Transcatheter arterial chemoembolization combined with radiofrequency ablation delays tumor progression and prolongs overall survival in patients with intermediate (BCLC B) hepatocellular carcinoma

BMC Cancer

Xin Yin¹  Lan Zhang¹  Yan-Hong Wang¹  Bo-Heng Zhang¹  Yu-Hong Gan¹  Ning-Lin Ge¹  Yi Chen¹  Li-Xin Li¹  Zheng-Gang Ren¹ 

[1] Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China

关键词: Survival;    Combination therapy;    Radiofrequency ablation;    Transcatheter arterial chemoembolization;    Hepatocellular carcinoma;   

Others  :  1118128
DOI  :  10.1186/1471-2407-14-849

 received in 2013-06-27, accepted in 2014-11-06,  发布年份 2014

【 摘 要 】

Background

This study was designed to evaluate the effectiveness of radiofrequency ablation in patients with intermediate (BCLC B) stage hepatocellular carcinoma who underwent transcatheter arterial chemoembolization.

Methods

Included in this study were 211 patients with intermediate stage HCC who underwent initial transcatheter arterial chemoembolization and were potentially amendable for radiofrequency ablation (single tumor with diameter 5-8 cm, median 6.0 cm; 2–5 multiple nodules with diameter less than 5 cm) between January 2005 and December 2011. According to the inclusion and exclusion criteria, 55 patients were treated with following radiofrequency ablation, and the remaining 156 patients were treated with transcatheter arterial chemoembolization alone. The treatment effectiveness, local tumor control and survival outcome between the two groups were compared.

Results

The complete tumor necrosis rate after treatment was 76.9% in combination group vs. 46.5% in transcatheter arterial chemoembolization alone group (P = 0.02). The major complication rate was 1.8% in combination group vs. 2.6% in transcatheter arterial chemoembolization alone group. Follow-up observation showed that the total tumor control rate was 74.5% in combination group versus 54.5% in transcatheter arterial chemoembolization alone group (P < 0.001). The 1-, 3- and 5-year survival rates in combination group were significantly higher than those in TACE alone group (P = 0.01).

Conclusions

Radiofrequency ablation following initial transcatheter arterial chemoembolization delays tumor progression and prolongs overall survival of patients with intermediate stage HCC tumors.

