The monocyte to lymphocyte ratio not only at baseline but also at relapse predicts poor outcomes in patients with hepatocellular carcinoma receiving locoregional therapy.

BACKGROUND: Monocyte to lymphocyte ratio (MLR) represents a pro-inflammatory immune microenvironment. The aim of this study was to elucidate the effect of MLR and subsequent MLR when relapse occurred (R-MLR) on prognosis for hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) combined with ablation. METHODS: A prospective analysis was conducted on 606 patients with HCC who were treated with TACE combined with local ablation in Beijing You'an Hospital affiliated to Capital Medical University from January 1, 2012 to December 31, 2016. MLR or R-MLR were stratified according to the optimal cut-off values. The cumulative recurrence-free survival (RFS), overall survival (OS) , and recurrence-death survival (RDS) rates were calculated by Kaplan-Meier method. The Cox proportion hazard model and logistic regression analysis was conducted to screen for independent predictive factors for indicating early relapse and long-term prognosis. RESULTS: High MLR was significantly associated with relapse, early recurrence, and overall survival. After a median follow-up of 59.4 months, The cumulative 1-, 3-, 5-year RFS rates of low MLR were 74.6%, 43.8%, and 34.0%; while 66.1%, 32.2%, and 22.6% for high group (P < 0.001). There were also significant differences in corresponding OS rates of the two groups (P = 0.003). The cumulative 1-, 3-, 5-year OS rates of low R-MLR were 99.5%, 87.2%, 75.5%; while 98.3%, 78.3%, 61.7% for high group (P < 0.001). There were also significant differences in corresponding RDS rates in the two groups (P = 0.008). 436 patients were divided into four groups on the base of cut-off values of MLR and R-MLR (low-low, low-high, high-low, and high-high). The low-low group has shown better outcomes including the cumulative 1-, 3-, 5-year OS, and RDS rates(P < 0.001). CONCLUSIONS: High MLR was related to unfavorable outcome. Subsequent change of MLR between baseline and HCC relapse could indicate poor long-term survival after relapse.

Clinical outcomes of percutaneous thermal ablation for pulmonary metastases from hepatocellular carcinoma: a retrospective study.

Purpose: To determine the effectiveness of ablation for pulmonary metastases (PM) from hepatocellular carcinoma (HCC).Methods: Between 2010 and 2017, the study analyzed 39 patients who had a median age of 59 years. Primary HCC was under control and the number of PM was less than 5 (median: 2), with a maximum diameter of ≤60 mm (median: 15 mm). The primary endpoints were overall survival (OS) and local tumor progression-free survival (LTPFS). Secondary endpoints included technique success (TS), complication and tumor response. TS referred to PM treated using the treatment protocol. Multivariate analysis using the Cox proportional hazard model was conducted on the potential risk factors (univariate: p < 0.5) to determine the independent factors (multivariate: p < 0.05).Results: The TS rate was 100%. Major complications included pneumothorax (n = 3) requiring chest tube placement and pleural effusion requiring drainage (n = 2). Complete ablation was achieved in 32/38 patients (valid percent: 84.2%) at 1 month after ablation. The 1-, 3- and 5-year OS rates were 79.8, 58 and 30.9%, respectively. The 1-, 3- and 5-year LTPFS rates were 60.7, 34.2 and 22.8%, respectively. The extent (unilateral vs. bilateral) of PM (hazard ratio (HR): 0.197, 95% confidence interval (CI): 0.043-0.890, p = 0.035) and the number (≤2 vs. >2) of PM (HR: 0.555, 95% CI: 0.311-0.991, p = 0.047) were found to be the independent risk factors for predicting OS.Conclusion: Percutaneous thermal ablation is a safe and effective treatment for PM from HCC.

Safety and technical feasibility of percutaneous ablation for lymph node metastases of hepatocellular carcinoma.

