months), and the complete ablation rate was 97% (66/68). Local tumor progression occurred in 11 lesions (16.2%), and the 6-, 12- and 18-month cumulative LTP rates were 4.0%, 8.2% and 20.5%, respectively. Two patients (3.5%, 2/57) developed major complications, and 12 patients had minor complications (22.8%, 12/57). The mean VAS score during the operation was 1.65 points (range, 1-3 points). Postoperative pain worsened in 3 patients, and the VAS scores reached 4-5. Transient changes in biochemical and hematologic markers were observed. CONCLUSION Percutaneous cryoablation for subcapsular HCC is safe and effective, the procedure is simple and the patients suffer less pain.
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Affiliation(s)
- Fuming Wang
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jianbing Ma
- Department of Radiology, The First Hospital of Jiaxing, Zhejiang, China
| | - Linlin Wu
- Department of Oncology, Tengzhou Central People's Hospital, Shandong, China
| | - Na Li
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rong Luo
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Guangxu Wei
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jijin Yang
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Matsuki Y, Matono T, Koda M, Miyoshi K, Sugihara T, Okano JI, Isomoto H. Preablation three-dimensional ultrasonography can predict therapeutic effect and local tumor progression after radiofrequency ablation for hepatocellular carcinoma. Eur J Radiol 2020; 133:109358. [PMID: 33126170 DOI: 10.1016/j.ejrad.2020.109358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/03/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the agreement between ablative margin (AM) predicted by preablation three-dimensional ultrasonography (3D-US) and AM measured on postablation computed tomography (CT)/magnetic resonance (MR) images. METHODS Sixty patients with 73 hepatocellular carcinoma nodules were enrolled. 3D-US data were collected immediately after puncture by the electrode before ablation. The maximum distance from the electrode to the edge of the tumor in the plane perpendicular to the electrode (C-plane) was defined as "a" and the diameter of the ablation zone as "b". We classified predicted AM into "0.5b - a" ≥0 mm as AM(+) or <0 mm as AM(-), and "0.5b - a" ≥3 mm or <3 mm. RESULTS Forty-eight nodules (66 %) were visualized in the C-plane. There was an agreement between the predicted and measured AMs for 39 (81 %) of the 48 nodules. Local tumor progression was observed in 3 (7%) of 43 nodules with predicted AM(+) and in 2 (40 %) of 5 nodules with predicted AM(-) but was not observed in any of 21 nodules with predicted AM ≥ 3 mm. The local tumor progression rate was significantly lower for nodules with predicted AM(+) compared with predicted AM(-)(p = 0.03), and for nodules with predicted AM ≥ 3 mm compared with predicted AM < 3 mm (p = 0.04). Local progression was detected in 2 (4.7 %) of 42 nodules with a sufficient AM (≥0 mm) on postablation CT/MR images and in 5 (83.3 %) of 6 nodules with an insufficient AM (<0 mm); the difference in progression rate was significant (p = 0.0008). CONCLUSION 3D-US allows prediction of the AM before radiofrequency ablation.
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Affiliation(s)
- Yukako Matsuki
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Tomomitsu Matono
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Masahiko Koda
- Department of Internal Medicine, Hino Hospital, Tottori 683-4504, Japan.
| | - Kenichi Miyoshi
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Takaaki Sugihara
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Jun-Ichi Okano
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Hajime Isomoto
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
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Ida Y, Tamai H, Shingaki N, Shimizu R, Maeshima S, Maekita T, Iguchi M, Terada M, Kitano M. Prognostic value of 18F-fluorodeoxyglucose positron emission tomography in patients with small hepatocellular carcinoma treated by radiofrequency ablation. Cancer Imaging 2020; 20:74. [PMID: 33076990 PMCID: PMC7574337 DOI: 10.1186/s40644-020-00356-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/11/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND 18F-fluorodeoxyglucose (18F-FDG) uptake in hepatocellular carcinoma (HCC) is significantly associated with early recurrence and survival after curative surgical resection. However, there are no reports regarding the relationship between 18F-FDG uptake and outcomes after radiofrequency ablation (RFA). A prospective cohort study was conducted to evaluate the prognostic value of 18F-FDG positron emission tomography (PET) in HCC patients after RFA. METHODS A total of 121 consecutive patients with primary HCC (≤3 tumors, of diameter ≤ 3 cm) without vascular invasion on imaging were examined by 18F-FDG-PET computed tomography prior to RFA. An HCC with a component of 18F-FDG uptake visibly stronger than that of surrounding liver was defined as 18F-FDG-PET positive. RESULTS The median follow-up period was 1267 days. There were 110 18F-FDG-PET negative and 11 positive tumors. The cumulative 1-year recurrence rates in the 18F-FDG negative and positive groups were 30 and 64% (P = 0.017), respectively, and cumulative 1-year metastatic recurrence rates were 6 and 36% (P < 0.001), respectively. The cumulative 5-year survival rates were 88 and 22% (P < 0.001), respectively. Multivariate analysis revealed 18F-FDG-PET positivity and tumor size as independent factors related to metastatic recurrence and survival after RFA. CONCLUSIONS 18F-FDG-PET positivity was significantly associated with outcomes after RFA. RFA should not be readily selected as the first-line treatment for small HCC that includes a component of visually strong 18F-FDG uptake.
