This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy...This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy,in treating advanced hepatocellular carcinoma(HCC).The potential application of this combination therapy for patients with advanced HCC is evaluated.展开更多
BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the liver,significantly compromising patient survival.While surgical resection improves outcomes for resectable cases,many patients have limited therapeutic ...BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the liver,significantly compromising patient survival.While surgical resection improves outcomes for resectable cases,many patients have limited therapeutic options.AIM To evaluate the role of laparoscopic ultrasound in resection and ablation of colorectal liver metastases(CRLM).METHODS Between June 2018 and June 2020,300 patients with CRC and liver metastases were admitted to our hospital.They were divided into two groups(150 cases each)based on treatment method:The control group(ethoxybenzyl diethylenetriamine penta-acetic acid enhanced magnetic resonance imaging)and the observation group[contrast-enhanced ultrasound with Sonazoid(S-CEUS)].RESULTS The study group demonstrated better efficacy(P<0.05),fewer adverse events(P<0.05),and better survival outcomes compared to the control group(1-year:80%vs 62%;3-year:54%vs 33%;5-year:32%vs 18%;median survival:48 months vs 30 months;hazard ratio=0.63,95%CI:0.48-0.83,P<0.001).Although Karnofsky Performance Status scores improved in both groups,the scores were significantly higher in the observation group(P<0.05).Multivariate analysis confirmed intraoperative S-CEUS and tumor differentiation as independent prognostic factors(P<0.05).CONCLUSION Laparoscopic ultrasound-guided resection/ablation improved outcomes in CRLM,reducing complications and enhancing survival.Intraoperative S-CEUS was an independent prognostic factor,supporting its clinical value.展开更多
BACKGROUND Hepatic hemangiomas represent the most prevalent benign liver tumors.Surgical management of large symptomatic hepatic hemangiomas remains controversial and there is an increasing interest in minimally invas...BACKGROUND Hepatic hemangiomas represent the most prevalent benign liver tumors.Surgical management of large symptomatic hepatic hemangiomas remains controversial and there is an increasing interest in minimally invasive techniques,such as transcatheter arterial chemoembolization(TACE)and microwave ablation(MWA).AIM To evaluate the efficacy and safety of TACE combined with MWA for large hepatic hemangiomas.METHODS This retrospective cohort study was conducted at Peking Union Medical College Hospital between January 2015 and January 2024.Eighty-two patients with hepatic hemangiomas>5 cm were divided into two groups:Observation(TACE+MWA,n=50)and control(TACE,n=32).Tumor diameter and treatment outcomes were evaluated at baseline,12 months,and>3 years.Appropriate statistical tests were chosen based on the type and distribution of the data.RESULTS At baseline,the median tumor diameter was 8.3(range:5.0-19.2)cm in the observation group and 8.5(range:5.0-20.0)cm in the control group.The median follow up duration was 44.6(95%confidence interval:36.7-52.5)months.At 12 months post-treatment,the observation group demonstrated a higher tumor reduction ratio compared to the control group(50.98%vs 23.28%,respectively;P<0.001).The objective response rate was 93.94%in the observation group,which was significantly higher than that in the control group(33.33%)(P<0.001).No recurrence occurred in the observation group,while one case occurred in the control group.Notably,no cases of hemoglobinuria or acute kidney injury were reported in the observation group.CONCLUSION Combination treatment enhances tumor shrinkage,promotes long-term tumor control,and reduces the complications associated with MWA,thereby presenting a promising alternative to surgical resection.展开更多
BACKGROUND Liver cancer is one of the most common malignant tumors of the digestive system,and early detection and effective treatment are crucial for improving the prognosis.Microwave ablation(MWA)has shown promising...BACKGROUND Liver cancer is one of the most common malignant tumors of the digestive system,and early detection and effective treatment are crucial for improving the prognosis.Microwave ablation(MWA)has shown promising results as a local therapeutic method for liver cancer;however,further improvement of its efficacy remains a key focus of current research.AIM To evaluate the clinical efficacy of Linggui Zhugan decoction combined with MWA for the treatment of primary liver cancer.METHODS Data were collected from 164 patients with primary liver cancer who underwent MWA at our hospital between March 2019 and April 2021.Among them,79 patients(control group)received routine treatments and 85 patients(research group)received Linggui Zhugan decoction in addition to routine treatment.The clinical efficacy,incidence of adverse reactions,and levels of serum alphafetoprotein(AFP),des-γ-carboxy prothrombin(DCP),AFP-L3,total bilirubin(TBil),alanine aminotransferase(ALT),CD4 cell count,CD8 cell count,and CD4/CD8 ratio were compared between the two groups,before and after treatment.The three-year recurrence rates between the two groups were compared,and independent prognostic factors for recurrence were identified.RESULTS The study results revealed that the objective response rate(ORR)in the research group was significantly higher than that in the control group(P=0.005).After treatment,the CD4 cell count and CD4/CD8 ratio significantly increased,whereas the CD8 cell count and TBil,ALT,AFP,DCP,and AFP-L3 Levels were significantly lower in the research group than in the control group(P<0.001).The Cox regression analysis revealed that the treatment regimen(P=0.003),presence of cirrhosis(P=0.019),tumor diameter(P=0.037),Child-Pugh score(P=0.003),pretreatment AFP level(P=0.006),and AFP-L3 Level(P=0.002)were independent prognostic factors for disease-free survival.CONCLUSION The combination of Linggui Zhugan decoction with MWA significantly improved the clinical efficacy and longterm prognosis of patients with primary liver cancer.展开更多
BACKGROUND Flat bone metastases are common in patients with advanced cancers,often resulting in severe pain,limited mobility,and reduced quality of life(QOL).Traditional treatment options,such as radiotherapy or syste...BACKGROUND Flat bone metastases are common in patients with advanced cancers,often resulting in severe pain,limited mobility,and reduced quality of life(QOL).Traditional treatment options,such as radiotherapy or systemic therapies,often fail to provide sufficient pain relief or improve functional outcomes in these patients.Microwave ablation(MWA)offers advantages,such as shorter pro-cedure times and larger ablation zones,while percutaneous osteoplasty(PO)enhances bone stability and prevents pathological fractures.Despite these be-nefits,the combination of these techniques for treating flat bone metastases re-mains underexplored.AIM To evaluate the efficacy and safety of C-arm computed tomography(CT)-guided MWA combined with PO for managing painful flat bone metastases,focusing on pain relief,functional improvement,and QOL enhancement.METHODS A total of 45 patients with refractory moderate-to-severe pain resulting from flat bone metastases who underwent C-arm CT-guided MWA combined with PO between January 2015 and January 2021 were included.The efficacy of the pro-cedure was assessed by changes in the visual analog scale(VAS),Oswestry disability index(ODI),and QOL,as well as the occurrence of complications.Tumor response was evaluated using RECIST v1.1 and mRECIST criteria,with overall response rate(ORR)and disease control rate(DCR)as the primary end-points.RESULTS No serious complications were observed in any of the patients.A significant reduction in VAS and ODI was noted at 1 week,1 month,and 3 months post-procedure.A marked improvement in QOL was observed at all follow-up points.Bone cement extravasation was observed in 10 patients;however,none exhibited significant clinical symptoms.Based on RECIST v1.1,the ORR was 26.7%and the DCR was 88.9%.The mRECIST evaluation revealed a higher ORR of 51.1%and DCR of 88.9%.CONCLUSION C-arm CT-guided MWA with PO provides a dependable and effective strategy for managing flat bone metastases.It demonstrates significant pain relief,improved functional outcomes,and enhanced QOL.This treatment combination also shows promising tumor response rates with a low complication profile.展开更多
