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Lin ZP, Huang DB, Zou XG, Chen Y, Li XQ, Zhang J. Percutaneous microwave ablation and transcatheter arterial chemoembolization for serum tumor markers and prognostics of middle-late primary hepatic carcinoma. World J Gastrointest Surg 2023; 15:2783-2791. [PMID: 38222024 PMCID: PMC10784823 DOI: 10.4240/wjgs.v15.i12.2783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/17/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Primary hepatic carcinoma (PHC) has an insidious onset and is usually diagnosed in the middle and late stages. Although transcatheter arterial chemoembolization (TACE) is the preferred option for treating middle- and advanced-stage PHC, it has limited efficacy in killing tumor cells and poor long-term efficacy. TACE plus percutaneous microwave coagulation therapy (PMCT) is more effective than interventional therapy alone and can improve survival time. However, there are few reports on the effects of TACE and PMCT on serum marker levels and the prognosis of patients with advanced PHC. AIM To investigate the effect of PMCT + TACE on serum tumor markers and the prognosis of middle-late PHC. METHODS This retrospective study included 150 patients with middle-late PHC admitted to Zhongshan People's Hospital between March 2018 and February 2021. Patients were divided into a single group (treated with TACE, n = 75) and a combined group (treated with TACE + PMCT, n = 75). Before and after treatment, the clinical efficacy and serum tumor marker levels [carbohydrate antigen 19-9 (CA19-9), alpha-fetoprotein (AFP), and carcinoembryonic antigen (CEA)] of both groups were observed. The 1-year survival rates and prognostic factors of the two groups were analyzed. RESULTS The combined group had 21 and 35 cases of complete remission (CR) and partial remission (PR), respectively. The single group had 13 and 25 cases of CR and PR, respectively. After 4 wk of treatment, the serum CA19-9, CEA, and AFP levels in the single and combined groups decreased, with the decrease in the combined group being more significant (P < 0.05). The 1-year survival rate of the combined group (80.00%) was higher than that of the single group (60.00%) (P < 0.05). The average survival time within 1 year in the combined group was 299.38 ± 61.13 d, longer than that in the single group (214.41 ± 72.97 d, P < 0.05). COX analysis revealed that tumor diameter, tumor number, and the treatment method were prognostic factors for patients with middle-late PHC (P < 0.05). CONCLUSION TACE + PMCT is effective in treating patients with mid-late PHC. It reduces the levels of tumor markers, prolongs survival, and improves prognosis.
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Affiliation(s)
- Zhi-Peng Lin
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Da-Bei Huang
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Xu-Gong Zou
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Yuan Chen
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Xiao-Qun Li
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Jian Zhang
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
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Zhang L, Xu K, Zhang X, Li L, Chong J, Yu N. A meta-analysis and trial sequential analysis of high intensity focused ultrasound ablation combined with transhepatic arterial chemotherapy and embolization for hepatoma. Front Oncol 2022; 12:1025177. [PMID: 36387209 PMCID: PMC9646942 DOI: 10.3389/fonc.2022.1025177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The efficacy of High Intensity Focused Ultrasound Ablation(HIFU) combined with Transhepatic Arterial Chemotherapy And Embolization(TACE) versus TACE alone in the treatment of hepatoma was evaluated by meta-analysis and trial sequential analyses(TSA). Methods Pubmed, Cochrane, Embase, Web of Science, Scoups and CNKI, CQVIP, Wanfang Data(China National Knowledge Infrastructure) databases were searched from database construction to April 2022, and randomized controlled trials were included. Revman and Stata software were used for meta-analysis of tumor changes, survival rate, laboratory indicators and adverse reactions in the included studies, and TSA0.9 was used for sequential analysis. Grade Pro was also used to evaluate the included indicators. Results Twelve studies were included with a sample size of 1025 cases. Meta-analysis showed that the tumor response rate in the combined treatment group was 1.54 times higher than that in TACE alone (OR: 2.54; 95%CI:1.81-3.57) and the 6-month to 5-year survival rate was 1-4 times higher, with statistically significant differences (P<0.05). Subgroup analysis showed that country, pathological type and study type were the sources of heterogeneity. Egger results showed that there was no publication bias (95%CI: -1.333, 3.552; Ppublication=0.276), and the sensitivity analysis results were reliable. TSA results suggest that there may be false positive results, which need to be further confirmed by more studies. Grade evaluation results indicated that the quality of evidence for response rate and one-year survival was low. Conclusion HIFU combined with TACE has better efficacy in the treatment of hepatoma, which is worthy of promotion. However, there may be false positive results in this study, which needs to be further verified by more extensive and more tests.