PURPOSE: This study aimed to assess the safety and technical feasibility of percutaneous ablation therapy for lymph node (LN) metastases of hepatocellular carcinoma (HCC). MATERIAL AND METHODS: A total of 31 consecutive HCC patients with LN metastases who were treated with ablation were included in this retrospective study. Percutaneous ablation was performed under local anesthesia and computed tomography-guidance. The primary endpoint was technique success; secondary endpoints were overall survival (OS), progression-free survival (PFS), and local progression-free survival (LPFS). Survival curves were constructed using Kaplan-Meier method. RESULTS: The median diameter of metastatic LNs was 30 mm (range, 10-77 mm). The 1-, 3-, and 5-year OS rates were 74.6%, 50.3%, and 50.3%, respectively. The 1-, 3-, and 5-year PFS rates were 24.7%, 0%, and not available for calculation (NA), respectively. The 1-, 3-, and 5-year LPFS rates were 78.7%, 69.9%, and 69.9%, respectively. The technique success and technical effectiveness rates were 100% and 64.5%, respectively. The technical effectiveness rates were 65.4% (17/26) and 60% (3/5) in abdominal LN metastases and distant LN metastases, respectively. Only one patient (1/31, 3.2%) had major complications (massive pleural effusion and severe pneumonia) related to ablation. Minor complications related to ablation included mild abdominal pain (10/31, 32.3%) and self-limiting hematoma (2/31, 6.5%). No ablation-related death occurred. CONCLUSION: Percutaneous ablation appears to be a safe and feasible method for treatment of metastatic LNs in patients with HCC.

A prognostic nomogram for colorectal cancer liver metastases after percutaneous thermal ablation.

PURPOSE: To assess the efficacy of percutaneous thermal ablation in treating colorectal cancer liver metastases (CRCLM), and to propose a prognostic nomogram for overall survival (OS). MATERIALS AND METHODS: Seventy-one patients with CRCLM undergoing thermal ablation at our institute from 2009 to 2013 were identified and analysed to formulate a prognostic nomogram. The concordance index (C-index) and calibration curve were calculated to evaluate the predictive accuracy of the nomogram. The nomogram was compared with two current prognostic nomograms for patients with CRCLM who had undergone hepatectomy (Kattan) and selective internal radiation therapy (Fendler). Predictive validity was assessed in the validation cohort of 25 patients who had undergone thermal ablation from 2014 to 2016. RESULTS: The median OS in the primary cohort was 26.4 months, whereas the 1-, 3- and 5-year OS rates were 72.2%, 37.2% and 17%, respectively. The median progression-free survival was 4.2 months. After univariate and multivariate analysis, a prognostic nomogram was formulated based on four predictors, including the number of tumours, maximum diameter of the tumour, CA19-9 level and ablation margin. The C-index of the nomogram was 0.815. Based on the patients of this study, the C-index was significantly higher than that of the Fendler nomogram (C-index, 0.698) and Kattan nomogram (C-index, 0.514, p < 0.001). Predictive accuracy of the proposed nomogram was also satisfactory in the validation cohort, with a C-index of 0.884. CONCLUSIONS: Thermal ablation was an effective therapy for CRCLM. Moreover, the nomogram was effective and simple for CRCLM patients undergoing thermal ablation.

Combination therapy of TACE and CT-guided partial hepatic segment ablation for liver cancer.

Aim: This study aimed to investigate the safety and efficacy of combination therapy of transcatheter arterial chemoembolization (TACE) and CT-guided percutaneous partial hepatic segment ablation. Material and methods: Liver cancer patients undergoing TACE plus partial segment ablation from 2012 to 2016 were retrospectively analyzed. Patient characteristics were collected. TACE was performed for all patients before ablation. After ablation, CT imagings were used to evaluate treatment and follow-up. Overall survival (OS) and local tumor progression free survival (LTPFS) were calculated. Results: Twenty-three patients with 68 liver tumors were included. The median tumor maximum diameter was 55 mm (range, 24 to 91 mm). The complete response rate of combination therapy was 87%. The one-, two-, three- and four-year overall survival rates were 78%, 65%, 54% and 54%, respectively. The three-year survival rate for BCLC stage C HCC patients was 53%. The one-, two- and three-year LTPFS rates were 54%, 35% and 35%, respectively. Tumor maximum diameter, vascular invasion and partial treatment response were independent risk factors for LTPFS. Only one patient suffered a major complication. Conclusion: TACE combined with partial hepatic segment thermal ablation is a safe and effective treatment for liver cancer patients, especially for those with more advanced disease.