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Affiliation(s)
- Yoshiyuki Ida
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
| | - Hideyuki Tamai
- Department of Hepatology, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama, 640-8505, Japan.
| | - Naoki Shingaki
- Department of Hepatology, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama, 640-8505, Japan
| | - Ryo Shimizu
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
| | - Shuya Maeshima
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
| | - Takao Maekita
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
| | - Mikitaka Iguchi
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
| | - Masaki Terada
- Wakayama Minami Radiology Clinic, 870-2 Kimiidera, Wakayama, 641-0012, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
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Wei J, Jiang H, Gu D, Niu M, Fu F, Han Y, Song B, Tian J. Radiomics in liver diseases: Current progress and future opportunities. Liver Int 2020; 40:2050-2063. [PMID: 32515148 PMCID: PMC7496410 DOI: 10.1111/liv.14555] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 02/05/2023]
Abstract
Liver diseases, a wide spectrum of pathologies from inflammation to neoplasm, have become an increasingly significant health problem worldwide. Noninvasive imaging plays a critical role in the clinical workflow of liver diseases, but conventional imaging assessment may provide limited information. Accurate detection, characterization and monitoring remain challenging. With progress in quantitative imaging analysis techniques, radiomics emerged as an efficient tool that shows promise to aid in personalized diagnosis and treatment decision-making. Radiomics could reflect the heterogeneity of liver lesions via extracting high-throughput and high-dimensional features from multi-modality imaging. Machine learning algorithms are then used to construct clinical target-oriented imaging biomarkers to assist disease management. Here, we review the methodological process in liver disease radiomics studies in a stepwise fashion from data acquisition and curation, region of interest segmentation, liver-specific feature extraction, to task-oriented modelling. Furthermore, the applications of radiomics in liver diseases are outlined in aspects of diagnosis and staging, evaluation of liver tumour biological behaviours, and prognosis according to different disease type. Finally, we discuss the current limitations of radiomics in liver disease studies and explore its future opportunities.
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Affiliation(s)
- Jingwei Wei
- Key Laboratory of Molecular ImagingInstitute of AutomationChinese Academy of SciencesBeijingChina
- Beijing Key Laboratory of Molecular ImagingBeijingChina
| | - Hanyu Jiang
- Department of RadiologyWest China HospitalSichuan UniversityChengduChina
| | - Dongsheng Gu
- Key Laboratory of Molecular ImagingInstitute of AutomationChinese Academy of SciencesBeijingChina
- Beijing Key Laboratory of Molecular ImagingBeijingChina
| | - Meng Niu
- Department of Interventional RadiologyThe First Affiliated Hospital of China Medical UniversityShenyangChina
| | - Fangfang Fu
- Department of Medical ImagingHenan Provincial People’s HospitalZhengzhouHenanChina
- Department of Medical ImagingPeople’s Hospital of Zhengzhou University. ZhengzhouHenanChina
| | - Yuqi Han
- Key Laboratory of Molecular ImagingInstitute of AutomationChinese Academy of SciencesBeijingChina
- Beijing Key Laboratory of Molecular ImagingBeijingChina
| | - Bin Song
- Department of RadiologyWest China HospitalSichuan UniversityChengduChina
| | - Jie Tian
- Key Laboratory of Molecular ImagingInstitute of AutomationChinese Academy of SciencesBeijingChina
- Beijing Key Laboratory of Molecular ImagingBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineSchool of MedicineBeihang UniversityBeijingChina
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of EducationSchool of Life Science and TechnologyXidian UniversityXi’anShaanxiChina
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Wang T, Yang X, Tang H, Kong J, Shen S, Qiu H, Wang W. Integrated nomograms to predict overall survival and recurrence-free survival in patients with combined hepatocellular cholangiocarcinoma (cHCC) after liver resection. Aging (Albany NY) 2020; 12:15334-15358. [PMID: 32788423 PMCID: PMC7467372 DOI: 10.18632/aging.103577] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/09/2020] [Indexed: 02/05/2023]
Abstract
The current clinical classification of primary liver cancer is unable to efficiently predict the prognosis of combined hepatocellular cholangiocarcinoma (cHCC). Accurate satellite nodules (SAT) and microvascular invasion (MVI) prediction in cHCC patients is very important for treatment decision making and prognostic evaluation. The aim of this work was to explore important factors affecting the prognosis of cHCC patients after liver resection and to develop preoperative nomograms to predict SAT and MVI in cHCC patients. The nomogram was developed using the data from 148 patients who underwent liver resection for cHCC patients at our hospital between January 2006 and December 2014. Based on the results of the multivariate analysis, a nomogram integrating all significant independent factors affecting overall survival and recurrence-free survival was constructed to predict the prognosis of cHCC. Next, risk factors for SAT and MVI were evaluated with logistic regression. Blood signatures were established using the LASSO regression, and then, we combined the clinical risk factors and blood signatures of the patients to establish predictive models for SAT and MVI. The C-index of the nomogram for predicting survival was 0.685 (95% CI, 0.638 to 0.732), which was significantly higher than the C-index for other liver cancer classification systems.