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Affiliation(s)
- Liang Zhang
- Department of Abdominal Ultrasound, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kuishuai Xu
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuehui Zhang
- Department of Abdominal Ultrasound, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Linqian Li
- Department of Abdominal Ultrasound, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing Chong
- Department of Abdominal Ultrasound, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ning Yu
- Department of Abdominal Ultrasound, the Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Ning Yu,
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Wang YB, Ma R, Wang ZB, Shi QL, Zhang L, Chen WZ, Gong JP, Bai J. Transcatheter Arterial Chemoembolization in Combination With High-Intensity Focused Ultrasound for Intermediate and Advanced Hepatocellular Carcinoma: A Meta-Analysis. Front Oncol 2022; 12:797349. [PMID: 35419281 PMCID: PMC8999843 DOI: 10.3389/fonc.2022.797349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background The study was conducted to explore whether high-intensity focused ultrasound (HIFU) can improve the effect of transcatheter arterial chemoembolization (TACE) in intermediate and advanced hepatocellular carcinoma (HCC). Methods PubMed, Embase, Cochrane Library, Web of Science, Wanfang Data, CQVIP, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical (CBM) databases were searched for randomized controlled trials (RCTs) comparing the effect of TACE in combination with HIFU group (group A) to TACE alone group (group B) in treating intermediate and advanced HCC. The primary outcomes were overall survival (OS) rate and tumor response rate. The odds ratio (OR) and 95% confidence interval (CI) for each study were calculated and then pooled with fixed effects model or random effects model. Sensitivity analyses and subgroup analyses were conducted. A publication bias was also evaluated. Results After literature selection, eleven RCTs involving 803 patients were included in this meta-analysis. This meta-analysis revealed that group A was associated with an increased 6-month OS rate (OR = 0.20), 12-month OS rate (OR = 0.23), 24-month OS rate (OR = 0.32), and overall response rate (WHO criterion, OR = 0.22; RECIST criterion, OR = 0.30). Furthermore, subgroup analyses showed no bias in the result. Given the limited number of studies that reported major complications, no additional meta-analysis of complication was conducted. Despite no special treatment, any complication following HIFU treatment was found to subside within 3-7 days. Conclusion TACE in combination with HIFU is associated with increased OS and tumor response in intermediate and advanced HCC. Current evidence supports the use of HIFU after TACE treatment in intermediate and advanced HCC.
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Affiliation(s)
- Yun-Bing Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rong Ma
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Biao Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Qiu-Ling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Lian Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Wen-Zhi Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jian-Ping Gong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jin Bai
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Zhang Q, Wang Y, Zhang J, Zhang W, Gong J, Ma R. TACE Combined with HIFU Versus Surgical Resection for Single Hepatocellular Carcinoma with Child-Pugh B Cirrhosis in Overall Survival and Progression-Free Survival: A Retrospective Study. Technol Cancer Res Treat 2021; 20:15330338211060180. [PMID: 34855560 PMCID: PMC8649445 DOI: 10.1177/15330338211060180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: To compare the effectiveness, safety and survival outcome
of transcatheter arterial chemoembolization (TACE) combined with high-intensity
focused ultrasound (HIFU) versus surgical resection for treating single
hepatocellular carcinoma (HCC) with Child-Pugh B cirrhosis.