Microwave ablation(MWA)is emerging as a highly effective treatment for colorectal liver metastases(CRLMs).This review explores the advantages of MWA compared to other ablative techniques such as radiofrequency ablatio...Microwave ablation(MWA)is emerging as a highly effective treatment for colorectal liver metastases(CRLMs).This review explores the advantages of MWA compared to other ablative techniques such as radiofrequency ablation and cryoablation and highlights its clinical efficacy,safety,and technical considerations.MWA offers significant benefits,including higher intratumoral temperatures,larger ablation zones,and reduced susceptibility to the heat-sink effect,which make it particularly suitable for tumors near large blood vessels.This review details the patient selection criteria,procedural approaches,and the use of advanced imaging techniques to improve the precision and effectiveness of MWA.Clinical outcomes indicate that MWA achieves high rates of complete tumor ablation and long-term survival with a favorable safety profile.This review is significant because it provides updated insights into the expanding role of MWA in treating unresectable CRLM and its potential as an alternative to surgical resection for resectable tumors.By summarizing recent studies and clinical trials,this review highlights the comparative effectiveness,safety,and integration with systemic therapies of MWA.In conclusion,MWA is a promising treatment option for CRLM and offers outcomes comparable to or better than those of other ablative techniques.Future research should focus on optimizing technical parameters,integrating MWA with systemic therapies,and conducting large-scale randomized controlled trials to establish standardized treatment protocols.Advancing our understanding of MWA will enhance its application and improve long-term survival and quality of life for patients with CRLM.展开更多
Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to...Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to recanalization and neoangiogenesis,which may interfere with the synergistic effects of combination therapy.This study aimed to investigate whether TACE simultaneously combined with microwave ablation(MWA)is more effective than sequential therapy in patients with HCC.Methods:A total of 129 HCC patients who underwent TACE combined with MWA were included in this study.Based on the time interval between the first combination therapy of TACE and MWA,patients were divided into the simultaneous and sequential groups.Propensity score matching(PSM)was performed to reduce bias between the groups.Overall survival(OS),time-to-progression(TTP),tumor response,and liver function were compared.Results:Before PSM,the simultaneous group had a higher tumor load.Following PSM,36 and 40 patients remained in the simultaneous and sequential groups,respectively.The median TTP and OS were 12.9 vs.10.6 months(P=0.262)and 44.0 vs.26.5 months(P=0.313)for the simultaneous and sequential groups,respectively.After 4–8 weeks,there were 16 complete responders and 17 partial responders in the simultaneous group and 15 and 22 patients in the sequential group,respectively(P=0.504).The median complete response duration was 11.3 and 9.2 months for the simultaneous and sequential groups,respectively(P=0.882).These results did not differ in BCLC stratified subgroups.Patients with small tumor sizes(≤5 cm),tumor nodules≤3,well-defined boundaries,and early-stage tumors were more likely to achieve complete response(all P<0.05).After 4–8 weeks,the liver function was significantly improved compared to that before or one day after treatment.Conclusions:TACE simultaneously combined with MWA is safe and effective but not superior to sequential therapy.展开更多
Purpose:The major limitation of tumor microwave ablation(MWA)operation is the lack of predictability of the ablation zone before surgery.Operators rely on their individual experience to select a treatment plan,which i...Purpose:The major limitation of tumor microwave ablation(MWA)operation is the lack of predictability of the ablation zone before surgery.Operators rely on their individual experience to select a treatment plan,which is prone to either inadequate or excessive ablation.This paper aims to establish an ablation prediction model that guides MWA tumor surgical planning.Methods:An MWA process was first simulated by incorporating electromagnetic radiation equations,thermal equations,and optimized biological tissue parameters(dynamic dielectric and thermophysical parameters).The temperature distributions(the short/long diameters,and the total volume of the ablation zone)were then generated and verified by 60 cases ex vivo porcine liver experiments.Subsequently,a series of data were obtained from the simulated temperature distributions and to further fit the novel ablation coagulated area prediction model(ACAPM),thus rendering the ablation-dose table for the guiding surgical plan.The MWA clinical patient data and clinical devices suggested data were used to validate the accuracy and practicability of the established predicted model.Results:The 60 cases ex vivo porcine liver experiments demonstrated the accuracy of the simulated temperature distributions.Compared to traditional simulation methods,our approach reduces the long-diameter error of the ablation zone from 1.1 cm to 0.29 cm,achieving a 74%reduction in error.Further,the clinical data including the patients'operation results and devices provided values were consistent well with our predicated data,indicating the great potential of ACAPM to assist preoperative planning.展开更多
BACKGROUND In-depth comparative investigations in terms of clinical efficacies of liver tumor microwave ablation(MWA)and laparoscopic hepatectomy(LH),which are both important treatment modalities for liver neoplasms,h...BACKGROUND In-depth comparative investigations in terms of clinical efficacies of liver tumor microwave ablation(MWA)and laparoscopic hepatectomy(LH),which are both important treatment modalities for liver neoplasms,have been limited in patients diagnosed with primary small liver cancer(PSLC).AIM To compare and analyze the clinical efficacy of liver tumor MWA and LH for PSLC.METHODS This study retrospectively analyzed the medical records of 123 patients with PSLC admitted to Xuzhou Central Hospital from January 2015 to November 2022 and categorized them based on treatment modalities into the LH and MWA groups.The LH group,consisting of 61 cases,received LH,and the MWA group,which included 62 cases,underwent liver tumor MWA.Basic data and various periop-erative indicators were compared between the two groups,including changes in liver function indicators[alanine aminotransferase(ALT),glutamic aminotrans-ferase(AST),and total bilirubin(TBIL)]pre-and post-treatment,and efficacy and postoperative complications were analyzed.RESULTS No statistically significant difference was observed between the two groups in terms of age,gender,tumor diameter,liver function Child-Pugh classification and number of tumors,body mass index,and educational status(P>0.05).The overall effective rate was higher in the MWA group than in the LH group(98.39%vs 88.52%)(χ2=4.918,P=0.027).The MWA group exhibited less operation time,intraoperative bleeding,defecation time,and hospital stay than the LH group(P<0.05).No difference was found in liver function indicators between the two groups pre-treatment(P>0.05),and ALT,AST,and TBIL levels decreased in both groups post-treatment,with the MWA group demonstrating lower levels(P<0.05).The MWA and LH groups exhibited postoperative complication rates of 4.84%and 19.67%,respectively,with statistically significant differences between the two groups(P=0.012,χ2=6.318).CONCLUSION MWA is more effective in treating PSLC,and it promotes faster postoperative recovery for patients,and more security improves liver function and reduces postoperative complications compared to LH.展开更多