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Affiliation(s)
- Tao Wang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, P. R. China
| | - Xianwei Yang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, P. R. China
| | - Huairong Tang
- Physical Examination Center, West China Hospital of Sichuan University, Chengdu 610041, P. R. China
| | - Junjie Kong
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, P. R. China
| | - Shu Shen
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, P. R. China
| | - Haizhou Qiu
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, P. R. China
| | - Wentao Wang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, P. R. China
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Zhang L, Wang J, Jiang J, Zhang M, Shen J. CTLA-4 Blockade Suppresses Progression of Residual Tumors and Improves Survival After Insufficient Radiofrequency Ablation in a Subcutaneous Murine Hepatoma Model. Cardiovasc Intervent Radiol 2020; 43:1353-1361. [PMID: 32607616 DOI: 10.1007/s00270-020-02505-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/23/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate whether anti-CTLA-4 therapy could suppress residual tumor progression and improve survival after insufficient radiofrequency ablation (RFA) in a subcutaneous murine hepatocellular carcinoma (HCC) model. MATERIALS AND METHODS Forty mice with tumors established on their right flanks were randomly divided into four groups: control group (no treatment), RFA group (insufficient RFA alone), anti-CTLA-4 group (anti-CTLA-4 monotherapy), and RFA + anti-CTLA-4 group (insufficient RFA + anti-CTLA-4). In each group, eight mice were assessed for residual tumors and survival; another two mice were killed on day 14 for histopathologic studies. On day 42, a re-challenge test was performed in the survived mice of RFA + anti-CTLA-4 group to determine whether systemic anti-tumor immunity was established. RESULTS The specific growth rate of residual tumors was significantly less in RFA + anti-CTLA-4 group than that of the other three groups (all p < 0.05). The disease control rate was 50% in RFA + anti-CTLA-4 group, while no animals in the other three groups showed disease control. Animals in RFA + anti-CTLA-4 group had longer survival times than those in the other three groups (all p < 0.05). Expression of CD4+ lymphocytes in residual tumors and IFN-γ production in response to H22 tumor cells were significantly higher in RFA + anti-CTLA-4 group than those in the other three groups (all p < 0.05). Three of the five survived mice in RFA + anti-CTLA-4 group underwent tumor re-challenge exhibited tumor rejection. CONCLUSIONS The present study demonstrated that CTLA-4 blockade injection could suppress the growth of residual tumors and improve survival after insufficient RFA in a subcutaneous murine HCC model.
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Affiliation(s)
- Liang Zhang
- Department of Oncology Interventional Therapy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Pudong, Shanghai, 200127, People's Republic of China
| | - Jun Wang
- Department of Oncology Interventional Therapy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Pudong, Shanghai, 200127, People's Republic of China
| | - Jinhua Jiang
- Department of Oncology Interventional Therapy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Pudong, Shanghai, 200127, People's Republic of China
| | - Mingming Zhang
- Department of Clinical Medicine, Jining Medical College, No. 16 Hehua Street, Jining, Shandong, People's Republic of China
| | - Jialin Shen
- Department of Oncology Interventional Therapy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Pudong, Shanghai, 200127, People's Republic of China.
