Transcatheter Arterial Chemoembolization Combined with Simultaneous Computed Tomography-guided Radiofrequency Ablation for Large Hepatocellular Carcinomas

Decision-Tree Models Indicative of Microvascular Invasion on MRI Predict Survival in Patients with Hepatocellular Carcinoma Following Tumor Ablation

Purpose

Histological microvascular invasion (MVI) is a risk factor for poor survival and early recurrence in hepatocellular carcinoma (HCC) after surgery. Its prognostic value in the setting of locoregional therapies (LRT), where no tissue samples are obtained, remains unknown. This study aims to establish CT-derived indices indicative of MVI on liver MRI with superior soft tissue contrast and evaluate their association with patient survival after ablation via interstitial brachytherapy (iBT) versus iBT combined with prior conventional transarterial chemoembolization (cTACE).

Patients and Methods

Ninety-five consecutive patients, who underwent ablation via iBT alone (n = 47) or combined with cTACE (n = 48), were retrospectively included between 01/2016 and 12/2017. All patients received contrast-enhanced MRI prior to LRT. Overall (OS), progression-free survival (PFS), and time-to-progression (TTP) were assessed. Decision-tree models to determine Radiogenomic Venous Invasion (RVI) and Two-Trait Predictor of Venous Invasion (TTPVI) on baseline MRI were established, validated on an external test set (TCGA-LIHC), and applied in the study cohorts to investigate their prognostic value for patient survival. Statistics included Fisher's exact and t-test, Kaplan-Meier and cox-regression analysis, area under the receiver operating characteristic curve (AUC-ROC) and Pearson's correlation.

Results

OS, PFS, and TTP were similar in both treatment groups. In the external dataset, RVI showed low sensitivity but relatively high specificity (AUC-ROC = 0.53), and TTPVI high sensitivity but only low specificity (AUC-ROC = 0.61) for histological MVI. In patients following iBT alone, positive RVI and TTPVI traits were associated with poorer OS (RVI: p < 0.01; TTPVI: p = 0.08), PFS (p = 0.04; p = 0.04), and TTP (p = 0.14; p = 0.03), respectively. However, when patients with combined cTACE and iBT were stratified by RVI or TTPVI, no differences in OS (p = 0.75; p = 0.55), PFS (p = 0.70; p = 0.43), or TTP (p = 0.33; p = 0.27) were observed.

Conclusion

The study underscores the role of non-invasive imaging biomarkers indicative of MVI to identify patients, who would potentially benefit from embolotherapy via cTACE prior to ablation rather than ablation alone.

Transarterial Chemoembolization Combined with Lenvatinib Plus Sequential Microwave Ablation for Large Hepatocellular Carcinoma Beyond Up-to-Seven Criteria: A Retrospective Cohort Study

RATIONALE AND OBJECTIVES

The aim of this study was to investigate the efficacy and safety of transarterial chemoembolization (TACE) combined with Lenvatinib plus sequential microwave ablation (MWA) for the treatment of patients with large hepatocellular carcinoma (HCC) beyond up-to-seven criteria.

MATERIALS AND METHODS

This retrospective cohort study assessed the medical records of patients with large HCC who underwent TACE combined with Lenvatinib plus sequential MWA (TLM) or TACE plus sequential MWA (TM). Lenvatinib was administered to patients within 3-5 days after TACE and sequential MWA was performed once they met the criteria for curative ablation after TACE or the combination therapy. The progression-free survival (PFS), overall survival (OS) and treatment-related complications were compared between two groups.

RESULTS

Of the 81 patients who underwent TLM or TM, 64 who met the eligibility criteria were included in this study. Among them, 28 patients underwent TLM and 36 underwent TM. The inverse probability weighting method (IPTW) was used to balance differences between two groups. The TLM group had longer PFS than the TM group (median, before IPTW: 18.53 vs. 5.62 months, p < 0.001; median, after IPTW: 28.27 vs. 5.30 months, p < 0.001). Univariate and multivariate analyses revealed that TLM and the maximum tumor diameter were independent prognostic factors for PFS. The overall incidence rate of minor complications related to TACE or MWA was lower in the TLM group (32.1% vs. 66.7%, p = 0.006).

CONCLUSION

TACE combined with Lenvatinib plus sequential MWA can prolong the progression-free survival of patients with large HCC beyond up-to-seven criteria.