Background:Balloon catheter isolation is a promising auxiliary method for thermal ablation treatment of liver cancer. We aimed to explore the safety and effectiveness of balloon catheter isolation-assisted ultrasound-...Background:Balloon catheter isolation is a promising auxiliary method for thermal ablation treatment of liver cancer. We aimed to explore the safety and effectiveness of balloon catheter isolation-assisted ultrasound-guided percutaneous microwave ablation (MWA) in treating liver cancer in difficult anatomical locations.Methods:Data of 132 patients with 145 difficult-site liver cancer treated with ultrasound-guided percutaneous MWA were retrospectively analyzed. Participants were classified into the isolation (n=40)and non-isolation (n=92) groups based on whether the patients were treated using a balloon catheter prior to ablation. The major complication rates, local tumor residuals (LTR), and tumor follow-up for local tumor progression (LTP) at 6 and 12 months post-ablation were compared between the two groups.Results:The rates of major postoperative complications did not significantly differ between the isolation and non-isolation groups (2.5%vs. 4.3%, P=0.609). The postoperative LTR rates were significantly different between the isolation and non-isolation groups (4.8%vs. 17.5%, P=0.032). Balloon catheter isolation [odds ratio (OR)=0.225, 95%confidence interval (CI):0.085–0.595, P=0.009] and tumor diameter(OR=2.808, 95%CI:1.186–6.647, P=0.019) were identified as independent factors influencing LTR rate.The cumulative LTP rates at 6 and 12 months after ablation showed no significant differences between the isolation and non-isolation groups (2.6%vs. 7.9%, P=0.661;4.9%vs. 9.8%, P=0.676, respectively).Cox proportional hazards regression analysis showed that tumor diameter was an independent risk factor for cumulative LTP rate (OR=3.445, 95%CI:1.406–8.437, P=0.017).Conclusions:Balloon catheter isolation-assisted MWA was safe and effective in the treatment of difficultsite liver cancer. Additionally, tumor diameter significantly influenced LTR and LTP rates after ablation.展开更多
BACKGROUND Hepatic arterial infusion chemotherapy and camrelizumab plus apatinib(TRIPLET protocol)is promising for advanced hepatocellular carcinoma(Ad-HCC).However,the usefulness of microwave ablation(MWA)after TRIPL...BACKGROUND Hepatic arterial infusion chemotherapy and camrelizumab plus apatinib(TRIPLET protocol)is promising for advanced hepatocellular carcinoma(Ad-HCC).However,the usefulness of microwave ablation(MWA)after TRIPLET is still controversial.AIM To compare the efficacy and safety of TRIPLET alone(T-A)vs TRIPLET-MWA(TM)for Ad-HCC.METHODS From January 2018 to March 2022,217 Ad-HCC patients were retrospectively enrolled.Among them,122 were included in the T-A group,and 95 were included in the T-M group.A propensity score matching(PSM)was applied to balance bias.Overall survival(OS)was compared using the Kaplan-Meier curve with the log-rank test.The overall objective response rate(ORR)and major complications were also assessed.RESULTS After PSM,82 patients were included both the T-A group and the T-M group.The ORR(85.4%)in the T-M group was significantly higher than that(65.9%)in the T-A group(P<0.001).The cumulative 1-,2-,and 3-year OS rates were 98.7%,93.4%,and 82.0%in the T-M group and 85.1%,63.1%,and 55.0%in the T-A group(hazard ratio=0.22;95%confidence interval:0.10-0.49;P<0.001).The incidence of major complications was 4.9%(6/122)in the T-A group and 5.3%(5/95)in the T-M group,which were not significantly different(P=1.000).CONCLUSION T-M can provide better survival outcomes and comparable safety for Ad-HCC than T-A.展开更多
BACKGROUND Hepatectomy is the first choice for treating liver cancer.However,inflammatory factors,released in response to pain stimulation,may suppress perioperative immune function and affect the prognosis of patient...BACKGROUND Hepatectomy is the first choice for treating liver cancer.However,inflammatory factors,released in response to pain stimulation,may suppress perioperative immune function and affect the prognosis of patients undergoing hepatectomies.AIM To determine the short-term efficacy of microwave ablation in the treatment of liver cancer and its effect on immune function.METHODS Clinical data from patients with liver cancer admitted to Suzhou Ninth People’s Hospital from January 2020 to December 2023 were retrospectively analyzed.Thirty-five patients underwent laparoscopic hepatectomy for liver cancer(liver cancer resection group)and 35 patients underwent medical image-guided microwave ablation(liver cancer ablation group).The short-term efficacy,complications,liver function,and immune function indices before and after treatment were compared between the two groups.RESULTS One month after treatment,19 patients experienced complete remission(CR),8 patients experienced partial remission(PR),6 patients experienced stable disease(SD),and 2 patients experienced disease progression(PD)in the liver cancer resection group.In the liver cancer ablation group,21 patients experienced CR,9 patients experienced PR,3 patients experienced SD,and 2 patients experienced PD.No significant differences in efficacy and complications were detected between the liver cancer ablation and liver cancer resection groups(P>0.05).After treatment,total bilirubin(41.24±7.35 vs 49.18±8.64μmol/L,P<0.001),alanine aminotransferase(30.85±6.23 vs 42.32±7.56 U/L,P<0.001),CD4+(43.95±5.72 vs 35.27±5.56,P<0.001),CD8+(20.38±3.91 vs 22.75±4.62,P<0.001),and CD4+/CD8+(2.16±0.39 vs 1.55±0.32,P<0.001)were significantly different between the liver cancer ablation and liver cancer resection groups.CONCLUSION The short-term efficacy and safety of microwave ablation and laparoscopic surgery for the treatment of liver cancer are similar,but liver function recovers quickly after microwave ablation,and microwave ablation may enhance immune function.展开更多
BACKGROUND Transarterial chemoembolization(TACE)combined with microwave ablation(MWA)is an effective treatment strategy for patients with advanced gastric cancer and liver metastasis.However,it may cause severe postop...BACKGROUND Transarterial chemoembolization(TACE)combined with microwave ablation(MWA)is an effective treatment strategy for patients with advanced gastric cancer and liver metastasis.However,it may cause severe postoperative pain and inflammatory responses.The paravertebral block(PVB)is a regional anesthetic technique that provides analgesia to the thoracic and abdominal regions.AIM To evaluate the effect of PVB on postoperative analgesia and inflammatory response in patients undergoing TACE combined with MWA for advanced gastric cancer and liver metastasis.METHODS Sixty patients were randomly divided into PVB and control groups.The PVB group received ultrasound-guided PVB with 0.375%ropivacaine preoperatively,whereas the control group received intravenous analgesia with sufentanil.The primary outcome was the visual analog scale(VAS)score for pain at 6 h,12 h,24 h,and 48 h after the procedure.Secondary outcomes were the dose of sufentanil used,incidence of adverse events,and levels of inflammatory markers(white blood cell count,neutrophil percentage,C-reactive protein,and procalcitonin)before and after the procedure.RESULTS The PVB group had significantly lower VAS scores at 6 h,12 h,24 h,and 48 h after the procedure compared with the control group(P<0.05).The PVB group also had a significantly lower consumption of sufentanil and a lower incidence of nausea,vomiting,and respiratory depression than did the control group(P<0.05).Compared with the control group,the PVB group had significantly lower levels of inflammatory markers 24 h and 48 h after the procedure(P<0.05).CONCLUSION PVB can effectively reduce postoperative pain and inflammatory responses and improve postoperative comfort and recovery in patients with advanced gastric cancer and liver metastasis treated with TACE combined with MWA.展开更多
