|
|
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 |
|
|
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 Author(s):
Yongping Yang
|
Online First Date: 04 July 2014
Issue Date: 02 March 2015
|
|
1 |
European Association For The Study Of The Liver1; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56(4): 908-943
pmid: 22424438
|
2 |
Asham EH, Kaseb A, Ghobrial RM. Management of hepatocellular carcinoma. Surg Clin North Am 2013; 93(6): 1423-1450
https://doi.org/10.1016/j.suc.2013.08.008
pmid: 24206860
|
3 |
Lencioni R. Loco-regional treatment of hepatocellular carcinoma. Hepatology 2010; 52(2): 762-773
https://doi.org/10.1002/hep.23725
pmid: 20564355
|
4 |
Adam R, Majno P, Castaing D, Giovenardi R, Bismuth H. Treatment of irresectable liver tumours by percutaneous cryosurgery. Br J Surg 1998; 85(11): 1493-1494
https://doi.org/10.1046/j.1365-2168.1998.00880.x
pmid: 9823908
|
5 |
Lee F, Bahn DK, McHugh TA, Onik GM, Lee FT Jr. US-guided percutaneous cryoablation of prostate cancer. Radiology 1994; 192(3): 769-776
pmid: 8058945
|
6 |
Morris DL. Ablative therapy for liver cancer: which? Ann Surg Oncol 2005; 12(3): 205-206
https://doi.org/10.1245/ASO.2005.12.915
pmid: 15827811
|
7 |
Sheen AJ, Siriwardena AK. The end of cryotherapy for the treatment of nonresectable hepatic tumors? Ann Surg Oncol 2005; 12(3): 202-204
https://doi.org/10.1245/ASO.2005.10.913
pmid: 15827810
|
8 |
Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, Ammatuna M, Morabito A, Gennari L. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334(11): 693-699
https://doi.org/10.1056/NEJM199603143341104
pmid: 8594428
|
9 |
Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005; 42(5): 1208-1236
https://doi.org/10.1002/hep.20933
pmid: 16250051
|
10 |
Lee HS, Kim JK, Cheong JY, Han EJ, An SY, Song JH, Jung YJ, Jeon SC, Jung MW, Jang EJ, Cho SW. Prediction of compensated liver cirrhosis by ultrasonography and routine blood tests in patients with chronic viral hepatitis. Korean J Hepatol 2010; 16(4): 369-375
https://doi.org/10.3350/kjhep.2010.16.4.369
pmid: 21415580
|
11 |
Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999; 19(3): 329-338
https://doi.org/10.1055/s-2007-1007122
pmid: 10518312
|
12 |
Wang C, Lu Y, Chen Y, Feng Y, An L, Wang X, Su S, Bai W, Zhou L, Yang Y, Xu D. Prognostic factors and recurrence of hepatitis B-related hepatocellular carcinoma after argon-helium cryoablation: a prospective study. Clin Exp Metastasis 2009; 26(7): 839-848
https://doi.org/10.1007/s10585-009-9283-6
pmid: 19784786
|
13 |
Yang Y, Wang C, Lu Y, Bai W, An L, Qu J, Gao X, Chen Y, Zhou L, Wu Y, Feng Y, Zhang M, Chang X, Lv J. Outcomes of ultrasound-guided percutaneous argon-helium cryoablation of hepatocellular carcinoma. J Hepatobiliary Pancreat Sci 2012; 19(6): 674-684
https://doi.org/10.1007/s00534-011-0490-6
pmid: 22187145
|
14 |
Zhou L, Wang CP, Lu YY, Bai WL, Qu JH, Lou M, Zeng Z, Wu Y, Chen Y, Wang H, Chang XJ, Yang YP. Decrease in size of non-treated lesions after cryoablation for hepatocellular carcinoma. Hepatogastroenterology 2012; 59(113): 252-254
pmid: 22260835
|
15 |
Seifert JK, Morris DL. World survey on the complications of hepatic and prostate cryotherapy. World J Surg 1999; 23(2): 109-113, discussion 113-114
https://doi.org/10.1007/PL00013173
pmid: 9880417
|
16 |
Hutchinson M, Shyn P, Silverman S. Cryoablation of Liver Tumors. In: Dupuy DE, Fong Y, McMullen WN. Image-Guided Cancer Therapy: New York: Springer, 2013: 491-503
|
17 |
Orlacchio A, Bazzocchi G, Pastorelli D, Bolacchi F, Angelico M, Almerighi C, Masala S, Simonetti G. Percutaneous cryoablation of small hepatocellular carcinoma with US guidance and CT monitoring: initial experience. Cardiovasc Intervent Radiol 2008; 31(3): 587-594
https://doi.org/10.1007/s00270-008-9293-9
pmid: 18236104
|
18 |