Combination therapy of three-dimensional (3D) visualisation operative treatment planning system and US-guided percutaneous microwave ablation in larger renal cell carcinomas (D ≥ 4 cm): preliminary results.

PURPOSE: To analyse the clinical outcomes of combination therapy of three-dimensional (3D) visualisation operative treatment planning system and US-guided percutaneous microwave ablation (PMWA) in larger renal cell carcinomas (RCCs) (D ≥ 4 cm). MATERIALS AND METHODS: The results from 20 patients with 20 larger RCCs treated with a 3D visualisation operative treatment planning system and US-guided PMWA were reviewed retrospectively. The patients were followed up by contrast-enhanced images at 1, 3, and 6 months and every 6 months thereafter. The outcomes of overall survival and local tumour progression rate were statistically analysed. RESULTS: The median follow-up period was 26 months. The mean time of ablation for one tumour was 1.1 ± 0.3 sessions. The average number of ablation points of one tumour was 4.5 ± 0.9. The mean output power of ablation was 50.50 ± 2.2 W. The mean time of ablation for one tumour was 1374.4 ± 391.1 s. Artificial ascites was used in 12 (60%) tumours adjacent to the intestinal tract, and thermal monitoring system was used in all tumours (100%). Technical effectiveness and metastasis-free status were achieved in all tumours. The 1- and 2-year local tumour progression rates were both 5%. The cancer-specific survival rate and 2-year overall survival rates were both 100%. No severe major complications occurred. There was no significant difference in creatinine or urea nitrogen before or 3 days after ablation. CONCLUSIONS: Combination therapy of 3D visualisation operative treatment planning system and US-guided PMWA appeared to be a safe and effective technique for the management of larger RCCs, which could improve clinical efficacy.

HCC with tumor thrombus entering the right atrium and inferior vena cava treated by percutaneous ablation.

BACKGROUND: In the advanced stages of hepatocellular carcinoma (HCC), a tumor thrombus (TT) can form in the portal or hepatic vein. The management of patients with advanced HCC and a TT extending into the right atrium (RA) and inferior vena cava (IVC) is extremely difficult and risky. CASE PRESENTATION: We report the case of a patient with HCC and a large TT (85 × 45 mm) extending into the RA through the hepatic vein and IVC, which is very rare. We performed percutaneous microwave ablation of the TT and the two intrahepatic tumors (maximum diameter, 57 mm). The treatment shrank the tumors, and the patient is in good condition and has survived for 16 months thus far. A literature review was also performed. This is the first such case to be treated with percutaneous microwave ablation. CONCLUSION: The outcomes in this case suggest that percutaneous ablation is useful for the treatment of TT extending into the RA and IVC in patients with HCC.

Radiofrequency ablation-increased CXCL10 is associated with earlier recurrence of hepatocellular carcinoma by promoting stemness.

