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Context: Microwave ablation (MWA) has been proven as a promising method to treat solid tumors. Aims: This study aims to evaluate the efficacy and safety of ultrasound (US)-guided MWA for treating adrenal metastasis and to explore the factors affecting survival. Settings and Design: This was a retrospective study performed on patients treated at our department. Subjects and Methods: A total of 43 patients with adrenal metastasis (22 hepatocellular carcinoma, eight renal cell carcinoma, five non-small cell lung cancer, four colorectal cancer, three liposarcoma, and one malignant fibrous histiocytoma) were enrolled. All patients were treated at our department at least once. The treatment protocol for each patient, the technique used, and the survival details were recorded. Statistical Analysis Used: Statistical analyses were performed using SPSS 26.0 software. Results: Technical success was achieved in all cases. MWA was a safe technique for treating all types of metastasis. No major complications were observed. The pathology of adrenal lesions was the significant risk factor contributing to overall survival (OS) (P = 0.040). The 1-year and 3-year OS rates for all patients were 0.828 and 0.389, respectively. Conclusions: Percutaneous US-guided MWA is safe and effective in terms of local control and survival of adrenal metastasis
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Aim: This study aimed to investigate the predictive power of the combination of Systemic Immune-Inflammation Index (SII) and albumin-bilirubin (ALBI) grade in prognosis outcomes of early-stage hepatocellular carcinoma (HCC) after thermal ablation. Materials and Methods: This retrospective study was reviewed and approved by our institutional review board, and written informed consent was obtained from each patient. According to the Milan criteria, a total of 405 treatment-naïve patients with clinicopathologically confirmed HCC were enrolled who subsequently underwent thermal ablation from 2011 to 2016. The outcomes of overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were statistically analyzed. Results: The median follow-up time of this study was 45.1 months (range, 1.3–83.2 months). After thermal ablation in patients with SII-ALBI Grades 1, 2, and 3, the cumulative 5-year OS rates were 81.7%, 63.2%, and 26.9%; the 5-year CSS rates were 82.4%, 67.5%, and 26.9%; and the 5-year RFS rates were 49.3%, 44.6%, and 25.3%, respectively (all P < 0.001). On multivariate Cox regression analyses, SII-ALBI was independently associated with the three outcomes after adjustment for various confounders (all P < 0.05). In addition, SII-ALBI played a predictive role in OS, CSS, and RFS for patients with negative alpha-fetoprotein (AFP) (P < 0.05). Compared with SII and ALBI, the AUCs for the prediction of OS and CSS using SII-ALBI were superior to single indicator (bothP < 0.05). Conclusion: Elevated preablation SII-ALBI is associated with shorter OS, CSS, and RFS in patients with early-stage HCC. Our indicator showed the potential to be a supplement tool for patients with negative AFP during follow-up
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Purpose: We aimed to compare the outcomes of microwave ablation (MWA) alone with those of transarterial chemoembolization combined with MWA (TACE-MWA) for Barcelona clinic liver cancer (BCLC) Stage B hepatocellular carcinoma (HCC) and to identify the prognostic factors associated with the two treatments. Materials and Methods: This retrospective study was conducted in 150 BCLC Stage B HCC patients from April 2006 to November 2017. Of these, 88 patients were treated with MWA alone while 62 with TACE-MWA. Propensity score matching (PSM) was conducted to adjust for imbalances in clinical parameters. Procedure-related complications, local tumor progression (LTP), recurrence-free survival (RFS), and overall survival (OS) were analyzed. Results: Before PSM, the maximal tumor diameters were 6.0 ± 1.0 cm and 6.7 ± 1.3 cm in the TACE-MWA and MWA groups, respectively, with a significant difference (P = 0.002); a significant difference was also detected in α-fetoprotein level (P = 0.013). After PSM, no difference was found in the two parameters (P = 0.067, 0.470). Before and after PSM, no difference was detected in the procedure-related complications (P = 0.803 vs. 1.000, P = 1.000 vs. 1.000), RFS (P = 0.786 vs. 0.689), and OS (P = 0.684 vs. 0.929). Tumor size and α-fetoprotein level were independent influencing factors for OS before and after PSM (P = 0.009, 0.023), while tumor size (D > 7) was an independent risk factor for poor OS (P = 0.011). Tumor number was an independent risk factor for RFS before and after PSM (P = 0.007 vs. P = 0.008). A significant difference was detected in LTP between the two groups with single tumor before and after PSM (P = 0.059 vs. P = 0.006). Conclusions: The MWA alone group had RFS and OS comparable to that of the TACE-MWA group. TACE-MWA was effective in controlling LTP in patients with a single tumor