Shimizu T, Sakuhara Y, Abo D, Hasegawa Y, Kodama Y, Endo H, Shirato H, Miyasaka K. Outcome of MR-guided percutaneous cryoablation for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 2009; 16(6): 816-823
https://doi.org/10.1007/s00534-009-0124-4
pmid: 19466377
|
19 |
Chen HW, Lai EC, Zhen ZJ, Cui WZ, Liao S, Lau WY. Ultrasound-guided percutaneous cryotherapy of hepatocellular carcinoma. Int J Surg 2011; 9(2): 188-191
https://doi.org/10.1016/j.ijsu.2010.11.008
pmid: 21093616
|
20 |
Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma<or=4 cm. Gastroenterology 2004; 127(6): 1714-1723
https://doi.org/10.1053/j.gastro.2004.09.003
pmid: 15578509
|
21 |
Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Ierace T, Solbiati L, Gazelle GS. Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology 2000; 214(3): 761-768
https://doi.org/10.1148/radiology.214.3.r00mr02761
pmid: 10715043
|
22 |
Rossi S, Ravetta V, Rosa L, Ghittoni G, Viera FT, Garbagnati F, Silini EM, Dionigi P, Calliada F, Quaretti P, Tinelli C. Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: a long-term cohort study. Hepatology 2011; 53(1): 136-147
https://doi.org/10.1002/hep.23965
pmid: 20967759
|
23 |
Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut 2005; 54(8): 1151-1156
https://doi.org/10.1136/gut.2004.045203
pmid: 16009687
|
24 |
Ogihara M, Wong LL, Machi J. Radiofrequency ablation versus surgical resection for single nodule hepatocellular carcinoma: long-term outcomes. HPB (Oxford)2005; 7(3): 214-221
https://doi.org/10.1080/13651820510028846
pmid: 18333193
|
25 |
Shiina S, Tateishi R, Arano T, Uchino K, Enooku K, Nakagawa H, Asaoka Y, Sato T, Masuzaki R, Kondo Y, Goto T, Yoshida H, Omata M, Koike K. Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol 2012; 107(4): 569-577, quiz 578
https://doi.org/10.1038/ajg.2011.425
pmid: 22158026
|
26 |
Kim YS, Lim HK, Rhim H, Lee MW, Choi D, Lee WJ, Paik SW, Koh KC, Lee JH, Choi MS, Gwak GY, Yoo BC. Ten-year outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: analysis of prognostic factors. J Hepatol 2013; 58(1): 89-97
https://doi.org/10.1016/j.jhep.2012.09.020
pmid: 23023009
|
27 |
Wong J, Lee KF, Lee PS, Ho SS, Yu SC, Ng WW, Cheung YS, Tsang YY, Ling E, Lai PB. Radiofrequency ablation for 110 malignant liver tumours: preliminary results on percutaneous and surgical approaches. Asian J Surg 2009; 32(1): 13-20
https://doi.org/10.1016/S1015-9584(09)60003-8
pmid: 19321397
|
28 |
Llovet JM, Vilana R, Brú C, Bianchi L, Salmeron JM, Boix L, Ganau S, Sala M, Pagès M, Ayuso C, Solé M, Rodés J, Bruix J; Barcelona Clínic Liver Cancer (BCLC) Group. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology 2001; 33(5): 1124-1129
https://doi.org/10.1053/jhep.2001.24233
pmid: 11343240
|
29 |
Wang CP, Wang H, Qu JH, Lu YY, Bai WL, Dong Z, Gao XD, Rong GH, Zeng Z, Yang YP. Tumour seeding after percutaneous cryoablation for hepatocellular carcinoma. World J Gastroenterol 2012; 18(45): 6587-6596
https://doi.org/10.3748/wjg.v18.i45.6587
pmid: 23236233
|
30 |
Wang CP, Yang YP. Percutaneous argon-helium cryoablation for hepatocellular carcinoma: safety and efficacy. Infect Dis Info 2012; 25: 312-316
|
31 |
Zhou L, Fu JL, Lu YY, Fu BY, Wang CP, An LJ, Wang XZ, Zeng Z, Zhou CB, Yang YP, Wang FS. Regulatory T cells are associated with post-cryoablation prognosis in patients with hepatitis B virus-related hepatocellular carcinoma. J Gastroenterol 2010; 45(9): 968-978
https://doi.org/10.1007/s00535-010-0243-3
pmid: 20411280
|
32 |
Zeng Z, Shi F, Zhou L, Zhang MN, Chen Y, Chang XJ, Lu YY, Bai WL, Qu JH, Wang CP, Wang H, Lou M, Wang FS, Lv JY, Yang YP. Upregulation of circulating PD-L1/PD-1 is associated with poor post-cryoablation prognosis in patients with HBV-related hepatocellular carcinoma. PLoS ONE 2011; 6(9): e23621
https://doi.org/10.1371/journal.pone.0023621
pmid: 21912640
|
|
Viewed |
|
|
|
Full text
|
|
|
|
|
Abstract
|
|
|
|
|
Cited |
|
|
|
|
|
Shared |
|
|
|
|
|
Discussed |
|
|
|
|