Radiofrequency ablation (RFA) represents a valuable choice in hepatocellular carcinoma (HCC); however, local recurrence of HCC is common after RFA. Here, 20 primary HCC patients treated by RFA were enrolled. Before (termed 0d) and after RFA treatment for 1 and 7 days (termed 1d and 7d, respectively), plasma and noncancerous tissue were collected. ELISA assay showed that plasma C-X-C motif chemokine 10 (CXCL10) was increased in ten patients (type I patients) but decreased in the other 10 patients (type II patients). The mean interval for HCC recurrence in type I patients was less than the mean interval in type II patients. Interestingly, a significant negative correlation between interval for HCC recurrence and fold change of plasma CXCL10 (1d/0d or 7d/0d) was identified, suggesting that RFA-induced CXCL10 is associated with earlier HCC recurrence. Immunofluorescence assay showed that the receptor of CXCL10, chemokine (C-X-C motif) receptor 3 (CXCR3), was significantly increased in type I, but not type II, patients after RFA. In vitro assay demonstrated that CXCL10 stimulus increased the rate of CD133(+) cancer stem cells (CSCs) in HepG2 cells by binding to CXCR3 and then inducing c-Myc expression. Many studies have reported that induction of CD133(+) CSCs contributes to HCC recurrence. Thus, CXCL10-increased CD133(+) CSCs by activating CXCR3/c-Myc pathway might accelerate HCC recurrence after RFA. These data might have potential implications for HCC therapy.

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.

A Huaier polysaccharide inhibits hepatocellular carcinoma growth and metastasis.

This study was carried out to evaluate the effects of a Huaier polysaccharide (TP-1) on the tumor growth and immune function in hepatocellular carcinoma (HCC) H22-based mouse in vivo. Results showed that TP-1 was capable of repressing transplanted H22 solid hepatic tumor cell growth in vivo, prolonging the live time of mice bearing ascetic H22 tumors, and repressing the pulmonary metastasis of H22-bearing mice. Moreover, the relative weight of immune organ (spleen and thymus) and lymphocyte proliferation were improved after TP-1 treatment. Furthermore, the treatment with TP-1 could promote immune-stimulating serum cytokines, such as IL-2 and IFN-γ, but inhibit immune-suppressing serum cytokines IL-10 secretion in H22-bearing mice. Besides, the percentage of CD4+ T cells and NK cells was increased, whereas the number of CD8+ T cells decreased in tumor-bearing mice following TP-1 administration. In addition, this compound displayed little toxic effects to major organ of tumor-bearing mice at the therapeutic dose, such as the liver and kidney. This experimental finding suggested that TP-1 exhibited prominent antitumor activities in vivo via enhancement of host immune system function in H22 tumor-bearing mice. This product could be developed individually as a safe and potent biological response modifier for HCC therapy.

A Huaier polysaccharide reduced metastasis of human hepatocellular carcinoma SMMC-7721 cells via modulating AUF-1 signaling pathway.

TP-1 is a polysaccharide from one famous fungus Huaier. Treatment with TP-1 significantly inhibited the cell growth, adhesion, migration, and motility of SMMC-7721 cells in a dose-dependent manner. Real-time quantitative RT-PCR revealed a dose-dependent decrease in RNA-binding factor 1 (AUF-1) and astrocyte elevated gene-1 (AEG-1) messenger RNA (mRNA) levels in TP-1-treated SMMC-7721 cells, which is consistent with their protein expression detected by Western blotting. On the contrary, microRNA-122 (miR-122) expression increased in SMMC-7721 cells following TP-1 treatment. Moreover, TP-1 treatment at three doses apparently increased epithelial marker E-cadherin protein expression but decreased the mesenchymal marker N-cadherin protein level. In addition, the hematoxylin-eosin (H & E) staining showed that the TP-1 significantly inhibited the lung metastasis of liver cancer in mice orthotopic implanted with SMMC-7721 tumor tissue. Taken together, these findings proved the inhibitory effect of TP-1 on the growth and metastasis of SMMC-7721 cells, and TP-1 might be offered for future application as a powerful chemopreventive agent against hepatocellular carcinoma (HCC) metastasis.

Complete remission of multiple lung metastases after ablation of hepatocellular carcinoma by transarterial infusion with the p53 gene.

