Analyses of clinical efficacy of ultrasound-guided radiofrequency ablation in liver cancer adjacent to the gallbladder and its prognosis.

PURPOSE: To explore the clinical efficacy of ultrasound-guided radiofrequency ablation (RFA) in liver cancer adjacent to the gallbladder and to analyze its prognosis. METHODS: 80 patients with liver cancer adjacent to the gallbladder, who were admitted to our hospital from January 2015 to April 2018, were enrolled and divided into the Observation group (n=40) and the Control group (n=40). All of the patients underwent cholecystectomy and lymph node dissection combined with postoperative chemotherapy. RFA was performed in the Observation group, while radical cholecystectomy and radical hepatectomy were conducted simultaneously in the Control group. Follow up was by telephone, and tumor-associated factor levels, liver function and cellular and humoral immune function-related indicators at 1 month after intervention, tumor size before and after treatment and cases of normal alpha-fetoprotein (AFP) level and tumor disappearance after treatment were compared between the two groups. The complications rates during treatment (increase in transaminases, elevation of bilirubin, intratumoral hemorrhage, bile duct injury and gastrointestinal perforation), clinical efficacy and 1-year survival in the two groups were statistically analyzed. RESULTS: At 1 month after intervention, the Observation group had substantially lower levels of tumor-associated factors AFP, carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) (p<0.05), obviously lower levels of liver function indicators aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), indirect bilirubin (IBIL) and direct bilirubin (DBIL) (p<0.05), but distinctly higher levels of immunoglobulin G (IgG), IgA and IgM, cluster of differentiation 4+ (CD4+), CD8+ and CD4+/CD8+ (p<0.05) than the Control group. Before and after treatment, the tumor size in the Observation group was smaller than in the Control group (p<0.05). The Observation group exhibited notably more cases of normal APF level and tumor disappearance after treatment (p<0.05), markedly lower incidence rates of increase in transaminases, elevation of bilirubin, intratumoral hemorrhage, bile duct injury and gastrointestinal perforation during treatment (p<0.05) than the Control group. Additionally, the rate of stable disease (SD) was notably higher and the 1-year survival rate was higher in the Observation group than in the Control group (p<0.05). CONCLUSIONS: RFA for liver cancer adjacent to the gallbladder can effectively lower the levels of tumor markers, improve liver function and enhance immunity, with a few operative complications and high efficacy, so it has a positive impact in prolonging the survival of patients.

Risk of prostate cancer diagnosis and mortality in men with a benign initial transrectal ultrasound-guided biopsy set: a population-based study.

BACKGROUND: The risk of missing prostate cancer in the transrectal ultrasound-guided systematic biopsies of the prostate in men with suspected prostate cancer is a key problem in urological oncology. Repeat biopsy or MRI-guided biopsies have been suggested to increase sensitivity for diagnosis of prostate cancer, but the risk of disease-specific mortality in men who present with raised prostate-specific antigen (PSA) concentration and a benign initial biopsy result remains unknown. We investigated the risk of overall and prostate cancer-specific mortality in men with a benign initial biopsy set. METHODS: Data were extracted from the Danish Prostate Cancer Registry-a population-based registry including all men undergoing histopathological assessment of prostate tissue. All men who were referred for transrectal ultrasound-guided biopsy for assessment of suspected prostate cancer between Jan 1, 1995, and Dec 31, 2011, in Denmark were eligible for inclusion. Follow-up data were obtained on April 28, 2015. The primary endpoint was the cumulative incidence of prostate cancer-specific mortality, analysed in a competing risk setting, with death from other causes as the competing event. FINDINGS: Between Jan 1, 1995, and Dec 31, 2011, 64 430 men were referred for transrectal ultrasound-guided biopsy, of whom 63 454 were eligible for inclusion. Median follow-up was 5·9 years (IQR 3·8-8·5) and the total follow-up time, from the enrolment of the first patient on Jan 1, 1995, until the extraction of causes of death on April 28, 2015, was 20 years. 10 407 (30%) of 35 159 men with malignant initial biopsy sets died from prostate cancer, compared with 541 (2%) of 27 181 men with benign initial biopsy sets. Estimated overall 20-year mortality was 76·1% (95% CI 73·0-79·2). In all men referred for transrectal ultrasound-guided biopsy, the cumulative incidence of prostate cancer-specific mortality after 20 years was 25·6% (24·7-26·5) versus 50·5% (47·5-53·5) for mortality from other causes. In men with benign initial biopsy sets, the cumulative incidence of prostate cancer-specific mortality was 5·2% (3·9-6·5) versus 59·9% (55·2-64·6) for mortality from other causes. In men with PSA concentrations 10 µg/L or lower and benign initial biopsy sets (2779 men), the cumulative incidence of prostate cancer-specific mortality was 0·7% (0·2-1·3). Cumulative incidence of prostate cancer specific mortality in men with benign initial biopsy sets was 3·6% (95% CI 0·1-7·2) for men with a PSA higher than 10 ng/mL but 20 ng/mL or less (855 men) and 17·6% (12·7-22·4) and for men with a PSA higher than 20 ng/mL (454 men). INTERPRETATION: The first systematic transrectal ultrasound-guided biopsy set holds important prognostic information. The 20-year risk of prostate cancer-specific mortality in men with benign initial results is low. Our findings question whether men with low PSA concentration and a benign initial biopsy set should undergo further diagnostic assessment in view of the high risk of mortality from other causes. FUNDING: Capital Region of Denmark's Fund for Health Research, Danish Cancer Society, Danish Association for Cancer Research, and Krista and Viggo Petersen's Foundation.

Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients.

AIMS: Pulmonary congestion is a common and important finding in heart failure (HF). While clinical examination and chest radiography are insensitive, lung ultrasound (LUS) is a novel technique that may detect and quantify subclinical pulmonary congestion. We sought to independently relate LUS and clinical findings to 6-month HF hospitalizations and all-cause mortality (composite primary outcome). METHODS: We used LUS to examine 195 NYHA class II-IV HF patients (median age 66, 61% men, 74% white, ejection fraction 34%) during routine cardiology outpatient visits. Lung ultrasound was performed in eight chest zones with a pocket ultrasound device (median exam duration 2 min) and analysed offline. RESULTS: In 185 patients with adequate LUS images in all zones, the sum of B-lines (vertical lines on LUS) ranged from 0 to 13. B-lines, analysed by tertiles, were associated with clinical and laboratory markers of congestion. Thirty-two per cent of patients demonstrated ≥3 B-lines on LUS, yet 81% of these patients had no findings on auscultation. During the follow-up period, 50 patients (27%) were hospitalized for HF or died. Patients in the third tertile (≥3 B-lines) had a four-fold higher risk of the primary outcome (adjusted HR 4.08, 95% confidence interval, CI 1.95, 8.54; P < 0.001) compared with those in the first tertile and spent a significantly lower number of days alive and out of the hospital (125 days vs. 165 days; adjusted P < 0.001). CONCLUSIONS: Pulmonary congestion assessed by ultrasound is prevalent in ambulatory patients with chronic HF, is associated with other features of clinical congestion, and identifies those who have worse prognosis.

Needle track seeding after percutaneous microwave ablation of malignant liver tumors under ultrasound guidance: analysis of 14-year experience with 1462 patients at a single center.

OBJECTIVE: To determine the incidence and risk factors associated with needle tract seeding after percutaneous microwave ablation (MWA) of liver cancer under ultrasound guidance. MATERIALS AND METHODS: Over a 14-year period, a total of 1462 patients with 2530 malignant nodules were treated by MWA. The influence of age, sex, Child-pugh classification, tumor size, tumor position, previous biopsy, insertion number and antenna type on the risk of neoplastic seeding was assessed. The survival of seeding patients after the MWA was analyzed. RESULTS: Eleven patients with 12 nodules (0.47% per tumor, 0.75% per patient) were identified with needle tract seeding with an interval time of 6-37 (median 10) months after MWA. The mean size of the seeding nodule was 2.3 ± 0.7 cm (from 1.3 to 3.9 cm). Only previous biopsy was significantly associated with neoplastic seeding (P=0.02). All the seeding lesions were successfully treated by resection, MWA, radiation or high intensity focus ultrasound. The median survival period of the 11 patients after the MWA was 36.0 months. The cumulative survival rates of the 11 patients after the MWA at 1-, 2-, 3-, 4- and 5-year were 90.9%, 72.7%, 62.3%, 31.2% and 15.6%, respectively. CONCLUSION: The results showed that the neoplastic seeding was a low risk complication of percutaneous MWA of liver cancer and was considered acceptable in general.