Hepatocellular Carcinoma With Tumor Thrombus Extension Into the Right Atrium of the Heart

Hepatocellular carcinoma (HCC) is the most common primary liver tumor. Most patients present to the hospital with systemic symptoms and typically have a history of liver disease. This case study involves a male in his 60s who presented to our hospital facility with a chief complaint of abdominal pain. He reported no history of liver disease but was diagnosed with HCC stage IVB during this hospitalization. Upon further imaging, a tumor thrombus was found invading the inferior vena cava with an extension into the right atrium. Our primary learning point in this article is to emphasize the importance of prompt surveillance for primary care physicians with patients who are at increased risk for HCC. Additionally, we discuss specific management aimed toward patients diagnosed with a tumor thrombus extending into the right atrium. This management includes dual immunotherapy (atezolizumab and bevacizumab) and transarterial chemotherapy embolization (TACE).

Transarterial Chemoembolization Combined with Simultaneous Thermal Ablation for Solitary Hepatocellular Carcinomas in Regions with a High Risk of Recurrence

OBJECTIVES

We evaluated the safety and efficacy of transarterial chemoembolization combined with percutaneous thermal ablation (radiofrequency or microwave ablation) in the treatment of solitary hepatocellular carcinoma tumors ranging from 2 to 4.5 cm at subdiaphragmatic, subcapsular, or perivascular locations.

MATERIALS AND METHODS

Fifteen patients (12 men, mean [range] age of 66.6 ± 10.88 [34-75] y) who received transarterial chemoembolization combined with simultaneous percutaneous radiofrequency ablation (n = 5) or microwave ablation (n = 10) for hepatocellular carcinoma in regions with high risk of recurrence (subdiaphragmatic, subcapsular, or perivascular) between 2012 and 2018 were evaluated. We retrospectively investigated tumor diameter and localization, success rate, safety, local efficacy (imaging at month 1 after treatment), local tumor response (3 months posttreatment), local tumor progression, intrahepatic distant recurrence, overall survival and complications.

RESULTS

Tumor diameter ranged from 20 to 45 mm (mean 31.7 ± 7.37 mm). Hepatocellular carcinoma diameter was 2 to 3 cm in 7 patients and 3.1 to 4.5 cm in 8 patients. The technical success rate was 100%, with no life-threatening complications. At enhanced imaging at 1-month follow-up, the complete necrosis rate was 100%; at 3 months, 100% of patients had a complete response. During a mean follow-up of 26 ± 13.6 months, 7 patients (46.7%) had tumor progression. Three patients (20%) had local tumor response, and 4 patients (26.7 %) experienced distant recurrences in the untreated liver. The mean local tumor progression and mean intrahepatic distance recurrence times were 11 months and 29.5 months, respectively. Overall survival rates were 100% at 1 year, 73% at 3 years, and 47% at 5 years.

CONCLUSIONS

Transarterial chemoembolization combined with simultaneous percutaneous thermal ablation is safe, feasible, and effective in enhancing the local control rate for solitary hepatocellular carcinoma ranging from 2 to 4.5 cm in regions with high risk of recurrence.

Comparison of the Efficacy and Safety of Transarterial Chemoembolization Plus Microwave Ablation versus Surgical Resection in Patients with Solitary Large Hepatocellular Carcinoma: A Propensity Score-Matched Analysis

Background

The liver resection for solitary large hepatocellular carcinoma (SLHCC) remains controversial due to the high risk of complications and recurrence after resection. This study aimed to compare the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus microwave ablation (MWA) with resection for SLHCC.

Methods

We retrospectively analyzed a total of 148 patients who were treated with either TACE-MWA (n = 94) or resection (n = 54) for SLHCC (≥5 cm). A matched cohort composed of 86 patients was included after propensity score matching (PSM). The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS) and safety.

Results

The TACE-MWA group was older with higher ALT and AST (all P < 0.05). After PSM, the 1-, 3-, and 5-year OS were 100%, 80.3%, and 51.0% in the TACE-MWA group, and 88.3%, 66.7%, and 39.4% in the liver resection group, respectively. The 1-, 3-, and 5-year PFS were 76.7%, 48.8%, and 19.6% in the TACE-MWA group, and 72%, 40.2%, and 22.6% in the liver resection group, respectively. There was no significant difference in OS and PFS between the two groups (all P > 0.05). For SLHCC patients with tumor size ≥7cm, TACE-MWA showed favorable OS than liver resection. The TACE-MWA group exhibited a lower rate of major complications and shorter hospital stay than the resection group.

