Original Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 7, 2012; 18(45): 6587-6596
Published online Dec 7, 2012. doi: 10.3748/wjg.v18.i45.6587
Tumour seeding after percutaneous cryoablation for hepatocellular carcinoma
Chun-Ping Wang, Hong Wang, Jian-Hui Qu, Yin-Ying Lu, Wen-Lin Bai, Zheng Dong, Xu-Dong Gao, Guang-Hua Rong, Zhen Zeng, Yong-Ping Yang
Chun-Ping Wang, Hong Wang, Jian-Hui Qu, Yin-Ying Lu, Wen-Lin Bai, Zheng Dong, Xu-Dong Gao, Guang-Hua Rong, Zhen Zeng, Yong-Ping Yang, Center of Therapeutic Research for Hepatocellular Carcinoma, 302 Hospital of PLA, Beijing 100039, China
Author contributions: Wang CP and Yang YP designed the study and wrote the manuscript; Wang H and Qu JH performed the data analysis and interpretation; Lu YY, Bai WL and Dong Z performed the treatment; Gao XD, Rong GH and Zeng Z provided the collection of all the patient material; Yang YP provided financial and administrative support for this work.
Supported by Grants from the Key Scientific and Technological Research Foundation of the National Special-Purpose Program, No. 2008ZX10002-018; Military Special-Purpose Program, No. BWS11J074; and the Capital Medical Research and Development Fund, No. 2009-2041, China
Correspondence to: Dr. Yong-Ping Yang, Center of Therapeutic Research for Hepatocellular Carcinoma, 302 Hospital of PLA, Beijing 100039, China. yongpingyang@hotmail.com
Telephone: +86-10-63879193 Fax: +86-10-63879193
Received: June 10, 2012
Revised: July 30, 2012
Accepted: August 14, 2012
Published online: December 7, 2012
Abstract

AIM: To assess the rate and risk factors for tumour seeding in a large cohort of patients.

METHODS: Over an 8-year period, 1436 hepatocellular carcinoma (HCC) patients with 2423 tumour nodules underwent 3015 image-guided percutaneous cryoablation sessions [1215 guided by ultrasonography and 221 by spiral computed tomography (CT)]. Follow-up CT or magnetic resonance imaging was performed every 3 mo. The detailed clinical data were recorded to analyse the risk factors for seeding.

RESULTS: The median follow-up time was 18 (range 1-90) mo. Seeding was detected in 11 patients (0.76%) at 1-24 (median 6.0) mo after cryoablation. Seeding occurred along the needle tract in 10 patients and at a distant location in 1 patient. Seeded tumours usually showed similar imaging and histopathological features to the primary HCCs. Univariate analyses identified subcapsular tumour location and direct subcapsular needle insertion as risk factors for seeding. Multivariate analysis showed that only direct subcapsular needle insertion was an independent risk factor for seeding (P = 0.017; odds ratio 2.57; 95%CI: 1.47-3.65). Seeding after cryoablation occurred earlier in patients with poorly differentiated HCC than those with well or moderately differentiated HCC [1.33 ± 0.577 mo vs 11.12 ± 6.896 mo; P = 0.042; 95%CI: (-19.115)-(-0.468)].

CONCLUSION: The risk of seeding after cryoablation for HCC is small. Direct puncture of subcapsular tumours should be avoided to minimise seeding.

Keywords: Cryoablation, Hepatocellular carcinoma, Tumour seeding, Clinical feature, Risk factor