Objective:To explore the effect of transarterial chemoembolization(TACE)+CT-guided microwave ablation(MWA)on treating patients with primary liver cancer.Methods:78 primary liver cancer cases were enrolled and divided ...Objective:To explore the effect of transarterial chemoembolization(TACE)+CT-guided microwave ablation(MWA)on treating patients with primary liver cancer.Methods:78 primary liver cancer cases were enrolled and divided into groups according to their assigned surgical plans.The control group was treated with TACE alone,and the observation group was treated with TACE+CT-guided MWA.The efficacy of the treatment and the liver function indicators and follow-up results of the patients of the two groups were compared.Results:The efficacy of the treatment received by the observation group was higher than that of the control group.Besides,the patients in the observation group exhibited better improvement in liver function indicators after 3 months of treatment.Furthermore,the survival rates of 1 and 2 years after surgery of the observation group were all higher than those of the control group(P<0.05).Conclusion:TACE combined with CT-guided MWA is more effective in treating primary liver cancer compared to TACE alone.Besides,it resulted in better improvement of liver function and long-term survival rate.Therefore,this treatment regime should be popularized.展开更多
BACKGROUND Subphrenic carcinoma has been identified as a significant risk factor for the thermal ablation of intrahepatic tumors,resulting in a high rate of residual tumor recurrence.Some studies have proposed that co...BACKGROUND Subphrenic carcinoma has been identified as a significant risk factor for the thermal ablation of intrahepatic tumors,resulting in a high rate of residual tumor recurrence.Some studies have proposed that combination treatment with transarterial chemoembolization(TACE)followed by radiofrequency ablation is both feasible and safe for tumors in the subphrenic region.However,research specifically examining the therapeutic outcomes of combination therapy using TACE and microwave ablation(TACE-MWA)in subphrenic tumors is lacking.AIM To evaluate the efficacy and safety of TACE-MWA in patients with subphrenic hepatocellular carcinoma(HCC).METHODS Between December 2017 and December 2021,49 patients diagnosed with HCC≤6 cm,who received TACE-MWA,were included in this retrospective cohort study.These patients were classified into subphrenic and non-subphrenic groups based on the distance between the diaphragm and the tumor margin.The rates of local tumor progression(LTP),progression-free survival(PFS),and overall survival(OS)were compared between the two groups.Complications were evaluated by using a grading system developed by the Society of Interventional Radiology.RESULTS After a median follow-up time of 38 mo,there were no significant differences in LTP between the subphrenic and non-subphrenic groups(27.3%and 22.2%at 5 years,respectively;P=0.66),PFS(55.5%at 5 years in both groups;P=0.91),and OS(85.0%and 90.9%in the subphrenic and non-subphrenic groups at 5 years;P=0.57).However,a significantly higher rate of LTP was observed in subphrenic HCC>3 cm compared to those≤3 cm(P=0.085).The dosage of iodized oil[hazard ratio(HR):1.52;95%confidence interval(CI):1.11-2.08;P=0.009]and multiple tumors(HR:13.22;95%CI:1.62-107.51;P=0.016)were independent prognostic factors for LTP.There were no significant differences in complication rates between the two groups(P=0.549).CONCLUSION Combined TACE and MWA was practical and safe for managing subphrenic HCC.The efficacy and safety levels did not vary significantly when tumors outside the subphrenic region were treated.展开更多
AIM: To analyze prognostic factors for survival after transarterial chemoembolization (TACE) combined with microwave ablation (MWA) for hepatocellular carcinoma (HCC).
AIM To assess the insulating effect of a poloxamer 407(P407)-based gel during microwave ablation of liver adjacent to the diaphragm.METHODS We prepared serial dilutions of P407, and 22.5%(w/w) concentration was identi...AIM To assess the insulating effect of a poloxamer 407(P407)-based gel during microwave ablation of liver adjacent to the diaphragm.METHODS We prepared serial dilutions of P407, and 22.5%(w/w) concentration was identified as suitable for ablation procedures. Subsequently, microwave ablations were performed on the livers of 24 rabbits(gel, saline, control groups, n = 8 in each). The P407 solution and 0.9% normal saline were injected into the potential space between the diaphragm and liver in experimental groups. No barriers were applied to the controls. After microwave ablations, the frequency, size and degree of thermal injury were compared histologically among the three groups. Subsequently, another 8 rabbits were injected with the P407 solution and microwave ablation was performed. The levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), blood urea nitrogen(BUN) and creatinine(Cr) in serum were tested at 1 d before microwave ablation and 3 and 7 d after operation. RESULTS In vivo ablation thermal injury to the adjacent diaphragm was evaluated in the control, saline and 22.5% P407 gel groups(P = 0.001-0.040). However, there was no significant difference in the volume of ablation zone among the three groups(P > 0.05). Moreover, there were no statistical differences among the preoperative and postoperative gel groups according to the levels of ALT, AST, BUN and Cr in serum(all P > 0.05).CONCLUSION Twenty-two point five percent P407 gel could be a more effective choice during microwave ablation of hepatic tumors adjacent to the diaphragm. Further studies for clinical translation are warranted.展开更多
AIM:To discuss the safety,feasibility and regularity of destruction to porcine spleen in vivo with congestion and tumescence by microwave ablation(MWA).METHODS:Ligation of the splenic vein was used to induce congestio...AIM:To discuss the safety,feasibility and regularity of destruction to porcine spleen in vivo with congestion and tumescence by microwave ablation(MWA).METHODS:Ligation of the splenic vein was used to induce congestion and tumescence in vivo in five porcine spleens,and microwave ablation was performed 2-4 h later.A total of 56 ablation points were ablated and the ablation powers were 30-100 W.The ablation time(1,2,3,4,5,6,7,8,9 and 10 min)was performed at a power of 60 W.After ablation,the ablation size was measured in pigs A,C,D and E and spleen resection.In pig B,the ablation size was measuredand 2 ablation points were sent for pathology analysis and all tissues were sutured following ablation.Pig B was killed 1 wk later and the ablation points were sent for pathology analysis.Bleeding,tissue carbonization surrounding electrodes,and pathological changes were observed,and the effect on destruction volume relative to different ablation powers,times and positions was analyzed.RESULTS:The incidence of bleeding(only small amounts,<20 mL)in the course of ablation was 5.4%(3/56)and was attributed to tissue carbonization surrounding electrodes,which also exhibited an incidence of 5.4%(3/56).The destruction volume was influenced by different ablation powers,times and points.It showed that the ablation lesion size increased with increased ablation time,from 1 to 10 min,when the ablation power was 60 W.Also,the ablation lesion size increased with the increase of ablation power,ranging from 30 to 100 W when the ablation time was set to 3 min.A direct correlation was seen between the destruction volume and ablation time by the power of 60 W(r=0.97542,P<0.0001),and also between the destruction volume and ablation powers at an ablation time of 3 min(r=0.98258,P<0.0001).The destruction volume of zoneⅡ(the extra-2/3 part of the spleen,relative to the fi rst or second class vascular branches),which was near the hilum of the spleen,was noteably larger than the destruction volume of zoneⅠ(the intra-1/3 part of the spleen)which was distal from the hilum of the spleen(P=0.0015).Pathological changes of ablation occurring immediately and 1 wk after MWA showed large areas of coagulation.Immediately following ablation,intact spleen tissues were observed in the areas of coagulation necrosis,mainly around arterioles,and there were no obvious signs of hydropsia and inflammation,while 1 wk following the ablation,the coagulation necrosis was well distributed and complete,as many nuclear fragmentations were detected,and there were obvious signs of hydropsia and inflammation.CONCLUSION:In vivo treatment of congestion and tumescence in the spleen using microwave ablation of water-cooled antenna is a safe and feasible method that is minimally invasive.展开更多