Methods: A hospital-based retrospective study with 146 patients
diagnosed with single HCC with Child-Pugh B cirrhosis from July 2010 to July
2018 was conducted in a tertiary teaching hospital. A total of 49 patients
underwent TACE combined with HIFU (the combined group), and 97 patients
underwent surgical resection (the resection group). Of them, 22 patients
undergoing TACE combined with HIFU and 45 patients undergoing surgical resection
had small HCC (tumor diameter ≤3 cm). The overall survival (OS) time,
progression-free survival (PFS) time and postoperative complications were
compared between the two groups. Results: In the single HCC tumor
cohort, there was no significant difference in OS between the two groups [hazard
ratio (HR) = 0.6379; 95% confidence interval (95% CI) = 0.3737 to 1.089;
P = .0995], while the resection group showed an obvious
superiority to the combined group regarding PFS (HR = 0.3545; 95%
CI = 0.2176-0.5775; P < .0001). The 1-year, 3-year and
5-year recurrence rates were 30.9%, 55.7%, 86.6% in the resection group and
53.1%, 77.6%, 89.8% in the combined group, respectively. In the small HCC tumor
cohort, there was also no difference in OS between the two groups (HR = 0.8808;
95% CI = 0.3295-2.355; P = .06396), while the resection group
showed an obvious superiority to the combined group regarding PFS (HR = 0.4273;
95% CI = 0.1927-0.9473; P = .0363). The 1-year, 3-year and
5-year recurrence rates were 28.9%, 53.3%, 93.3% in the resection group and
40.9%, 68.2%, 81.8% in the combined group, respectively. Furthermore, the
incidence of complications of the combined group was 38.8%, which was
significantly less than the 56.7% of the resection group
(P = .041), and the duration of general anesthesia in the
combined group was shorter than that in the resection group
(P = .001). Therein, there was no difference in the incidence
of grade I complications (Clavien-Dindo classification) between the two groups
(P = .866). Conclusion: For patients with
single or single small HCCs, TACE combined with HIFU may not be inferior to
surgical resection in terms of the long-term survival rate, while surgical
resection still has a definite advantage in terms of delaying recurrence. In
addition, the combination of TACE and HIFU has higher safety than surgical
resection.
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Affiliation(s)
- Qiwei Zhang
- People's Hospital of Chongqing Banan District, Chongqing, P. R. China
| | - Yunbing Wang
- 585250The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Junyong Zhang
- 585250The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Wenfeng Zhang
- 585250The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Jianping Gong
- 585250The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Rong Ma
- 585250The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
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Ji Y, Zhu J, Zhu L, Zhu Y, Zhao H. High-Intensity Focused Ultrasound Ablation for Unresectable Primary and Metastatic Liver Cancer: Real-World Research in a Chinese Tertiary Center With 275 Cases. Front Oncol 2020; 10:519164. [PMID: 33194582 PMCID: PMC7658544 DOI: 10.3389/fonc.2020.519164] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
This retrospective analysis was conducted to evaluate the feasibility and safety of high-intensity focused ultrasound ablation for primary liver cancer and metastatic liver cancer. Patients with liver cancer who received high-intensity focused ultrasound were included in this analysis, including a primary liver cancer cohort (n=80) and a metastatic liver cancer cohort (n=195). The primary endpoint of our research was tumor response. The secondary endpoints included survival outcomes, visual analog scale pain scores, alpha-fetoprotein relief, and complications. Objective response rate and disease control rate were observed to be 71.8% and 81.2%, respectively, in patients with primary liver cancer and were 63.7% and 83.2% in cases with metastatic liver cancer. Alpha-fetoprotein levels and visual analogue scale levels significantly decreased after treatment compared with the baseline levels in patients with primary liver cancer (p<0.05). Median overall survival was estimated to be 13.0 and 12.0 months in the primary liver cancer and metastatic liver cancer cohorts. The 1-year survival rate was 70.69% and 48.00%, respectively. Multivariate regression analysis showed that visual analogue scale ≥ 5, longest diameter ≥ 5 cm, and portal vein invasion were the independent risk factors for poor survival in primary liver cancer. For patients with metastatic liver cancer, independent risk factors were identified as visual analogue scale ≥ 5, longest diameter ≥ 5 cm, existence of extrahepatic metastases, existence of portal vein invasion, and time to high-intensity focused ultrasound treatment from diagnosis < 3 months. Severe adverse events were rarely reported. In conclusion, high-intensity focused ultrasound might be an effective and safe option for patients with liver cancer regardless of primary and metastatic lesions.
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Affiliation(s)
| | | | | | | | - Hong Zhao
- HIFU Center of Oncology Department, Huadong Hospital Affiliated to Fudan University, Shanghai, China
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