Conclusion

TACE-MWA showed comparable efficacy to liver resection in patients with SLHCC, but better safety and shorter hospital stay. TACE-MWA might provide a longer OS than liver resection for SLHCC patients with tumor size ≥7cm.

Recent Perspectives on the Mechanism of Recurrence After Ablation of Hepatocellular Carcinoma: A Mini-Review

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Hepatectomy, liver transplantation, and ablation are the three radical treatments for early-stage hepatocellular carcinoma (ESHCC), but not all patients are fit for or can tolerate surgery; moreover, liver donors are limited. Therefore, ablation plays an important role in the treatment of ESHCC. However, some studies have shown that ablation has a higher local recurrence (LR) rate than hepatectomy and liver transplantation. The specific mechanism is unknown. The latest perspectives on the mechanism of recurrence after ablation of HCC were described and summarized. In this review, we discussed the possible mechanisms of recurrence after ablation of HCC, including epithelial–mesenchymal transition (EMT), activating autophagy, changes in non-coding RNA, and changes in the tumor microenvironment. A systematic and comprehensive understanding of the mechanism will contribute to the research and development of related treatment, combined with ablation to improve the therapeutic effect in patients with ESHCC.

Transarterial Chemoembolization Combined With Radiofrequency Ablation Versus Hepatectomy for Hepatocellular Carcinoma: A Meta-Analysis

Background

Although many studies reported the effectiveness of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) or surgical resection (SR) in the treatment of hepatocellular carcinoma (HCC), the efficacy of these two strategies remains controversial. Therefore, this meta-analysis aimed to evaluate and compare the efficacy of sequential use of TACE plus RFA (TACE + RFA) and SR alone in treating HCC.

Methods

Relevant studies with unmatched and propensity score-matched patients were identified by comprehensive search of MEDLINE, PubMed, EMBASE, Web of Science, and Cochrane electronic databases. Meta-analysis was conducted using Review Manager (RevMan) software version 5.4.1. Finally, 12 eligible studies were included in this study, including 11 case–control studies and 1 randomized controlled trial. The primary outcome of interest for this study was to compare the 1-, 3-, and 5-year overall survival (OS) and disease-free survival (DFS), major complications, 5-year OS in different tumor diameters between the two treatment strategies, and hospital stay time.

Results

HCC patients who received TACE + RFA had a lower incidence of complication rates and shorter hospital stay time than those who received SR alone. Among these studies using propensity score-matched cohorts, SR had better 3- and 5-year OS than TACE + RFA, whereas there were no significant differences between TACE + RFA and SR regarding the 1-, 3-, and 5-year DFS. When the tumor diameter is longer than 3 cm, the 5-year OS rate is better when SR is selected.

Conclusion

There was no significant difference in the short-term survival outcomes between TACE + RFA and SR in HCC patients. Moreover, SR is superior to TACE + RFA in terms of long-term beneficial effects but may result in a higher risk of major complications and a longer hospital stay time.

Quality of Life after Transcatheter Arterial Chemoembolization Combined with Radiofrequency Ablation in Patients with Unresectable Hepatocellular Carcinoma Compared with Transcatheter Arterial Chemoembolization alone

AIM

The aim of this study was to assess quality of life (QoL) in patients with unresectable hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) compared to TACE plus radiofrequency ablation (RFA) done at the same sitting, and to assess tumor therapy response after these 2 palliative interventions.

METHODS

73 patients with unresectable HCC (BCLC-B) were included. Patients with tumor ≤ 5 cm were subjected to TACE (N = 45) while patients with tumors > 5 cm were subjected to TACE followed immediately by RFA (N = 28). QoL was evaluated with two validated questionnaires (EORTC QLQ-30 and EORTC HCC18). These questionnaires were filled out before intervention, 2 weeks and 2 months after intervention. Pre/post interventional changes were analyzed. The modified response evaluation criteria in solid tumor (mRECIST) were employed for the evaluation of therapeutic efficacy.

RESULTS

Baseline global health status/QoL was significantly higher in TACE group (64.1%) compared to TACE-RFA group (51.2%). Two weeks after intervention: the absolute decrease in global health state was higher in TACE-RFA (- 12.1%) compared to TACE (- 6.3%, p = 0.411). Less impairment was found in TACE group compared to TACE-RFA group for physical/social functioning, fatigue and pain but it was statistically insignificant. Two months after intervention; TACE-RFA group showed significant improvement in global health score, social and physical functioning scores, as well as significant improvement in pain and fatigue compared to TACE group. The therapeutic efficacy of TACE-RFA was better than TACE alone: complete remission, partial remission, stable disease and progressive disease were 17.9%, 32.1%, 42.9% and 7.1% Vs11.1%, 22.2%, 48.9% and 17.8%, respectively).