BACKGROUND Microwave ablation(MWA)is an effective treatment option for patients with primary liver cancer.However,it has been reported that the MWA procedure induces a hepatic inflammatory response and injury,which ma...BACKGROUND Microwave ablation(MWA)is an effective treatment option for patients with primary liver cancer.However,it has been reported that the MWA procedure induces a hepatic inflammatory response and injury,which may negatively affect the efficacy of MWA.As such,the discovery of reliable markers to monitor the patient’s response to MWA is needed.Golgi protein 73(GP73)has been shown to be associated with chronic liver disease.To date,the potential value of serum GP73 in the dynamic monitoring during MWA of liver cancer remains unclear.AIM To examine the effects of MWA on the serum levels of GP73 in patients with primary liver cancer.METHODS A total of 150 primary liver cancer patients with a single small lesion(≤3 cm in diameter)were retrospectively enrolled spanning the period between January 2016 and October 2018.All of the patients received MWA for the treatment of primary liver cancer.Serum GP73,alpha-fetoprotein(AFP),and widely used liver biochemical indicators[serum albumin,total bilirubin(TBIL),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)]were compared before MWA and at different time points,including 1,2,and 4 wk following the ablation procedure.RESULTS Complete tumor ablation was achieved in 95.33%of the patients at 1 mo after MWA.The 1-,2-,and 3-year disease-free survival rates were 74.67%,59.33%,and 54.00%,respectively.The serum AFP levels were significantly decreased at 1,2,and 4 wk after MWA;they returned to the normal range at 12 wk after MWA;and they remained stable thereafter during follow-up in those cases without recurrence.In contrast,the serum GP73 levels were significantly increased at 1 and 2 wk after MWA.The serum GP73 levels reached the peak at 2 wk after MWA,started to decline after hepatoprotective treatment with glycyrrhizin and reduced glutathione,and returned to the pretreatment levels at 12 and 24 wk after MWA.Notably,the changes of serum GP73 in response to MWA were similar to those of TBIL,ALT,and AST.CONCLUSION Serum GP73 is markedly increased in response to MWA of liver cancer.Thus,serum GP73 holds potential as a marker to monitor MWA-induced inflammatory liver injury in need of amelioration.展开更多
Objective:To construct a nomogram based on the albumin-bilirubin(ALBI)grade to provide prognostic value for hepatitis C virus(HCV)-related hepatocellular carcinoma(HCC)patients who underwent ultrasound-guided percutan...Objective:To construct a nomogram based on the albumin-bilirubin(ALBI)grade to provide prognostic value for hepatitis C virus(HCV)-related hepatocellular carcinoma(HCC)patients who underwent ultrasound-guided percutaneous microwave ablation(US-PMWA).Methods:From April 2005 to January 2018,183 treatment-naIve patients with 251 HCV-related HCCs according to the Milan criteria received US-PMWA subsequently.The overall survival(OS)and recurrence-free survival(RFS)were compared between groups classified by ALBI grade.Cox proportional hazard regression model based on risk factors for survival and recurrence was used to construct the nomogram.Results:The cumulative OS rates at 1-,3-,5-and 10-year were 97.7%,73.6%,54.5%and 34.5%,respectively.Stratified according to ALBI grade,the 1-,3-,and 5-year OS in the ALBI grade 1 group and grade 2 group were 99.2%,92.4%,77.9% and 97.7%,52.3%,38.6%,respectively,with significant statistical difference(P<0.001).No significant statistical difference was detected in the1-,3-,and 5-year RFS rates in the ALBI grade 1 group and grade 2 group(P=0.220).The major complication rate was 1.6%.Multivariate analysis results showed age,α-fetoprotein level,tumor number,platelet count,location,Child-Turcotte-Pugh(CTP)and ALBI grade were associated with OS,which generated the nomograms.Internal validation with 1000 bootstrapped sample sets had good concordance index of 0.769(95%CI 0.699-0.839)in OS.Conclusions:This nomogram based on ALBI grade was a visualization risk model,which could provide personalized prediction of long-term outcomes for HCV-related HCC patients after US-PMWA.展开更多
文摘This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy,in treating advanced hepatocellular carcinoma(HCC).The potential application of this combination therapy for patients with advanced HCC is evaluated.
基金Supported by National Clinical Key Specialty Major Research Project of Hunan Provincial Health Commission in 2023,No.Z2023165.
文摘BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the liver,significantly compromising patient survival.While surgical resection improves outcomes for resectable cases,many patients have limited therapeutic options.AIM To evaluate the role of laparoscopic ultrasound in resection and ablation of colorectal liver metastases(CRLM).METHODS Between June 2018 and June 2020,300 patients with CRC and liver metastases were admitted to our hospital.They were divided into two groups(150 cases each)based on treatment method:The control group(ethoxybenzyl diethylenetriamine penta-acetic acid enhanced magnetic resonance imaging)and the observation group[contrast-enhanced ultrasound with Sonazoid(S-CEUS)].RESULTS The study group demonstrated better efficacy(P<0.05),fewer adverse events(P<0.05),and better survival outcomes compared to the control group(1-year:80%vs 62%;3-year:54%vs 33%;5-year:32%vs 18%;median survival:48 months vs 30 months;hazard ratio=0.63,95%CI:0.48-0.83,P<0.001).Although Karnofsky Performance Status scores improved in both groups,the scores were significantly higher in the observation group(P<0.05).Multivariate analysis confirmed intraoperative S-CEUS and tumor differentiation as independent prognostic factors(P<0.05).CONCLUSION Laparoscopic ultrasound-guided resection/ablation improved outcomes in CRLM,reducing complications and enhancing survival.Intraoperative S-CEUS was an independent prognostic factor,supporting its clinical value.
基金Supported by the Peking Union Medical College Hospital Central High-Level Hospital Clinical Research Project,No.2022-PUMCH-B-069。
文摘BACKGROUND Hepatic hemangiomas represent the most prevalent benign liver tumors.Surgical management of large symptomatic hepatic hemangiomas remains controversial and there is an increasing interest in minimally invasive techniques,such as transcatheter arterial chemoembolization(TACE)and microwave ablation(MWA).AIM To evaluate the efficacy and safety of TACE combined with MWA for large hepatic hemangiomas.METHODS This retrospective cohort study was conducted at Peking Union Medical College Hospital between January 2015 and January 2024.Eighty-two patients with hepatic hemangiomas>5 cm were divided into two groups:Observation(TACE+MWA,n=50)and control(TACE,n=32).Tumor diameter and treatment outcomes were evaluated at baseline,12 months,and>3 years.Appropriate statistical tests were chosen based on the type and distribution of the data.RESULTS At baseline,the median tumor diameter was 8.3(range:5.0-19.2)cm in the observation group and 8.5(range:5.0-20.0)cm in the control group.The median follow up duration was 44.6(95%confidence interval:36.7-52.5)months.At 12 months post-treatment,the observation group demonstrated a higher tumor reduction ratio compared to the control group(50.98%vs 23.28%,respectively;P<0.001).The objective response rate was 93.94%in the observation group,which was significantly higher than that in the control group(33.33%)(P<0.001).No recurrence occurred in the observation group,while one case occurred in the control group.Notably,no cases of hemoglobinuria or acute kidney injury were reported in the observation group.CONCLUSION Combination treatment enhances tumor shrinkage,promotes long-term tumor control,and reduces the complications associated with MWA,thereby presenting a promising alternative to surgical resection.
