Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2024; 16(7): 2941-2951
Published online Jul 15, 2024. doi: 10.4251/wjgo.v16.i7.2941
Effectiveness and safety of sequential transarterial chemoembolization and microwave ablation for subphrenic hepatocellular carcinoma: A comprehensive evaluation
Zi-Yi Zhu, Zhen Qian, Zhong-Qiang Qin, Bo Xie, Jian-Zhu Wei, Pei-Pei Yang, Mu Yuan
Zi-Yi Zhu, Zhen Qian, Zhong-Qiang Qin, Bo Xie, Jian-Zhu Wei, Pei-Pei Yang, Mu Yuan, Department of Interventional Radiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, Anhui Province, China
Author contributions: Yuan M contributed to the conception and design; Qian Z, Qin ZQ, Xie B, Wei JZ, and Yang PP are responsible for the provision of the study materials and data collection; Zhu ZY and Yuan M contributed to the data analysis and interpretation; Zhu ZY contributed to the manuscript writing; All authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by The First Affiliated Hospital of Bengbu Medical University (Approval No. 2024KY047).
Informed consent statement: Informed consent was waived by the First Affiliated Hospital of Bengbu Medical University Institutional Review Board.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
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: Mu Yuan, MD, Associate Chief Physician, Department of Interventional Radiology, The First Affiliated Hospital of Bengbu Medical University, No. 287 Changhuai Road, Longzihu District, Bengbu 233004, Anhui Province, China. yuanmu2008@163.com
Received: January 1, 2024
Revised: April 11, 2024
Accepted: May 27, 2024
Published online: July 15, 2024
Processing time: 193 Days and 6.2 Hours
Abstract
BACKGROUND

Subphrenic carcinoma has been identified as a significant risk factor for the thermal ablation of intrahepatic tumors, resulting in a high rate of residual tumor recurrence. Some studies have proposed that combination treatment with transarterial chemoembolization (TACE) followed by radiofrequency ablation is both feasible and safe for tumors in the subphrenic region. However, research specifically examining the therapeutic outcomes of combination therapy using TACE and microwave ablation (TACE-MWA) in subphrenic tumors is lacking.

AIM

To evaluate the efficacy and safety of TACE-MWA in patients with subphrenic hepatocellular carcinoma (HCC).

METHODS

Between December 2017 and December 2021, 49 patients diagnosed with HCC ≤ 6 cm, who received TACE-MWA, were included in this retrospective cohort study. These patients were classified into subphrenic and non-subphrenic groups based on the distance between the diaphragm and the tumor margin. The rates of local tumor progression (LTP), progression-free survival (PFS), and overall survival (OS) were compared between the two groups. Complications were evaluated by using a grading system developed by the Society of Interventional Radiology.

RESULTS

After a median follow-up time of 38 mo, there were no significant differences in LTP between the subphrenic and non-subphrenic groups (27.3% and 22.2% at 5 years, respectively; P = 0.66), PFS (55.5% at 5 years in both groups; P = 0.91), and OS (85.0% and 90.9% in the subphrenic and non-subphrenic groups at 5 years; P = 0.57). However, a significantly higher rate of LTP was observed in subphrenic HCC > 3 cm compared to those ≤ 3 cm (P = 0.085). The dosage of iodized oil [hazard ratio (HR): 1.52; 95% confidence interval (CI): 1.11-2.08; P = 0.009] and multiple tumors (HR: 13.22; 95%CI: 1.62-107.51; P = 0.016) were independent prognostic factors for LTP. There were no significant differences in complication rates between the two groups (P = 0.549).

CONCLUSION

Combined TACE and MWA was practical and safe for managing subphrenic HCC. The efficacy and safety levels did not vary significantly when tumors outside the subphrenic region were treated.

Keywords: Hepatocellular carcinoma; Transarterial chemoembolization; Microwave ablation; Prognosis; Subphrenic

Core Tip: Tumors located under the diaphragm present a challenge when it comes to percutaneous thermal ablation of liver tumors, as they have a higher likelihood of recurrence compared to resection and laparoscopic ablation. There is a solution that can enhance the accuracy of localization and increase the coverage of ablation: the combination of transarterial chemoembolization and percutaneous thermal ablation. In addition, the concurrent application of multiple antennas to create a confluent ablation zone has been successfully employed in recent years. Thus, we aim to investigate the effectiveness and safety of the combination therapy for tumors located under the diaphragm.