Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2024; 30(11): 1533-1544
Published online Mar 21, 2024. doi: 10.3748/wjg.v30.i11.1533
Efficacy of radiofrequency ablation combined with sorafenib for treating liver cancer complicated with portal hypertension and prognostic factors
Li-Min Yang, Hong-Juan Wang, Shan-Lin Li, Guan-Hua Gan, Wen-Wen Deng, Yong-Sheng Chang, Lian-Feng Zhang
Li-Min Yang, Hong-Juan Wang, Guan-Hua Gan, Wen-Wen Deng, Lian-Feng Zhang, Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Shan-Lin Li, Department of Gastroenterology, Zhoukou Central Hospital of Henan Province, Zhoukou 466000, Henan Province, China
Yong-Sheng Chang, Department of Gastroenterology, The First Affiliated Hospital of Xinxiang Medical College, Xinxiang 453000, Henan Province, China
Co-corresponding authors: Li-Min Yang and Lian-Feng Zhang.
Author contributions: Yang LM and Zhang LF contributed equally to this work and are co-corresponding authors, including those involved in the design of the study, the acquisition and analysis of the data from the experiments, and the writing of the manuscript. Yang LM, Zhang LF and Wang HJ designed the experiment and conducted the clinical data collection; Li SL and Gan GH performed the postoperative follow-up and recorded the data; Deng WW and Chang YS conducted a number of collations and statistical analyses; all the authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University, and the need to provide informed consent was waived.
Informed consent statement: After review by the Ethics Committee, a waiver of informed consent was granted for this subject.
Conflict-of-interest statement: The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data sharing statement: All the data generated or analyzed during this study are included in this published article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Min Yang, MD, Associate Chief Physician, Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou 450052, Henan Province, China. ylmsunny6153@126.com
Received: January 5, 2024
Peer-review started: January 5, 2024
First decision: January 23, 2024
Revised: February 18, 2024
Accepted: March 8, 2024
Article in press: March 8, 2024
Published online: March 21, 2024
Processing time: 76 Days and 3 Hours
Abstract
BACKGROUND

Patients with liver cancer complicated by portal hypertension present complex challenges in treatment.

AIM

To evaluate the efficacy of radiofrequency ablation in combination with sorafenib for improving liver function and its impact on the prognosis of patients with this condition.

METHODS

Data from 100 patients with liver cancer complicated with portal hypertension from May 2014 to March 2019 were analyzed and divided into a study group (n = 50) and a control group (n = 50) according to the treatment regimen. The research group received radiofrequency ablation (RFA) in combination with sorafenib, and the control group only received RFA. The short-term efficacy of both the research and control groups was observed. Liver function and portal hypertension were compared before and after treatment. Alpha-fetoprotein (AFP), glypican-3 (GPC-3), and AFP-L3 levels were compared between the two groups prior to and after treatment. The occurrence of adverse reactions in both groups was observed. The 3-year survival rate was compared between the two groups. Basic data were compared between the survival and non-surviving groups. To identify the independent risk factors for poor prognosis in patients with liver cancer complicated by portal hypertension, multivariate logistic regression analysis was employed.

RESULTS

When comparing the two groups, the research group's total effective rate (82.00%) was significantly greater than that of the control group (56.00%; P < 0.05). Following treatment, alanine aminotransferase and aspartate aminotransferase levels increased, and portal vein pressure decreased in both groups. The degree of improvement for every index was substantially greater in the research group than in the control group (P < 0.05). Following treatment, the AFP, GPC-3, and AFP-L3 levels in both groups decreased, with the research group having significantly lower levels than the control group (P < 0.05). The incidence of diarrhea, rash, nausea and vomiting, and fatigue in the research group was significantly greater than that in the control group (P < 0.05). The 1-, 2-, and 3-year survival rates of the research group (94.00%, 84.00%, and 72.00%, respectively) were significantly greater than those of the control group (80.00%, 64.00%, and 40.00%, respectively; P < 0.05). Significant differences were observed between the survival group and the non-surviving group in terms of Child-Pugh grade, history of hepatitis, number of tumors, tumor size, use of sorafenib, stage of liver cancer, histological differentiation, history of splenectomy and other basic data (P < 0.05). Logistic regression analysis demonstrated that high Child-Pugh grade, tumor size (6–10 cm), history of hepatitis, no use of sorafenib, liver cancer stage IIIC, and previous splenectomy were independent risk factors for poor prognosis in patients with liver cancer complicated with portal hypertension (P < 0.05).

CONCLUSION

Patients suffering from liver cancer complicated by portal hypertension benefit from the combination of RFA and sorafenib therapy because it effectively restores liver function and increases survival rates. The prognosis of patients suffering from liver cancer complicated by portal hypertension is strongly associated with factors such as high Child-Pugh grade, tumor size (6-10 cm), history of hepatitis, lack of sorafenib use, liver cancer at stage IIIC, and prior splenectomy.

Keywords: Radiofrequency ablation; Sorafenib; Liver cancer; Portal hypertension; Efficacy; Prognosis analysis

Core Tip: The combination of radiofrequency ablation (RFA) and sorafenib shows promise in treating liver cancer with portal hypertension. This approach demonstrated improved short- and long-term efficacy, with significant reduction in portal vein pressure and enhancement of liver function. Patients treated with this combination had higher survival rates compared to those receiving RFA alone. Moreover, the study identified key prognostic factors, such as Child-Pugh grade, tumor size, history of hepatitis, and the use of sorafenib, providing valuable insights for managing liver cancer complicated by portal hypertension. These findings suggest that the RFA and sorafenib combination could be a beneficial therapeutic strategy, but further research with larger sample sizes is warranted to validate these outcomes.