文摘BACKGROUND Liver cancer is one of the most common malignant tumors of the digestive system,and early detection and effective treatment are crucial for improving the prognosis.Microwave ablation(MWA)has shown promising results as a local therapeutic method for liver cancer;however,further improvement of its efficacy remains a key focus of current research.AIM To evaluate the clinical efficacy of Linggui Zhugan decoction combined with MWA for the treatment of primary liver cancer.METHODS Data were collected from 164 patients with primary liver cancer who underwent MWA at our hospital between March 2019 and April 2021.Among them,79 patients(control group)received routine treatments and 85 patients(research group)received Linggui Zhugan decoction in addition to routine treatment.The clinical efficacy,incidence of adverse reactions,and levels of serum alphafetoprotein(AFP),des-γ-carboxy prothrombin(DCP),AFP-L3,total bilirubin(TBil),alanine aminotransferase(ALT),CD4 cell count,CD8 cell count,and CD4/CD8 ratio were compared between the two groups,before and after treatment.The three-year recurrence rates between the two groups were compared,and independent prognostic factors for recurrence were identified.RESULTS The study results revealed that the objective response rate(ORR)in the research group was significantly higher than that in the control group(P=0.005).After treatment,the CD4 cell count and CD4/CD8 ratio significantly increased,whereas the CD8 cell count and TBil,ALT,AFP,DCP,and AFP-L3 Levels were significantly lower in the research group than in the control group(P<0.001).The Cox regression analysis revealed that the treatment regimen(P=0.003),presence of cirrhosis(P=0.019),tumor diameter(P=0.037),Child-Pugh score(P=0.003),pretreatment AFP level(P=0.006),and AFP-L3 Level(P=0.002)were independent prognostic factors for disease-free survival.CONCLUSION The combination of Linggui Zhugan decoction with MWA significantly improved the clinical efficacy and longterm prognosis of patients with primary liver cancer.
文摘BACKGROUND Flat bone metastases are common in patients with advanced cancers,often resulting in severe pain,limited mobility,and reduced quality of life(QOL).Traditional treatment options,such as radiotherapy or systemic therapies,often fail to provide sufficient pain relief or improve functional outcomes in these patients.Microwave ablation(MWA)offers advantages,such as shorter pro-cedure times and larger ablation zones,while percutaneous osteoplasty(PO)enhances bone stability and prevents pathological fractures.Despite these be-nefits,the combination of these techniques for treating flat bone metastases re-mains underexplored.AIM To evaluate the efficacy and safety of C-arm computed tomography(CT)-guided MWA combined with PO for managing painful flat bone metastases,focusing on pain relief,functional improvement,and QOL enhancement.METHODS A total of 45 patients with refractory moderate-to-severe pain resulting from flat bone metastases who underwent C-arm CT-guided MWA combined with PO between January 2015 and January 2021 were included.The efficacy of the pro-cedure was assessed by changes in the visual analog scale(VAS),Oswestry disability index(ODI),and QOL,as well as the occurrence of complications.Tumor response was evaluated using RECIST v1.1 and mRECIST criteria,with overall response rate(ORR)and disease control rate(DCR)as the primary end-points.RESULTS No serious complications were observed in any of the patients.A significant reduction in VAS and ODI was noted at 1 week,1 month,and 3 months post-procedure.A marked improvement in QOL was observed at all follow-up points.Bone cement extravasation was observed in 10 patients;however,none exhibited significant clinical symptoms.Based on RECIST v1.1,the ORR was 26.7%and the DCR was 88.9%.The mRECIST evaluation revealed a higher ORR of 51.1%and DCR of 88.9%.CONCLUSION C-arm CT-guided MWA with PO provides a dependable and effective strategy for managing flat bone metastases.It demonstrates significant pain relief,improved functional outcomes,and enhanced QOL.This treatment combination also shows promising tumor response rates with a low complication profile.
基金Supported by the Joint Medical Scientific Research Project of Chongqing Science and Technology Committee and Chongqing Health Committee,No.2021MSXM308.
文摘Microwave ablation(MWA)is emerging as a highly effective treatment for colorectal liver metastases(CRLMs).This review explores the advantages of MWA compared to other ablative techniques such as radiofrequency ablation and cryoablation and highlights its clinical efficacy,safety,and technical considerations.MWA offers significant benefits,including higher intratumoral temperatures,larger ablation zones,and reduced susceptibility to the heat-sink effect,which make it particularly suitable for tumors near large blood vessels.This review details the patient selection criteria,procedural approaches,and the use of advanced imaging techniques to improve the precision and effectiveness of MWA.Clinical outcomes indicate that MWA achieves high rates of complete tumor ablation and long-term survival with a favorable safety profile.This review is significant because it provides updated insights into the expanding role of MWA in treating unresectable CRLM and its potential as an alternative to surgical resection for resectable tumors.By summarizing recent studies and clinical trials,this review highlights the comparative effectiveness,safety,and integration with systemic therapies of MWA.In conclusion,MWA is a promising treatment option for CRLM and offers outcomes comparable to or better than those of other ablative techniques.Future research should focus on optimizing technical parameters,integrating MWA with systemic therapies,and conducting large-scale randomized controlled trials to establish standardized treatment protocols.Advancing our understanding of MWA will enhance its application and improve long-term survival and quality of life for patients with CRLM.
基金supported by grants from Guangzhou Sci-ence and Technology Bureau City-University(College)Joint Fund-ing Project(2023A03J0224)2024 Guangzhou Basic and Applied Basic Research Scheme(Project for Maiden Voyage)(SL2023A04J00258)。
文摘Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to recanalization and neoangiogenesis,which may interfere with the synergistic effects of combination therapy.This study aimed to investigate whether TACE simultaneously combined with microwave ablation(MWA)is more effective than sequential therapy in patients with HCC.Methods:A total of 129 HCC patients who underwent TACE combined with MWA were included in this study.Based on the time interval between the first combination therapy of TACE and MWA,patients were divided into the simultaneous and sequential groups.Propensity score matching(PSM)was performed to reduce bias between the groups.Overall survival(OS),time-to-progression(TTP),tumor response,and liver function were compared.Results:Before PSM,the simultaneous group had a higher tumor load.Following PSM,36 and 40 patients remained in the simultaneous and sequential groups,respectively.The median TTP and OS were 12.9 vs.10.6 months(P=0.262)and 44.0 vs.26.5 months(P=0.313)for the simultaneous and sequential groups,respectively.After 4–8 weeks,there were 16 complete responders and 17 partial responders in the simultaneous group and 15 and 22 patients in the sequential group,respectively(P=0.504).The median complete response duration was 11.3 and 9.2 months for the simultaneous and sequential groups,respectively(P=0.882).These results did not differ in BCLC stratified subgroups.Patients with small tumor sizes(≤5 cm),tumor nodules≤3,well-defined boundaries,and early-stage tumors were more likely to achieve complete response(all P<0.05).After 4–8 weeks,the liver function was significantly improved compared to that before or one day after treatment.Conclusions:TACE simultaneously combined with MWA is safe and effective but not superior to sequential therapy.