We describe the case of a 68-year-old man who presented with a massive lesion in the right liver. It was confirmed by preoperative aspiration biopsy to be a case of moderately differentiated hepatocellular carcinoma, and the patient was shown by immunohistochemistry to have a mutation in the p53 gene. The hepatic lesion showed complete necrosis after arterial embolization combined with microwave ablation. During a re-examination 3 months after ablation, the α-fetoprotein level was found to have increased markedly. Bilateral pulmonary metastases were shown by a lung computed tomography scan, with a focal diameter smaller than 1 cm. Hepatic and bronchial intra-arterial infusion with the recombinant adenovirus p53 gene (rAd-p53) was performed twice. The second time the infusion was administered, interleukin-2 was used in combination with rAd-p53. After 2 months of treatment, the bilateral pulmonary lesions had almost disappeared. After 7 months of treatment, the bilateral pulmonary metastases disappeared completely, and no further recurrence has been identified in the lungs and liver.

Astrocyte elevated gene-1 is a novel biomarker of epithelial-mesenchymal transition and progression of hepatocellular carcinoma in two China regions.

Astrocyte elevated gene-1 (AEG-1) is involved in important biological processes including cell invasion, metastasis, and carcinogenesis. However, its clinical significance has remained largely unknown in hepatocellular carcinoma. Here, specimens from 144 patients with hepatocellular carcinomas in Beijing and Heilongjiang regions were investigated by immunohistochemical staining for AEG-1, vimentin, and E-cadherin expressions. A clinicopathological study revealed that AEG-1 expression level in tumor cells was significantly correlated with TNM stage (P = 0.001) and Edmonson grade (P < 0.0001). In addition, AEG-1, vimentin, and E-cadherin (epithelial-mesenchymal transition (EMT) biomarker) expressions were correlated with each other. These findings suggest that AEG-1 may be an epithelial-mesenchymal transition-associated biomarker in human hepatocellular carcinoma and play important roles in the progression of hepatocellular carcinoma. In addition, the AEG-1 gene is a potential target for elimination of hepatocellular carcinoma in the future.

Astrocyte elevated gene-1 (AEG-1) shRNA sensitizes Huaier polysaccharide (HP)-induced anti-metastatic potency via inactivating downstream P13K/Akt pathway as well as augmenting cell-mediated immune response.

Astrocyte elevated gene-1 (AEG-1) is an important force in the development and progression of hepatocellular carcinoma (HCC). To extend our study, we examined here the role of AEG-1 in anti-metastatic effects of Huaier polysaccharide (HP) on the human HCC MHCC97-H cell line. AEG-1 shRNA contributed to the anti-proliferation effect of HP on MHCC97-H cells. Furthermore, results of Transwell insert chambers showed that low expression of AEG-1 could effectively facilitate HP to suppress MHCC97-H cell migration and invasion. We achieved this by reducing phosphoinositide 3-kinases (P13K) and phosphorylated Akt (pAkt) expression as well as enhancing natural killer (NK) cell activity. Taken together, our data strongly suggested that AEG-1 shRNA could block the carcinogenesis and progression of MHCC97-H cells and highlight the therapeutic potential of HP in HCC treatment, at least by part, by inhibiting the activation of the PI3K/Akt pathway and enhancing the NK cell-mediated immune response. These findings may provide a new strategy for HCC treatment.

GALAD score as a prognostic model for recurrence of hepatocellular carcinoma after local ablation.

