Pulsed Microwave Liver Ablation: An Additional Tool to Treat Hepatocellular Carcinoma
Abstract
:Simple Summary
Abstract
1. Introduction
2. Material and Methods
- −
- Patients not suitable for liver resection (due to performance status, portal hypertension, or the status of end-stage liver disease)
- −
- The absence of extrahepatic spread or vascular invasion
- −
- HCC < 70 mm
2.1. Pulsed Microwave Ablation
2.2. Radiological Follow-Up
2.3. Statistical Analysis
3. Results
3.1. Population
3.2. Disease
3.3. Procedures
3.4. Complications According to Clavien–Dindo and Outcome
3.5. Follow-Up
4. Discussion
4.1. Safety and Efficacy
4.2. Survival
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Results |
---|---|
Age, mean ± SD (range); median | 68.2 ± 9.2 (36–88); 69 |
Sex (M/F), n (%) | 88 (77.9)/25 (22.1) |
Etiology, n (%) | |
Alcohol-related | 22/113 (19.5) |
Alcohol-related and metabolic | 5/113 (4.4) |
Viral | 68/113 (60.2) |
HCV | 43/113 (38.1) |
HCV + HIV | 2/113 (1.8) |
HCV + ETOH | 2/113 (1.8) |
HBV | 17/113 (15.0) |
HBV + ETOH | 4/113 (3.5) |
Metabolic | 11/113 (9.7) |
Other | 7/113 (6.2) |
BCLC, n (%) | |
0 | 11 (10) |
A | 59 (52) |
B | 33 (29) |
C | 6 (5) |
D | 2 (2) |
NR | 2 (2) |
MELD, Mean ± SD (Range) | Results |
---|---|
Considering procedures | 9.4 ± 3.1 (6–21) |
Considering patients (MELD score at the first procedure) | 9.4 ± 3.2 (6–21) |
Child–Pugh, n (%) | |
A5 | 52 (46.0) |
A6 | 40 (35.4) |
B7 | 13 (11.5) |
B8 | 2 (1.8) |
B9 | 1 (0.9) |
C10 | 2 (1.8) |
C11 | 1 (0.9) |
*NR = not reported/missing data | 2 (1.8) |
Portal thrombosis, n (%) | 10 (8.1) |
CEA (ng/mL), mean ± SD (range); median | 3.4 ± 4.9 (0.5–49.4); 2.3 |
CA 19.9 (U/mL), mean ± SD (range); median | 28.7 ± 37.3 (0.6–296); 18 |
AFP (ng/mL), mean ± SD (range) | 51.0 ± 138.1 (1–851) |
Ascites, n (%) | 33 (26.4) |
Portal hypertension, n (%) | 83 (67.5) |
*NR = not reported/missing data |
Lesions’ size (mm), mean ± SD (range); median | 17.3 ± 11.7 (7–70); 13 |
Clusters of diameters, n (%) | |
<3 cm | 253/286 (88.5) |
3–5 cm | 29/286 (10.1) |
>5 cm | 4/286 (1.4) |
Site of lesions, n (%) | |
Posterior segments (s1, s6, s7, s8) | 132 (47.2) |
Anterior segments and left lobe (s2, s3, s4a, s4b, s5) | 154 (53.8) |
Multinodular disease, n (%) | 90 (78.9) |
Number of lesions in patients, mean ± SD (range); median | 3.5 ± 2.2 (1–10); 3 |
Previous surgical treatments (n°), mean ± SD (range); median | 1.9 ± 2.2 (0–11); 3 |
Previous loco-regional treatments (n°), mean ± SD (range) | |
PEI | 0.1 ± 0.7 (0–6) |
RFA/MWA | 0.5 ± 0.8 (0–4) |
TACE | 0.7 ± 0.9 (0–4) |
Previous resection (n°), mean ± SD (range); median | 0.2 ± 0.5 (0–2) |
Surgical approach, n (%) | |
VLS | 105 (83.3) |
Laparotomic | 14 (11.1) |
Percutaneous | 7 (5.6) |
Time of ablation (min), mean ± SD (range); median | 8.0 ± 7.0 (1–40); 6.0 |