CONCLUSION

Neither TACE nor TACE-RFA showed a significant decrease in QoL in patients with unresectable HCC two weeks after intervention. However, two months after intervention; TACE-RFA showed significant improvement in global health score compared to TACE monotherapy. TACE-RFA appeared safe, effective and more favorable than TACE monotherapy.
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A comprehensive intervention on feasibility, efficacy, and safety between TAE combined with multi-applicator ablation therapy and TACE in the treatment of large hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) is one of the most common tumors in recent days with high mortality and low early diagnosis rate, resulting in the fourth leading cause of deaths globally. This study aimed to evaluate the feasibility, efficacy, and safety between transcatheter arterial embolization (TAE) therapy followed by multi-applicator ablation and transarterial chemoembolization (TACE) for the treatment of large HCC.

METHODS

An intervention study conducted at the Cancer Center of Sun Yat-sen University, Guangzhou, China, with whom had large HCC. A comparison between the two groups (intervention and control group) was evaluated at different time dimensions by repeated-measures analysis of variance, Mann-Whitney U rank-sum test, where Kaplan-Meier and log-rank test calculated for the overall survival (OS), tumor response (TR), and progression-free survival (PFS).

RESULTS

This study found the improved survival rate (SR) and PFS after 1-year treatment in the observation group (Group-I) by 56.4% and 12.8%, compared to 38.3% and 8.5% in the control group (Group-II). Likewise, 1- and 2-year OS rates (OSRs) in Group-I were 66.7% and 51.4%, wherein Group-II were 48.9% and 30.0%, respectively. The short-term efficacy of Group-I, such as complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD) were 28.21%, 56.41%, 0, 15.38%, while in Group-II was 2.13%, 68.79%, 6.38% 22.70% respectively, which were significant. The short-term efficacy was more excellent in the Group-I than Group-II. The quality of life (QOL) was better in Group-I than that of Group-II.

CONCLUSIONS

TAE combined with multi-applicator ablation therapy is safer, effective with prolonged survival, and less severe adverse reactions compared to TACE therapy for the treatment of large HCC.

Transarterial chemoembolization combined with radiofrequency ablation for solitary large hepatocellular carcinoma ranging from 5 to 7 cm: an 8-year prospective study

PURPOSE

This prospective study was performed to investigate long-term (8-year) survival in patients with solitary large hepatocellular carcinoma (HCC) ranging from 5 to 7 cm who underwent transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) and identify factors that significantly affected outcomes.

METHODS

Forty-eight patients with large HCC (36 men, 12 women; mean age, 57.0 ± 11.2 [range, 37-82] years) without fever or signs of infection were enrolled. All patients were treated with TACE + RFA. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. Prognostic factors were assessed using the Cox hazards regression method.

RESULTS

The median OS duration was 47.0 months, and the 1-, 3-, 5-, and 8-year OS rates were 73%, 57%, 53%, and 27%, respectively. The median DFS duration was 9.05 (3.99-12.01) months, and the 1-, 3-, and 5-year DFS rates were 35%, 9%, and 0%, respectively. Cox hazards regression analysis revealed that the Child-Pugh class, platelet count, lymphocyte-to-monocyte ratio (LMR), and DFS were independent predictive factors of OS (p = 0.000, 0.003, 0.020, and 0.000, respectively). The LMR and platelet-to-lymphocyte ratio (PLR) were independent predictive factors of recurrence (p = 0.046 and 0.016, respectively).

CONCLUSION

TACE + RFA may be a safe and effective treatment for selected solitary large HCC ranging from 5 to 7 cm. Measurement of the LMR (> 4) and PLR (≤ 100) in peripheral blood before the intervention might help to identify which patients with solitary large HCC are suitable for TACE + RFA. Registration number: ChiCTR-TRC-12002768 ( https://www.chictr.org.cn ).

Comparison of Angio-CT and cone-beam CT-guided immediate radiofrequency ablation after transcatheter arterial chemoembolization for large hepatocellular carcinoma

PURPOSE

To evaluate the rapeutic effectiveness of Angio-CT or cone-beam CT (CBCT)-guided immediate radiofrequency ablation (RFA) after transcatheter arterial chemoembolization (TACE) for large hepatocellular carcinoma (HCC).