BACKGROUND: Currently, the high recurrence rate still forms severe challenges in hepatocellular carcinoma (HCC) treatment. The GALAD score, including age, gender, alpha-fetoprotein (AFP), lens culinaris agglutinin-reactive AFP (AFP-L3), and des-gamma-carboxyprothrombin (DCP) was developed as a diagnostic model. However, evidence is still lacking to confirm the capability of the GALAD score to predict the recurrence of HCC. METHODS: This study included 390 HCC patients after local ablation at Beijing You'an Hospital from January 1, 2018, to December 31, 2022. Firstly, the area under the receiver operating characteristic (ROC) curve (AUC) was calculated to assess the predictive capability of the GALAD score. Then, the Kaplan-Meier (KM) curve and log-rank test were used to compare the prognosis between two groups classified by GALAD score. Finally, a nomogram for high-risk patients was established by Lasso-Cox regression. It was assessed by ROC curves, calibration curves, and decision curve analysis (DCA). RESULTS: The ROC curve (AUC: 0.749) and KM curve showed the GALAD score had good predictive ability and could clearly stratify patients into two groups through the risk of recurrence. Prognostic factors selected by Lasso-Cox regression contained tumor number, tumor size, and globulin. The nomogram for high-risk patients showed reliable discrimination, calibration, and clinical utility. CONCLUSION: This research displayed that the GALAD score is an effective model for predicting the recurrence of HCC. Meanwhile, we found the poor prognosis of the high-risk group and created a nomogram for these patients.

Therapeutic analysis of 632 cases treated by transcatheter arterial chemoembolization combined with ablation in hepatocellular carcinoma: A retrospective study.

OBJECTIVES: This study aims to analyze the efficacy of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) in hepatocellular carcinoma (HCC). METHODS: A retrospective analysis was conducted on 632 patients with HCC at Barcelona Clinic Liver Cancer Staging (BCLC) System stages 0, A, and B from Beijing You'an Hospital affiliated with Capital Medical University. The primary outcomes analyzed were overall survival (OS) and progression-free survival (PFS), while the secondary outcomes included one-, three-, and five-year OS rates among different groups. RESULTS: The median follow-up period for 632 cases identified with HCC was 52.1 months (range: 3-162 months), while 127 patients died during follow-up. The one-, three-, and five-year OS rates were 97.1 %, 89.5 %, and 80.4 %, respectively. Moreover, the one-, three-, and five-year PFS rates were 58.1 %, 29.3 %, and 19.8 %, respectively. Multivariate analysis revealed that the BCLC stages and complete ablation were independent predictors of OS and PFS (all p < 0.05). Subgroup analysis showed no difference in OS rate among TACE-RFA, TACE-MWA, and TACE-CA groups, but TACE-CA showed better efficacy in improving the PFS rate (all p < 0.05). CONCLUSIONS: The combination of TACE and ablation is effective in early-stage HCC and BCLC stage B. Complete ablation and BCLC stages are significant prognostic factors for PFS and OS. Further research, including randomized controlled trials, is needed to validate these findings.

Radiofrequency ablation plays double role in immunosuppression and activation of PBMCs in recurrent hepatocellular carcinoma.

Background: Radiofrequency ablation (RFA) is the primary curative treatment for hepatocellular carcinoma (HCC) patients who are not eligible for surgery. However, the effects of RFA on the global tumor immune response remain unclear. Method: In this study, we examined the phenotypic and functional changes in peripheral blood mononuclear cells (PBMCs) from recurrent HCC patients who had undergone two RFA treatments using mass cytometry and high-throughput mRNA assays. Results: We observed significant increase in monocytes and decrease in T cell subpopulations three days after the first RFA treatment and three days after the second RFA treatment. The down-regulation of GZMB, GZMH, GZMK, and CD8A, which are involved in the cytotoxic function of T cells, was observed following RFA. Furthermore, the population of CD8 effector and memory T cells (CD8 Teff and CD8 Tem) significantly decreased after RFA. The expression of CD5 and CD161 in various T cell subpopulations also showed significant reductions. Additionally, elevated secretion of VEGF was observed in monocytes, B cells, regulatory T cells (Tregs), and CD4 naive T cells. Conclusion: In recurrent HCC patients, serum components derived from radiofrequency therapy can enhance the antigen-presenting capacity of monocytes. However, they also inhibit the anti-cancer immune response by reducing the population of CD8 effector and memory T cells and suppressing the activation of T cells, as well as down-regulating the expression of CD161 and CD5 in various T cell subpopulations. These tumor-derived components also contribute to an immunosuppressive microenvironment by promoting the secretion of VEGF in monocytes, Tregs, B cells, and CD4 naive T cells.

