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 ).

Copper chelation by trientine dihydrochloride inhibits liver RFA-induced inflammatory responses in vivo.

OBJECTIVE: Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third most common cause of cancer-related death worldwide. Radiofrequency ablation (RFA) is currently performed widely for managing HCC. RFA treatment causes damage around the ablation. Trientine dihydrochloride has been used to reduce the copper in liver. METHODS: The rats were treated with trientine dihydrochloride for 5 days before liver RFA. Liver function, copper concentration, inflammation biomarkers and MDA, SOD were analyzed after RFA treatment for 2 h, 2 and 5 days. RESULTS: The results indicated that trientine dihydrochloride reduced the copper in plasma and liver tissue significantly. And trientine dihydrochloride significantly inhibited RFA-induced inflammatory gene expression in liver. Similar inhibitory effects of trientine dihydrochloride were observed on ROS-induced malondialdehyde production in liver tissues. CONCLUSION: These results suggest that pre-treatment with the selective copper chelator trientine dihydrochloride can inhibit inflammatory response effectively during and after liver RFA in vivo. Chelation of copper to a lower level before liver RFA may be a novel strategy to prevent or ameliorate inflammatory responses in liver induced by RFA and to protect the parenchyma tissues in liver during and after RFA in HCC patients.

Microwave ablation of hepatocellular carcinoma with portal vein tumor thrombosis after transarterial chemoembolization: a prospective study.

AIMS: To prospectively assess the use of microwave ablation (MWA) to treat hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) after transarterial chemoembolization (TACE), and to evaluate factors that significantly affect treatment outcomes. METHODS: Sixty patients with HCC [55 male, 5 female; mean age, 54.1 ± 10.2 (range 36-77) years] + PVTT were enrolled. Patients were treated with MWA after TACE. Results were compared with those of 54 patients treated by TACE alone in another retrospective study. Data analyzed included patient demographics, Eastern Cooperative Oncology Group performance status, liver cirrhosis, liver volume, Child-Pugh class, Cancer of the Liver Italian Program (CLIP) score, and imaging findings. Survival time (from occurrence of PVTT to last follow-up) and predictive factors and their correlation with survival were statistically evaluated. RESULTS: The median 3-year overall survival (OS) duration was 13.5 months, and the 1- and 3-year OS rates were 48 and 23 %, respectively. Cox hazards regression analysis revealed that change in the neutrophil-to-lymphocyte ratio, CLIP score, and treatment efficacy were the only independent predictive factors for outcome (p = 0.035, 0.024, and 0.000, respectively). CONCLUSIONS: Combination therapy with MWA after TACE may provide a substantial benefit for patients with HCC + PVTT type I, II, or partial III and Child-Pugh class A or B by reducing the tumor burden. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Register (ChiCTR): ChiCTR-ONC-12002689.

C-arm Lipiodol CT in transcatheter arterial chemoembolization for small hepatocellular carcinoma.

AIM: To investigate the value of C-arm Lipiodol computed tomography (CT) for intra-procedural hepatocellular carcinoma (HCC) lesion detection during transcatheter arterial chemoembolization (TACE). METHODS: Forty patients (37 male, 3 female; mean age, 52.6 ± 12.5 years, age range: 25-82 years) diagnosed with HCC were enrolled in this study. All patients underwent 64-slice CT 1-2 wk before TACE. During the procedure, hepatic angiography was performed first. Following diagnostic embolization with Lipiodol injected into the hepatic artery, a C-arm CT scan was immediately conducted (C-arm Lipiodol CT). If new HCC lesions were confirmed, gelfoam particles were super-selectively injected into the tumor-nourishing blood vessel. A Lipiodol CT scan was performed 7-14 d after TACE. All images acquired from 64-slice CT, digital subtraction angiography (DSA), C-arm Lipiodol CT and Lipiodol CT were retrospectively reviewed by four radiologists and the number of detected lesions in each examination was counted, respectively. The results of Lipiodol CT were taken as the diagnostic reference. Alpha-fetoprotein values were examined both before and after TACE. This study only takes into account the lesions that were not found or were considered suspicious on 64-slice CT before TACE. RESULTS: Preprocedural 64-slice CT detected a total of 13 suspicious lesions in the 40 patients. DSA detected ten definite and four suspicious lesions. C-arm Lipiodol CT detected 71 lesions in total and Lipiodol CT confirmed 67 lesions with a diameter range of 3-12 mm. Four false-positive lesions, which were detected by C-arm Lipiodol CT, were considered to be hepatic artery-portal vein fistulas. The average alpha-fetoprotein values before and after TACE were significantly different (452.3 ± 192.6 ng/mL vs 223.8 ± 93.2 ng/mL; P = 0.039). CONCLUSION: C-arm Lipiodol CT has a higher diagnostic sensitivity for small HCC lesions. This technique may help physicians make intraprocedural decisions to provide patients with earlier treatment.

Randomized trial of [131I] metuximab in treatment of hepatocellular carcinoma after percutaneous radiofrequency ablation.

To assess the efficacy of combining radioimmunoconjugate [(131)I] metuximab with radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) treatment compared with RFA alone, a single-center randomized controlled trial was conducted on 127 patients with Barcelona Clinic Liver Cancer staging system (BCLC) classifications of 0-B stage. Patients received either RFA followed by [(131)I] metuximab (n = 62) or RFA alone (n = 65). The primary outcome was overall tumor recurrence. Statistical tests were two-sided. The one- and two-year recurrence rates in the combination group were 31.8% and 58.5%, whereas those in the RFA group were 56.3% and 70.9%, respectively. The median time to overall tumor recurrence was 17 months in the combination group and 10 months in the RFA group (P = .03). The RFA-[(131)I] metuximab treatment showed a greater antirecurrence benefit than RFA in the metuximab target (ie, CD147)-positive subpopulation (P = .007). [(131)I] metuximab may yield prevention of tumor recurrence after RFA.

[Study on low-temperature alkaline lipase from Bohaisea-9145].

Lipase-overproducing marine yeast Bohaisea-9145 isolated from the Bohai sea region was identified as psychrotrophlic Yarrowia lipolytica. The optimum composition of culture medium was ground soybean 4%, rice bran 4%, peanut power 4%, crude peanut oil 0.5%, MgSO4 0.05%, KH2PPO4 0.2%. The optimum temperature and pH were 26 +/- 1 degrees C pH5.0, the time of fermentation cycle was 23h. The lipase activity was improved to 258.67 U/mL through optimization, four-fold more than that of initial strain. The lipase displayed maximum activity at pH 8.5, 35 degrees C and was stable within the range of pH 4.0 - 9.0 at low temperature. It had high thermosensitivity, good compatibility with familiar metal ions and chemical reagents. It was antioxidant and had strong resistance to high salinity. As a novel marine low-temperature lipase, it has promising prospect in many fields, especially as an additive of detergent.