METHODS

117 large HCC patients (mean maximum diameter: 9.3 cm; range 5.3-17.7 cm) were retrospective studied and divided into Angio-CT group (n = 66 cases), CBCT group (n = 21 cases), and single TACE group (n = 30 cases) according to treatment (Angio-CT/CBCT-guided immediate RFA after TACE, single TACE, respectively). The operative time, effective radiation dose, local-regional tumor responses, overall survival (OS), and progression‑free survival (PFS) time and complications were recorded.

RESULTS

The operative time and effective radiation dose of Angio-CT group and CBCT group were higher than those of TACE group (P < 0.01). The local-regional tumor responses on 1-month follow-up MRI (complete response + partial response) of Angio-CT group and CBCT group were 100%, which were significantly higher than that of single TACE group (76.7%, P < 0.05). There was no significant difference in local-regional tumor responses of 1-month follow-up between Angio-CT group and CBCT group (P = 0.831). The median PFS and OS time of Angio-CT group were 14.7 ± 1.43 months and 18.21 ± 0.88 months, CBCT group were 13.9 ± 1.53 months and 17.87 ± 1.78 months, TACE group were 10.4 ± 1.21 months and 12.87 ± 0.91 months, respectively. No procedure-related major complications occurred.

CONCLUSIONS

MIYABI Angio-CT or CBCT-guided immediate RFA after TACE for large HCC both have more effective than single TACE. The former is worth popularizing, due to its advantages of convenience, shorter operative time, and less radiation dose for doctors.

Assessment in the Survival Outcome After Transarterial Chemoembolization Combined with Cryoablation for Hepatocellular Carcinoma (Diameter > 4cm) Based on the Albumin-Bilirubin Grade and Platelet-Albumin-Bilirubin ‎grade: ‎ A Preliminary Study

Objective

Based on the albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grade to assess the long-term outcomes of patients with large hepatocellular carcinoma (HCC) after transarterial chemoembolization combined with cryoablation (TACE-CRA).

Materials and Methods

We studied 86 patients with HCC nodules (up to 3 HCCs with maximum diameters of 4.1–12.0 cm) who subsequently underwent TACE-CRA from July 2007 to August 2018. The overall survival (OS) was compared between groups classified by ALBI and PALBI grade. Baseline characteristics were collected to identify the risk factors for determination of poor OS after TACE-CRA. The prognostic performances of CTP class, ALBI and PALBI grade were compared.

Results

After a median follow-up time of 33.8 months, 41 patients had died. The cumulative1-, 3- and 5-year OS rates were 74.5%, 38.0% and 29.3%, respectively. Stratified according to ALBI grade, the cumulative 3- and 5-year OS rates were 41.2% and 41.2% in grade 1, respectively, and 20.9% and 9.8% in grades 2–3, respectively (P < 0.001). Stratified according to PALBI grade, the cumulative 3- and 5-year OS rates were 41.2% and 37.5% in grade 1, respectively, and 36.3% and 21.2% in grades 2–3, respectively (P = 0.002). Multivariate analysis results showed that older age, and ALBI grade 2–3 were associated with overall mortality. ALBI grade demonstrated significantly greater area under the curve values than CTP class and PALBI in predicting 1-, 3- and 5-year OS.

Conclusion

ALBI grade offers accurate prediction of long-term outcome for patients with HCC (diameter > 4 cm) after TACE-CRA.

Safety and effectiveness of multi-antenna microwave ablation-oriented combined therapy for large hepatocellular carcinoma

BACKGROUND

In patients with a large, unresectable hepatocellular carcinoma (HCC), the primary recommendation is for transarterial chemoembolization (TACE) but used alone TACE is not typically curative. Combinations of TACE followed in a delayed fashion by single-applicator thermal ablation have also been suboptimal. As an alternative, we investigated the combination of TACE followed within 1-3 days by multi-antenna microwave ablation (MWA) in patients with a large HCC, to determine the feasibility, safety, local control, and short-term survival rates of this approach.

METHODS

We retrospectively studied 43 patients with a large HCC (mean diameter, 8.8 cm; SD, 2.8 cm) treated between July 2015 and July 2018, who underwent TACE followed within 3 days by multi-antenna simultaneous MWA. We measured the liver and renal function before and after treatment, recorded complications, used three-dimensional software and imaging to calculate tumor necrosis rates at 1 month after therapy, and calculated overall survival (OS) and progression-free survival (PFS) using the Kaplan-Meier method.