基金supported by the National Major Scientific Instruments and Equipment Development Project Funded by the National Natural Science Foundation of China(81827803)the Jiangsu Province Key Research and Development Program(Social Development)Project(BE2020705).
文摘Purpose:The major limitation of tumor microwave ablation(MWA)operation is the lack of predictability of the ablation zone before surgery.Operators rely on their individual experience to select a treatment plan,which is prone to either inadequate or excessive ablation.This paper aims to establish an ablation prediction model that guides MWA tumor surgical planning.Methods:An MWA process was first simulated by incorporating electromagnetic radiation equations,thermal equations,and optimized biological tissue parameters(dynamic dielectric and thermophysical parameters).The temperature distributions(the short/long diameters,and the total volume of the ablation zone)were then generated and verified by 60 cases ex vivo porcine liver experiments.Subsequently,a series of data were obtained from the simulated temperature distributions and to further fit the novel ablation coagulated area prediction model(ACAPM),thus rendering the ablation-dose table for the guiding surgical plan.The MWA clinical patient data and clinical devices suggested data were used to validate the accuracy and practicability of the established predicted model.Results:The 60 cases ex vivo porcine liver experiments demonstrated the accuracy of the simulated temperature distributions.Compared to traditional simulation methods,our approach reduces the long-diameter error of the ablation zone from 1.1 cm to 0.29 cm,achieving a 74%reduction in error.Further,the clinical data including the patients'operation results and devices provided values were consistent well with our predicated data,indicating the great potential of ACAPM to assist preoperative planning.
文摘BACKGROUND In-depth comparative investigations in terms of clinical efficacies of liver tumor microwave ablation(MWA)and laparoscopic hepatectomy(LH),which are both important treatment modalities for liver neoplasms,have been limited in patients diagnosed with primary small liver cancer(PSLC).AIM To compare and analyze the clinical efficacy of liver tumor MWA and LH for PSLC.METHODS This study retrospectively analyzed the medical records of 123 patients with PSLC admitted to Xuzhou Central Hospital from January 2015 to November 2022 and categorized them based on treatment modalities into the LH and MWA groups.The LH group,consisting of 61 cases,received LH,and the MWA group,which included 62 cases,underwent liver tumor MWA.Basic data and various periop-erative indicators were compared between the two groups,including changes in liver function indicators[alanine aminotransferase(ALT),glutamic aminotrans-ferase(AST),and total bilirubin(TBIL)]pre-and post-treatment,and efficacy and postoperative complications were analyzed.RESULTS No statistically significant difference was observed between the two groups in terms of age,gender,tumor diameter,liver function Child-Pugh classification and number of tumors,body mass index,and educational status(P>0.05).The overall effective rate was higher in the MWA group than in the LH group(98.39%vs 88.52%)(χ2=4.918,P=0.027).The MWA group exhibited less operation time,intraoperative bleeding,defecation time,and hospital stay than the LH group(P<0.05).No difference was found in liver function indicators between the two groups pre-treatment(P>0.05),and ALT,AST,and TBIL levels decreased in both groups post-treatment,with the MWA group demonstrating lower levels(P<0.05).The MWA and LH groups exhibited postoperative complication rates of 4.84%and 19.67%,respectively,with statistically significant differences between the two groups(P=0.012,χ2=6.318).CONCLUSION MWA is more effective in treating PSLC,and it promotes faster postoperative recovery for patients,and more security improves liver function and reduces postoperative complications compared to LH.
基金supported by a grant from the National Natural Science Foundation of China (82171937)。
文摘Background:Balloon catheter isolation is a promising auxiliary method for thermal ablation treatment of liver cancer. We aimed to explore the safety and effectiveness of balloon catheter isolation-assisted ultrasound-guided percutaneous microwave ablation (MWA) in treating liver cancer in difficult anatomical locations.Methods:Data of 132 patients with 145 difficult-site liver cancer treated with ultrasound-guided percutaneous MWA were retrospectively analyzed. Participants were classified into the isolation (n=40)and non-isolation (n=92) groups based on whether the patients were treated using a balloon catheter prior to ablation. The major complication rates, local tumor residuals (LTR), and tumor follow-up for local tumor progression (LTP) at 6 and 12 months post-ablation were compared between the two groups.Results:The rates of major postoperative complications did not significantly differ between the isolation and non-isolation groups (2.5%vs. 4.3%, P=0.609). The postoperative LTR rates were significantly different between the isolation and non-isolation groups (4.8%vs. 17.5%, P=0.032). Balloon catheter isolation [odds ratio (OR)=0.225, 95%confidence interval (CI):0.085–0.595, P=0.009] and tumor diameter(OR=2.808, 95%CI:1.186–6.647, P=0.019) were identified as independent factors influencing LTR rate.The cumulative LTP rates at 6 and 12 months after ablation showed no significant differences between the isolation and non-isolation groups (2.6%vs. 7.9%, P=0.661;4.9%vs. 9.8%, P=0.676, respectively).Cox proportional hazards regression analysis showed that tumor diameter was an independent risk factor for cumulative LTP rate (OR=3.445, 95%CI:1.406–8.437, P=0.017).Conclusions:Balloon catheter isolation-assisted MWA was safe and effective in the treatment of difficultsite liver cancer. Additionally, tumor diameter significantly influenced LTR and LTP rates after ablation.
文摘BACKGROUND Hepatic arterial infusion chemotherapy and camrelizumab plus apatinib(TRIPLET protocol)is promising for advanced hepatocellular carcinoma(Ad-HCC).However,the usefulness of microwave ablation(MWA)after TRIPLET is still controversial.AIM To compare the efficacy and safety of TRIPLET alone(T-A)vs TRIPLET-MWA(TM)for Ad-HCC.METHODS From January 2018 to March 2022,217 Ad-HCC patients were retrospectively enrolled.Among them,122 were included in the T-A group,and 95 were included in the T-M group.A propensity score matching(PSM)was applied to balance bias.Overall survival(OS)was compared using the Kaplan-Meier curve with the log-rank test.The overall objective response rate(ORR)and major complications were also assessed.RESULTS After PSM,82 patients were included both the T-A group and the T-M group.The ORR(85.4%)in the T-M group was significantly higher than that(65.9%)in the T-A group(P<0.001).The cumulative 1-,2-,and 3-year OS rates were 98.7%,93.4%,and 82.0%in the T-M group and 85.1%,63.1%,and 55.0%in the T-A group(hazard ratio=0.22;95%confidence interval:0.10-0.49;P<0.001).The incidence of major complications was 4.9%(6/122)in the T-A group and 5.3%(5/95)in the T-M group,which were not significantly different(P=1.000).CONCLUSION T-M can provide better survival outcomes and comparable safety for Ad-HCC than T-A.