CT-guided radiofrequency ablation following high-dose chemotherapy of a liver-metastasizing pancreatoblastoma with tumor thrombus in the portal vein.

Pancreatoblastoma is a rare neoplasm encountered most commonly in infants and young children. Unresectable or metastatic tumors have a poor prognosis despite adjuvant chemotherapy or radiotherapy. We report the successful use of CT-guided radiofrequency ablation subsequent to intensive chemotherapy in an 8-year-old girl with liver-metastasizing pancreatoblastoma and with right and segment 4 portal vein tumor thrombosis. She has been in remission for 3 years.

Comparison of diagnostic sensitivity of C-arm CT, DSA and CT in detecting small HCC.

BACKGROUND/AIMS: To compare the detection rate of 64-slice CT, digital subtraction angiography (DSA) and C-arm computed tomography (C-arm CT) in small lesions with a diameter ≤3.0 cm of hepatocellular carcinoma (HCC). METHODOLOGY: Sixty-six patients with HCC underwent 64-slice CT, DSA, and C-arm CT, and were followed up by lipiodol CT two weeks after transcatheter arterial chemoembolization (TACE). Whose result was used as diagnostic reference. The number of detected lesions with diameter ≤3.0 cm in each imaging modality was counted independently by 4 radiologists. RESULTS: A total of 174 lesions out of the 66 patients were confirmed by lipiodol CT, among which 47.7% were detected by 64-slice CT, 82.2% by DSA, and 97.1% by C-arm CT. McNemar test showed the statistical difference in detection rate between each two methods of CT, DSA and C-arm CT (all p<0.0001). All lesions were further classified into 3 groups (group A, B, C) according to the diameter (≤1cm, 1-2cm, 2-3cm), where C-arm CT showed significantly higher diagnostic sensitivity in group A and B. CONCLUSIONS: Compared to 64-slice CT and DSA, C-arm CT has the best sensitivity by detecting small lesions of HCC, and thus may play a guiding role in TACE procedure.

Effect of HBsAg expression in liver tissue on prognosis of hepatocellular carcinoma after minimally invasive interventional therapy.

Background: The aim of this study was to investigate the association between pathologic markers and prognosis in patients with hepatocellular carcinoma who received transcatheter chemoembolization combined with locoregional ablation therapy. Methods: This retrospective study included 111 hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC). All patients underwent transcatheter arterial chemoembolization (TACE) combined with locoregional ablation therapy, and received core needle biopsy before therapy in Beijing You 'an Hospital affiliated to Capital Medical University from January 1, 2013 to December 31, 2016. Demographic, pathological indicators and clinical laboratory data were collected. The cumulative recurrence-free survival (RFS) and overall survival (OS) were calculated and compared by Kaplan-Meier method and Log-rank test, and Cox proportional risk model was used to screen for independent predictors of recurrence and long-term prognosis in HCC patients. Results: There was a correlation between HBsAg expression in liver tissue and prognosis of HCC patients. Patients with negative HBsAg expression had longer 1-,3- and 5-year RFS rates than positive HBsAg expression (78.3%, 43.5%, 30.4% and 58.5%, 24.5%, 17.0%, P=0.018). Meanwhile,the postoperative 1-,3-and 5-year OS rates of HCC patients in the negative HBsAg expression group were significantly higher than those of HCC patients in the positive HBsAg expression group (100%, 89.1%, 80.4% and 100%, 75.5%, 58.5%, P=0.008). Conclusions: The prognosis of patients with hepatocellular carcinoma with negative HBsAg expression was better than that with positive HBsAg expression. Accordingly, the expression of the liver HBsAg before combined therapy was a prognostic indicator for OS and RFS. For patients with liver HBsAg positive, follow-up should be strengthened and corresponding intervention measures should be taken to improve prognosis.