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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2015, Vol. 9 Issue (1) : 63-71     DOI: 10.1007/s11684-014-0342-2
RESEARCH ARTICLE |
Cryotherapy for cirrhosis-based hepatocellular carcinoma: a single center experience from 1595 treated cases
Guanghua Rong,Wenlin Bai,Zheng Dong,Chunping Wang,Yinying Lu,Zhen Zeng,Jianhui Qu,Min Lou,Hong Wang,Xudong Gao,Xiujuan Chang,Linjing An,Yan Chen,Yongping Yang()
Center of Therapeutic Research for Hepatocellular Carcinoma, the 302 Hospital, Beijing 100039, China
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Abstract  

Cryoablation is a less prevalent percutaneous ablative therapy for hepatocellular carcinoma (HCC), and current evidence about its usefulness is limited. We report our experience in treating 1595 HCC cases with percutaneous cryoablation to give a comprehensive profile about the effectiveness, safety and long-term outcome of this therapy. From January 2003 to December 2013, 1595 patients with 2313 HCC nodules were ablated with 2945 cryoablation sessions in our center. Complete ablation was achieved in 1294 patients for 1893 nodules with a mean diameter of 3.4±2.2 cm. The complete ablation rate was 81.2%, 99.4%, 94.4%, and 45.6% in all tumors, tumors<3 cm, tumors<5 cm, and tumors>5 cm, respectively. Major complications were observed after 80 (3.4%) of the 2945 cryoablations and minor complications were observed after 330 cryoablations with no treatment-related deaths. After a median follow-up of 33.4 months, 937 patients developed different types of recurrence. The 5- and 10-year overall survival was 25.7% and 9.2%, respectively. Cryoablation showed reliable safety and efficacy and should be considered as a promising technique, particularly when a large zone of ablation is required.

Keywords hepatocellular carcinoma      percutaneous cryoablation      efficacy      safety     
Corresponding Authors: Yongping Yang   
Online First Date: 04 July 2014    Issue Date: 02 March 2015
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-014-0342-2     OR     http://academic.hep.com.cn/fmd/EN/Y2015/V9/I1/63
Characteristics Value
Age (years)
Mean±SD (range) 53.1±10.2 (17–87)
Gender
Male/female, n (%) 1317 (82.6%) / 278 (17.4%)
Etiology of HCC, n (%)
HBV 1324 (83.0%)
HCV 198 (14.4%)
HBV-HCV 13 (0.8%)
Other 60 (3.8%)
Liver function related tests (Mean±SD)
Serum albumin (g/L) 32.4±7.1
Total bilirubin (umol /L) 21.3±9.4
Cholinesterase (U/L) 4735±1938
Prothrombin time (%) 85.4±17.1
Platelet counts( × 109/L) 124.9±82.4
AFP, n (%)
<20 ng/ml 465 (29.2%)
20–400 ng/ml 605 (37.9%)
>400 ng/ml 525 (32.9%)
Child-Pugh class, n (%)
A 1132 (70.9%)
B 463 (16.2%)
Tumor number, n 2313
Patients with 1 tumor, n (%) 1069 (67.0%)
Patients with 2 tumors, n (%) 334 (20.9%)
Patients with 3 tumors, n (%) 192 (12.1%)
Tumor size (cm)
Mean±SD (range) 3.8±2.5 (1.2–15 cm)
Tab.1  Baseline characteristics of the 1595 patients who received percutaneous cryoablation
Fig.1  A typical percutaneous cryoablation procedure. MRI scan was applied to determine the location and size of HCC as well as the number of cryoprobes to be used before treatment (A). Under CT guidance, sheath catheters (2 in the selected case) and guide wire were first positioned to the desire sites of tumor (B), whose location was further confirmed by CT scan (C and D). Cryoprobes were then inserted followed by the initiation of cryoablation (E). CT scan was performed 1 week after cryoablation to evaluate the efficacy of treatment. In the selected case, the 5.8 cm HCC lesion was totally replaced by hypovascular necrotic tissue with hypervascular inflammatory rim indicating a complete ablation of the tumor with a single cryoablation session (F).
Major complications Number (Percent)
Tumor seeding 21 (0.90%)
Cryorecation 25 (1.08%)
Severe liver dysfunction 12 (0.52%)
Hepatic hemorrhage 9 (0.38%)
Liver abscess 4 (0.17%)
Pleural abscess 4 (0.22%)
Hemothorax requiring drainage 7 (0.30%)
Pleural effusion requiring drainage 9 (0.39%)
Bowel injure and intestinal fistulas 1 (0.04%)
Total 80 (3.4%)
Minor complications Number (Percent)
Postoperative pain 72 (3.1%)
Postoperative fever 67 (2.9%)
Transient elevation of aminotransferase 55 (1.7%)
Self limiting pleural effusion 39 (2.4%)
Self limiting pneumothorax 22 (0.9%)
Skin frostbite 17 (0.7%)
Stress ulcer 19 (0.8%)
Bleeding at the probe-inserting point 39 (1.7%)
Total 330 (14.3%)
Tab.2  Complications during the cryoablation of 2313 HCC lesions
Fig.2  The overall survival (OS) curve of 1595 patients who received percutaneous cryoablation. The OS rate at 1-, 3-, 5-, and 10-year were 85.7%, 44.6%, 25.7% and 9.2%, respectively, the median survival of 31.8 months.
Cryoablation RFA
Mechanisms Freeze-thaw cycle [16] Thermal coagulation [22]
Anesthesia Local anesthesia [12,13,16] General or local anesthesia [23,24]
Intraoperative visibility Excellent [16] Good [16]
Hemostasis Needle tract packed with surgical through vascular sheath [12,13] Electrocautery needle tract [22]
Treatment efficacy Curative [12,13,16] Curative [3]
Percutaneous treatment Yes [12,13,16] Yes [3]
Best treatable tumor size ≤5 cm [12,13] ≤3 cm [1,3]
Safety Good [12,13] Good [1,3]
Complete ablation rate 94.4% in diamter<5 cm 94.7% – 99.4% in diamter≤3 cm [22,25,26]
Local recurrence rate 11.9% in diamter<5 cm 2.1%–16.4% in diamter≤3 cm [22,25,26]
Overall survival 5- and 10-year survival rates in diamter1.2–15 cm25.7% and 9.2% 5- and 10-year survival rates in diamter≤3 cm59.7%–60.2% and 27.3%–32.3% [22,25,26]
EAE 6.3% NA
Bleeding 1.7% 2.5% [27]
Tumor seeding 0.9% 12.5% [28]
Tab.3  Comparison of cryoablation and RFA therapy in treating HCC
Fig.3  A typical percutaneous cryoablation procedure. MRI scan was applied to determine the location and size of HCC as well as the number of cryoprobes to be used before treatment (A). Under CT guidance, sheath catheters (2 in the selected case) and guide wire were first positioned to the desire sites of tumor (B), whose location was further confirmed by CT scan (C and D). Cryoprobes were then inserted followed by the initiation of cryoablation (E). CT scan was performed 1 week after cryoablation to evaluate the efficacy of treatment. In the selected case, the 5.8 cm HCC lesion was totally replaced by hypovascular necrotic tissue with hypervascular inflammatory rim indicating a complete ablation of the tumor with a single cryoablation session.
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