【 授权许可】

   
2014 Yin et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Parkin DM, Bray F, Ferlay J, Pisani P: Global cancer statistics, 2002. CA Cancer J Clin 2005, 55:74-108.
• [2]Stuart KE, Anand AJ, Jenkins RL: Hepatocellular carcinoma in the United States. Prognostic features, treatment outcome, and survival. Cancer 1996, 77:2217-2222.
• [3]Benson AB 3rd, Abrams TA, Ben-Josef E, Bloomston PM, Botha JF, Clary BM, Covey A, Curley SA, D'Angelica MI, Davila R, Ensminger WD, Gibbs JF, Laheru D, Malafa MP, Marrero J, Meranze SG, Mulvihill SJ, Park JO, Posey JA, Sachdev J, Salem R, Sigurdson ER, Sofocleous C, Vauthey JN, Venook AP, Goff LW, Yen Y, Zhu AX: NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Cancer Netw 2009, 7:350-391.
• [4]Omata M, Lesmana LA, Tateishi R, Chen PJ, Lin SM, Yoshida H, Kudo M, Lee JM, Choi BI, Poon RT, Shiina S, Cheng AL, Jia JD, Obi S, Han KH, Jafri W, Chow P, Lim SG, Chawla YK, Budihusodo U, Gani RA, Lesmana CR, Putranto TA, Liaw YF, Sarin SK: Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 2010, 4:439-474.
• [5]Llovet JM, Real MI, Montaña X, Planas R, Coll S, Aponte J, Ayuso C, Sala M, Muchart J, Solà R, Rodés J, Bruix J, Barcelona Liver Cancer Group. Liver Unit, Digestive Disease Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain: Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002, 359:1734-1739.
• [6]Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, Fan ST, Wong J: Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002, 35:1164-1171.
• [7]Lovet JM, Bruix J: Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 2003, 37:429-442.
• [8]Li X, Feng GS, Zheng CS, Zhuo CK, Liu X: Expression of plasma vascular endothelial growth factor in patients with hepatocellular carcinoma and effect of transcatheter arterial chemoembolization therapy on plasma vascular endothelial growth factor level. World J Gastroenterol 2004, 10:2878-2882.
• [9]Lencioni R, Cioni D, Crocetti L, Franchini C, Pina CD, Lera J, Bartolozzi C: Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 2005, 234:961-967.
• [10]Tateishi R, Shiina S, Teratani T, Obi S, Sato S, Koike Y, Fujishima T, Yoshida H, Kawabe T, Omata M: Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1,000 cases. Cancer 2005, 103:1201-1209.
• [11]Mulier S, Mulier P, Ni Y, Miao Y, Dupas B, Marchal G, De Wever I, Michel L: Complications of radiofrequency coagulation of liver tumors. Br J Surg 2002, 89:1206-1222.
• [12]Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ, Lin XJ, Lau WY: A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 2006, 243:321-328.
• [13]Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Ierace T, Solbiati L, Gazelle GS: Hepatocellular carcinoma:radiofrequency ablation of medium and large lesions. Radiology 2000, 214:761-768.
• [14]Wang W, Shi J, Xie WF: Transarterial chemoembolization in combination with percutaneous ablation therapy in unresectable hepatocellular carcinoma: a meta-analysis. Liver Int 2010, 30:741-749.
• [15]Nishikawa H, Osaki Y, Kita R, Kimura T, Inuzuka T, Takeda H, Nakajima J, Matsuda F, Sakamoto A, Henmi S, Hatamaru K, Saito S, Nasu A: Transcatheter arterial infusion chemotherapy prior to radiofrequency thermal ablation for single hepatocellular carcinoma reduces the risk of intrahepatic distant recurrence. Int J Oncol 2012, 41:903-909.
• [16]Zheng JS, Long J, Sun B, Lu NN, Fang D, Zhao LY, Du N: Transcatheter arterial chemoembolization combined with radiofrequency ablation can improve survival of patients with hepatocellular carcinoma with portal vein tumour thrombosis: extending the indication for ablation? Clin Radiol 2014, 69:e253-e263.
• [17]Kim JH, Won HJ, Shin YM, Kim SH, Yoon HK, Sung KB, Kim PN: Medium-sized (3.1-5.0 cm) hepatocellular carcinoma: transarterial chemoembolization plus radiofrequency ablation versus radiofrequency ablation alone. Ann Surg Oncol 2011, 18:1624-1629.
• [18]Bruix J, Sherman M: Management of hepatocellular carcinoma: an update. Hepatology 2011, 53:1020-1022.
• [19]Ren ZG, Lin ZY, Xia JL, Ye SL, Ma ZC, Ye QH, Qin LX, Wu ZQ, Fan J, Tang ZY: Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor: a retrospective control study. World J Gastroenterol 2004, 10:2791-2794.
• [20]Yang B, Zou J, Xia J, Ren Z, Gan Y, Wang Y, Zhang B, Ge N, Wang D, Chen Y, Chen R, Li L, Ye S, Wang X: Risk factors for recurrence of small hepatocellular carcinoma after long-term follow-up of percutaneous radiofrequency ablation. Eur J Radiol 2011, 79:196-200.
• [21]Lencioni R, Llovet JM: Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010, 30:52-60.
• [22]Buscarini L, Buscarini E, Di Stasi M, Quaretti P, Zangrandi A: Percutaneous radiofrequency thermal ablation combined with transcatheter arterial embolization in the treatment of large hepatocellular carcinoma. Ultraschall Med 1999, 20:47-53.
• [23]Lencioni R, Cioni D, Donati F, Bartolozzi C: Combination of interventional therapies in hepatocellular carcinoma. Hepatogastroenterology 2001, 48:8-14.
• [24]Siriapisith T, Siwasattayanon P, Tongdee T: Radiofrequency ablation alone versus radiofrequency ablation combined with chemoembolization in unresectable hepatocellular carcinoma. J Med Assoc Thai 2012, 95:430-436.
• [25]Peng ZW, Zhang YJ, Chen MS, Xu L, Liang HH, Lin XJ, Guo RP, Zhang YQ, Lau WY: Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma: a prospective randomized trial. J Clin Oncol 2013, 31:426-432.
• [26]Shibata T, Isoda H, Hirokawa Y, Arizono S, Shimada K, Togashi K: Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment? Radiology 2009, 252:905-913.