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Huang Q, Zeng Q, Long Y, Tan L, Zheng R, Xu E, Li K. Fusion imaging techniques and contrast-enhanced ultrasound for thermal ablation of hepatocellular carcinoma - A prospective randomized controlled trial. Int J Hyperthermia 2020; 36:1207-1215. [PMID: 31813295 DOI: 10.1080/02656736.2019.1687945] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objectives: This randomized controlled trial (RCT) aims to compare the clinical application values of contrast-enhanced ultrasound (CEUS), computed tomography/magnetic resonance-CEUS (CT/MR-CEUS), and three-dimensional ultrasound-CEUS (3DUS-CEUS) Fusion imaging (FI) techniques in the assistance of thermal ablation for hepatocellular carcinoma (HCC).Methods: A RCT was conducted on 374 patients with 456 HCCs between January 2016 and September 2017. CEUS, CT/MR-CEUS, and 3DUS-CEUS FI techniques were randomly used to assist HCC ablation. All lesions were ablated according to a previously determined plan, and FI groups required a 5-mm ablative margin. The primary endpoints were technical efficacy of thermal ablation and local tumor progression (LTP).Results: According to randomization, 153 (18.8 ± 8.0 cm), 153 (18.3 ± 6.6 cm) and 150 (19.1 ± 6.9 cm) HCCs were assigned to CT/MR-CEUS, 3DUS-CEUS and CEUS groups respectively. Technical efficacy rates (99.3% vs. 100% vs. 100%) were achieved in the three groups, showing no statistical differences (p = 1.000). The median follow-up time was 24 (1-37) months. LTP rates at 1 and 2 years were 3.4%, 12.2% for CT/MR-CEUS FI, 4.8%, 9.0% for 3DUS-CEUS FI, and 8.6%, 19.9% for CEUS, respectively (p = .105). The results of subgroup analysis for LTP were statistically significant when patients with albumin-bilirubin (ALBI) grade 2 and 3 (p = .000), and tumor located at risky positions (p = .042). In addition, the p value in group of multiple tumors was close to .05 (p = .052).Conclusions: All the three techniques are feasible for intraoperative HCC thermal ablation. Compared with CEUS, FI techniques are more suitable in patients with ALBI grade 2 and 3, multiple tumors, and in tumors at risky locations.
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Affiliation(s)
- Qiannan Huang
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Qingjing Zeng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Yinglin Long
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Lei Tan
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Rongqin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Erjiao Xu
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
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Acetic acid versus radiofrequency ablation for the treatment of hepatocellular carcinoma: A randomized controlled trial. Diagn Interv Imaging 2020; 101:101-110. [DOI: 10.1016/j.diii.2019.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/12/2019] [Accepted: 06/19/2019] [Indexed: 12/25/2022]
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50
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Ju JX, Zeng QJ, Xu EJ, He XQ, Tan L, Huang QN, Li K, Zheng RQ. Intraprocedural contrast-enhanced ultrasound-CT/MR fusion imaging assessment in HCC thermal ablation to reduce local tumor progression: compared with routine contrast-enhanced ultrasound. Int J Hyperthermia 2020; 36:785-793. [PMID: 31431086 DOI: 10.1080/02656736.2019.1640899] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: To evaluate whether local tumor progression (LTP) would be further reduced when contrast-enhanced ultrasound (CEUS)-CT/MR fusion imaging was used as intraprocedural assessment method in hepatocellular carcinoma (HCC) thermal ablation compared with routine CEUS. Materials and methods: This prospective non-randomized study was conducted from December 2010 to July 2012. CEUS-CT/MR fusion imaging and routine CEUS were used for treatment response assessment in the ablation procedure of 146 HCCs and 122 HCCs, respectively. Supplementary ablations were performed immediately if necessary. The primary technique efficacy rate, LTP rate and overall survival (OS) rate were calculated. Results: For CEUS-CT/MR fusion imaging and routine CEUS, the technical success rate, technique efficacy rate and supplementary ablation rate were 86.3% (126/146) and 98.4% (120/122) (p = .000), 99.2% (125/126) and 94.2% (113/120) (p = .032), and 14.3% (18/126) and 4.2% (5/120) (p = .006), respectively. The cumulative LTP rate and OS rate were not significantly different between fusion imaging group and routine CEUS group. However, for lesions that were larger than 3 cm or close to major vessels (41 lesions in fusion imaging group and 44 lesions in routine CEUS group, who received transcatheter arterial chemoembolization before ablation), the cumulative LTP rate was significantly lower in fusion imaging group than in routine CEUS group (p = .032). Conclusion: Although intraprocedural CEUS-CT/MR fusion imaging has certain limitations in application, it might provide a potential more efficient method compared with routine CEUS in reducing LTP in HCC thermal ablation, especially for difficult ablation lesions.
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Affiliation(s)
- Jin-Xiu Ju
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Qing-Jing Zeng
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Er-Jiao Xu
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Xu-Qi He
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Lei Tan
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Qian-Nan Huang
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Kai Li
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Rong-Qin Zheng
- Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
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