RESULTS

Mean follow up was 12.2 (range, 3.5-35.6) months. All patients completed the treatment protocol. At 1 month after combined therapy, tumor necrosis was complete in 16 (37.2%), nearly complete in 19 (44.2%), and partial in 8 (18.6%) patients. The 1- and 2-year OS rates were 64.0% and 46.8%, respectively, with a median OS of 23.0 months; and the 1- and 2-year PFS rates were 19.9% and 4.4%, respectively, with a median PFS of 4.2 months. A transient change in liver function occurred 3 days after MWA but resolved within 1 month. Only two patients had major complications, which were treatable and resolved.

CONCLUSION

Multi-antenna MWA-oriented combined therapy is feasible and well tolerated, and it results in satisfactory initial local control and short-term survival in some but not all patients with a large HCC.

Efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE) combined with radiofrequency ablation versus DEB-TACE alone in Chinese hepatocellular carcinoma patients

To compare the efficacy of drug-eluting bead transarterial chemoembolization combined with radiofrequency ablation (DEB-TACE+RFA) versus DEB-TACE alone in Chinese hepatocellular carcinoma (HCC) patients.The 28 patients receiving DEB-TACE+RFA and 74 HCC patients receiving DEB-TACE were recruited in this study. Treatment responses, progression-free survival (PFS), and overall survival (OS) were evaluated.One to 3 months after treatments, the proportion of patients achieving complete response (CR) (78.6% vs 33.8%, P <.001) and objective response rate (ORR) (92.9% vs 78.4%, P =.010) were elevated in DEB-TACE+RFA group compared with DEB-TACE group. Multivariate logistic regression displayed that DEB-TACE+RFA was an independently predicting factor for better CR (P = .006). Subgroup analysis of CR achievement illuminated that DEB-TACE+RFA disclosed better CR achievement in patients with history of cirrhosis (P <.001), tumor located in right liver (P = .003), bilobar disease (P = .013), tumor size <3.3 cm (P = .001), no portal vein invasion (P = .001), no hepatic vein invasion (P <.001), Child-pugh stage A (P <.001), Barcelona Clinic Liver Cancer (BCLC) stage 0, A-B (P <.001), abnormal alpha-fetoprotein (AFP) (P = .001) and normal AFP (P = .016). The PFSs were similar between 2 groups (P = .112), however, the OS was more prolonged in DEB-TACE+RFA group (P = .025) compared with DEB-TACE group. And subgroup analysis displayed that PFS of patients with largest nodule size >3.3 cm (P = .025) was longer and patients with unilobar disease (P = .009), and patients with no hepatic invasion (P = .019) and Child-pugh stage A (P = .037) had more favorable OS in DEB-TACE+RFA group compared with DEB-TACE group.DEB-TACE+RFA achieved better treatment responses and OS compared with DEB-TACE alone in Chinese HCC patients.

Ultrasound-guided percutaneous microwave ablation assisted by athree-dimensional visualization treatment platform combined with transcatheter arterial chemoembolization for a single large hepatocellular carcinoma 5 cm or larger: a preliminary clinical application

Objective: To assess the clinical efficiency and feasibility of ultrasound-guided percutaneous microwave ablation (US-PMWA) assisted by a three-dimensional (3D) visualization platform for treating a single large hepatocellular carcinoma (HCC) (diameter ≥5 cm).Methods: We included 40 patients with a single large HCC from May 2015 to August 2017. Nineteen patients who underwent US-PMWA assisted by a 3D visualization platform formed the 3D group; 21 patients without 3D visualization assistance formed the control group. Preoperative planning and post-procedural evaluation were performed successfully with the 3D visualization treatment platform. Thermal ablative parameters, survival and recurrence were compared between groups.Results: The primary efficacy rate and recurrence-free survival (RFS) rate in the 3D group were higher than those in the control group (p = .007 and p = .014, respectively). The number of inserted probes in the 3D group was higher than that in the control group (p = .016). The overall survival (OS) rate in the 3D group was comparable to that of controls (p = .745). Estimated 3-year OS and RFS rates were 38.5% and 64.6% in the 3D group and 34.4% and 18.8% in the control group, respectively. Treatment effects were evaluated using a tumor map and confirmed by traditional contrast-enhanced ultrasound in the 3D group. After the first treatment, nine patients (47.4%) achieved complete ablation with a 5-mm safety margin. No major complications related to ablation occurred.Conclusions: US-PMWA assisted by a 3D visualization treatment platform can improve treatment efficiency and appears to be a safe, effective and innovative technique to manage a single large HCC.