Probe power (W), mean ± SD (range); median | 81.2 ± 19.7 (40–120); 75 |
Associated resection, n (%) | 24 (18.6) |
Major | 1 (0.8) |
Minor | 23 (18.0) |
Hospital stay (days), mean ± SD (range); median | |
All | 4.96 (1–26); 4 |
VLS (105) | 4.84 (1–26); 4 |
Open (14) | 8.15 (4–20); 7 |
Percutaneous (7) | 1.0 (1); 1 |
Hospital stay for patients scored Clavien–Dindo 1, 2, and 3 | |
n = 41 (32.5%) | 5.09 (1–26); 4 |
12-Month LTP | n = 286 |
0 | 182 (90.1%) |
1 | 20 (9.9%) |
12-month LTP according to nodule size (mm) | n = 286—p = 0.0956 |
<30 (n = 253) | 15 (8.4%) |
30–50 (n = 29) | 4 (21.1%) |
>50 (n = 4) | 1 (25%) |
12-month LTP according to the BCLC stage | n = 286—p = 0.0111 |
0 (n = 13) | 1 (9.1%) |
A (n = 113) | 14 (16.9%) |
B (n = 137) | 4 (3.9%) |
C (n = 15) | 0 (0.0%) |
D (n = 8) | 1 (50.0%) |
12-month IHR | n = 126 |
0 | 70 (72.2%) |
1 | 27 (27.8%) |
12-month IHR according to nodule size (mm) | n = 126—p = 0.7636 |
<30 (n = 103) | 22 (27.8%) |
30–50 (n = 21) | 4 (25.0%) |
>50 (n = 2) | 1 (50.0%) |
Author, Year | Procedures (n°) | Diameter (cm) | Follow-Up (months) | LTP (%) |
---|---|---|---|---|
Lu MD et al., 2005 [37] | 49 | ≤3 cm 3–5 cm | 25.1 | 6.8% 30.0% |
Ohmoto K et al., 2009 [38] | 49 | ≤2 cm | 12 | 13% |
Ding J et al., 2013 [39] | 113 | ≤3 cm 3–5 cm | 18.3 | 7.3% 21.2% |
Vogl TJ et al., 2015 [40] | 28 | ≤5 cm | 12 | 11.1% |
Li W et al., 2017 [41] | 60 | ≤3 cm | 12 | 14.9% |
Xu Y et al., 2017 [42] | 294 | ≤3 cm 3–5 cm 5–6 cm | 12 | 10.6% 16.9% 28.6% |
Baker EH et al., 2017 [22] | 219 | 1–6 cm (median 3.2 cm) | 9.9 | 8.5% |
Santambrogio et al., 2017 [43] | 60 | ≤3 cm | 26.9 | 8.3% |
Liu W et al., 2018 [41] | 126 | ≤3 cm | 36.8 | 11.7% |
Cillo U et al., 2019 [32] | 815 | ≤5 cm | 6 | 23.1% |
Our experience—2020 | 126 | All <3 cm 3–5 cm >5 cm | 12 | 9.9% 8.4% 21.1% 25% |
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Zanus, G.; Tagliente, G.; Rossi, S.; Bonis, A.; Zambon, M.; Scopelliti, M.; Brizzolari, M.; Grossi, U.; Romano, M.; Finotti, M. Pulsed Microwave Liver Ablation: An Additional Tool to Treat Hepatocellular Carcinoma. Cancers 2022, 14, 748. https://doi.org/10.3390/cancers14030748
Zanus G, Tagliente G, Rossi S, Bonis A, Zambon M, Scopelliti M, Brizzolari M, Grossi U, Romano M, Finotti M. Pulsed Microwave Liver Ablation: An Additional Tool to Treat Hepatocellular Carcinoma. Cancers. 2022; 14(3):748. https://doi.org/10.3390/cancers14030748
Chicago/Turabian StyleZanus, Giacomo, Giovanni Tagliente, Serena Rossi, Alessandro Bonis, Mattia Zambon, Michele Scopelliti, Marco Brizzolari, Ugo Grossi, Maurizio Romano, and Michele Finotti. 2022. "Pulsed Microwave Liver Ablation: An Additional Tool to Treat Hepatocellular Carcinoma" Cancers 14, no. 3: 748. https://doi.org/10.3390/cancers14030748