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Objective: To compare the overall survival (OS), disease-free survival (DFS) and liver-cancer-specific survival (LCSS) of elderly (≥65 years) and younger patients (< 65 years) with early-stage hepatocellular carcinoma (HCC) using ultrasound-guided percutaneous microwave ablation (US-PMMA). Materials and Methods: From January 2002 to December 2017, 510 elderly and 1053 younger patients were diagnosed with early-stage HCC according to the Milan criteria. All of these patients were treatment-naïve to US-PMMA. Baseline characteristics were collected to identify any risk factors to determine the survival outcomes. OS, DFS, and LCSS probabilities were calculated with the Kaplan-Meier method and compared using the Log-rank test. Results: Complete ablation was achieved in all patients. Elderly patients were more likely to be, hepatitis C virus infection, comorbidities, cirrhosis, larger tumors, poor liver functional reservation, more ablation points, longer ablation time, longer hospital stays, and higher hospitalization costs (P < 0.05). Over the follow-up period (12–156 months), no significant differences were detected in OS, DFS, and LCSS between the two groups ( P = 0.092, 0.318, and 0.183). r-GT, ALB and ablation session were significant factors for OS, r-GT and ALB for LCSS, and cirrhosis, tumor number, AFP and ablation points for RFS in the multivariate analysis, respectively. No treatment-related deaths occurred in the two groups. Any complications were treated as appropriate. Conclusions: Although advanced age and comorbidities are intrinsic factors in elderly HCC patients, similar survival outcomes were obtained in elderly and younger HCC patients treated by US-PMWA, despite elderly patients having more comorbidities
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Objective: The objective of this study is to assess the clinical effect and safety of ultrasound-guided percutaneous microwave ablation (US-PMWA) assisted by three-dimensional (3D) visualization operative treatment planning system in larger adrenal metastasis (LAM) (D ≥ 4 cm). Materials and Methods: From Dec 2011 to Dec 2017, 12 consecutive LAM patients with pathologically proven with a mean diameter of 5.2±1.3cm (range 4.1-7.6) were treated. Artificial ascites and thermal monitoring system as ancillary technique were used. The patients were followed up with imagings and complications were recorded. Results: The median follow-up period was 31 months (ranged 6–52 m). All LAM achieved completely ablation according to the 3D planning preoperation. Complete ablation was achieved in 10 (10/12, 83.3%) patients by one session and 2 patients (2/12, 16.7%) by two sessions. Recurrence was detected at the treated site in 3 patients (3/12, 25.0%) at 5, 9, and 13 months after ablation and received another ablation. Progression of metastasis disease at extra-adrenal sites occurred in 9 patients (9/12, 75%). Seven (7/12, 58.3%) patients died during the follow-up period. Therefore, the 1-, 2-, and 3-year local tumor control rates were 83.3%, 75.0%, and 75.0%, and 1-, 2-, 3- and 4-year overall survival rates were 91.7%, 75.0%, 50.0%, and 41.7%, respectively. No severe complications related to ablation occurred, except 3 (3/12, 25%) patients developed hypertension during ablation. Conclusions: US-PMWA assisted by 3D visualization preoperative treatment planning system maybe a safe and efficient therapy for LAM, which could promote ablation precision, improve the clinical outcomes
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Objective: The aim of the study is to evaluate the effectiveness of ultrasound (US)-guided interventional treatments in local tumor control (LTC) for thoracoabdominal wall seeding tumor (TAWST) from hepatocellular carcinoma (HCC), and explore the survival outcomes of the patients underwent surgical resection (SR) and microwave ablation (MWA) for intrahepatic tumor. Materials and Methods: A total of 40 patients with 47 TAWST from HCC were recruited from April 2007 to May 2018. LTC was evaluated by contrast-enchanced image. Long-time survival outcomes were compared. Overall survival (OS), disease-free survival (DFS), and local seeding progress-free survival (LSPFS) were analyzed. Results: One-year LTC rate was 65.2% in all patients; 72%, 0%, 50%, and 0% in the patients who underwent MWA, high-intensity focused US, iodine-125 (125I) brachytherapy and MWA combined with 125I brachytherapy, respectively. The 3-year OS, DFS rates and LSPFS rates were 51.8% and 28.6%, 12.0% and 23.8%, and 10.0% and 10.0% after MWA and SR, respectively. Univariate analysis results showed that age (P = 0.049), Karnofsky performance scale (KPS) (P = 0.002), and chemoradiation (P = 0.032); and multivariate analysis results showed that age (P = 0.045) and KPS (P = 0.010) might be predictors for LCT. While univariate analysis results showed that KPS (P = 0.032), intrahepatic tumor size (P = 0.006), chemoradiation (P = 0.003), preoperative alpha-fetoprotein level (P = 0.007), metastasis (P = 0.049), and albumin-bilirubin grade (P = 0.002), and multivariate analysis results showed that comorbidities (P = 0.004), KPS (P = 0.007), and metastasis (P = 0.009) might be predictors for OS. The pain degree of patients was improved obviously after treatments. Conclusions: US-guided interventional treatments were an effective option in LTC for TAWST from HCC, and MWA could achieve comparable long-time survival outcomes with SR for HCC patients with TAWST