文摘BACKGROUND Hepatectomy is the first choice for treating liver cancer.However,inflammatory factors,released in response to pain stimulation,may suppress perioperative immune function and affect the prognosis of patients undergoing hepatectomies.AIM To determine the short-term efficacy of microwave ablation in the treatment of liver cancer and its effect on immune function.METHODS Clinical data from patients with liver cancer admitted to Suzhou Ninth People’s Hospital from January 2020 to December 2023 were retrospectively analyzed.Thirty-five patients underwent laparoscopic hepatectomy for liver cancer(liver cancer resection group)and 35 patients underwent medical image-guided microwave ablation(liver cancer ablation group).The short-term efficacy,complications,liver function,and immune function indices before and after treatment were compared between the two groups.RESULTS One month after treatment,19 patients experienced complete remission(CR),8 patients experienced partial remission(PR),6 patients experienced stable disease(SD),and 2 patients experienced disease progression(PD)in the liver cancer resection group.In the liver cancer ablation group,21 patients experienced CR,9 patients experienced PR,3 patients experienced SD,and 2 patients experienced PD.No significant differences in efficacy and complications were detected between the liver cancer ablation and liver cancer resection groups(P>0.05).After treatment,total bilirubin(41.24±7.35 vs 49.18±8.64μmol/L,P<0.001),alanine aminotransferase(30.85±6.23 vs 42.32±7.56 U/L,P<0.001),CD4+(43.95±5.72 vs 35.27±5.56,P<0.001),CD8+(20.38±3.91 vs 22.75±4.62,P<0.001),and CD4+/CD8+(2.16±0.39 vs 1.55±0.32,P<0.001)were significantly different between the liver cancer ablation and liver cancer resection groups.CONCLUSION The short-term efficacy and safety of microwave ablation and laparoscopic surgery for the treatment of liver cancer are similar,but liver function recovers quickly after microwave ablation,and microwave ablation may enhance immune function.
文摘BACKGROUND Transarterial chemoembolization(TACE)combined with microwave ablation(MWA)is an effective treatment strategy for patients with advanced gastric cancer and liver metastasis.However,it may cause severe postoperative pain and inflammatory responses.The paravertebral block(PVB)is a regional anesthetic technique that provides analgesia to the thoracic and abdominal regions.AIM To evaluate the effect of PVB on postoperative analgesia and inflammatory response in patients undergoing TACE combined with MWA for advanced gastric cancer and liver metastasis.METHODS Sixty patients were randomly divided into PVB and control groups.The PVB group received ultrasound-guided PVB with 0.375%ropivacaine preoperatively,whereas the control group received intravenous analgesia with sufentanil.The primary outcome was the visual analog scale(VAS)score for pain at 6 h,12 h,24 h,and 48 h after the procedure.Secondary outcomes were the dose of sufentanil used,incidence of adverse events,and levels of inflammatory markers(white blood cell count,neutrophil percentage,C-reactive protein,and procalcitonin)before and after the procedure.RESULTS The PVB group had significantly lower VAS scores at 6 h,12 h,24 h,and 48 h after the procedure compared with the control group(P<0.05).The PVB group also had a significantly lower consumption of sufentanil and a lower incidence of nausea,vomiting,and respiratory depression than did the control group(P<0.05).Compared with the control group,the PVB group had significantly lower levels of inflammatory markers 24 h and 48 h after the procedure(P<0.05).CONCLUSION PVB can effectively reduce postoperative pain and inflammatory responses and improve postoperative comfort and recovery in patients with advanced gastric cancer and liver metastasis treated with TACE combined with MWA.
文摘Objective:To explore the effect of transarterial chemoembolization(TACE)+CT-guided microwave ablation(MWA)on treating patients with primary liver cancer.Methods:78 primary liver cancer cases were enrolled and divided into groups according to their assigned surgical plans.The control group was treated with TACE alone,and the observation group was treated with TACE+CT-guided MWA.The efficacy of the treatment and the liver function indicators and follow-up results of the patients of the two groups were compared.Results:The efficacy of the treatment received by the observation group was higher than that of the control group.Besides,the patients in the observation group exhibited better improvement in liver function indicators after 3 months of treatment.Furthermore,the survival rates of 1 and 2 years after surgery of the observation group were all higher than those of the control group(P<0.05).Conclusion:TACE combined with CT-guided MWA is more effective in treating primary liver cancer compared to TACE alone.Besides,it resulted in better improvement of liver function and long-term survival rate.Therefore,this treatment regime should be popularized.
文摘BACKGROUND Subphrenic carcinoma has been identified as a significant risk factor for the thermal ablation of intrahepatic tumors,resulting in a high rate of residual tumor recurrence.Some studies have proposed that combination treatment with transarterial chemoembolization(TACE)followed by radiofrequency ablation is both feasible and safe for tumors in the subphrenic region.However,research specifically examining the therapeutic outcomes of combination therapy using TACE and microwave ablation(TACE-MWA)in subphrenic tumors is lacking.AIM To evaluate the efficacy and safety of TACE-MWA in patients with subphrenic hepatocellular carcinoma(HCC).METHODS Between December 2017 and December 2021,49 patients diagnosed with HCC≤6 cm,who received TACE-MWA,were included in this retrospective cohort study.These patients were classified into subphrenic and non-subphrenic groups based on the distance between the diaphragm and the tumor margin.The rates of local tumor progression(LTP),progression-free survival(PFS),and overall survival(OS)were compared between the two groups.Complications were evaluated by using a grading system developed by the Society of Interventional Radiology.RESULTS After a median follow-up time of 38 mo,there were no significant differences in LTP between the subphrenic and non-subphrenic groups(27.3%and 22.2%at 5 years,respectively;P=0.66),PFS(55.5%at 5 years in both groups;P=0.91),and OS(85.0%and 90.9%in the subphrenic and non-subphrenic groups at 5 years;P=0.57).However,a significantly higher rate of LTP was observed in subphrenic HCC>3 cm compared to those≤3 cm(P=0.085).The dosage of iodized oil[hazard ratio(HR):1.52;95%confidence interval(CI):1.11-2.08;P=0.009]and multiple tumors(HR:13.22;95%CI:1.62-107.51;P=0.016)were independent prognostic factors for LTP.There were no significant differences in complication rates between the two groups(P=0.549).CONCLUSION Combined TACE and MWA was practical and safe for managing subphrenic HCC.The efficacy and safety levels did not vary significantly when tumors outside the subphrenic region were treated.
文摘AIM: To analyze prognostic factors for survival after transarterial chemoembolization (TACE) combined with microwave ablation (MWA) for hepatocellular carcinoma (HCC).
基金Supported by the Clinical-Basic Cooperation Program from Capital Medical University,No.15JL10the National Key Research and Development Program,No.2016YFA0201504the Beijing Training Project For The Leading Talents in S&T,No.Z14110700154002
文摘AIM To assess the insulating effect of a poloxamer 407(P407)-based gel during microwave ablation of liver adjacent to the diaphragm.METHODS We prepared serial dilutions of P407, and 22.5%(w/w) concentration was identified as suitable for ablation procedures. Subsequently, microwave ablations were performed on the livers of 24 rabbits(gel, saline, control groups, n = 8 in each). The P407 solution and 0.9% normal saline were injected into the potential space between the diaphragm and liver in experimental groups. No barriers were applied to the controls. After microwave ablations, the frequency, size and degree of thermal injury were compared histologically among the three groups. Subsequently, another 8 rabbits were injected with the P407 solution and microwave ablation was performed. The levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), blood urea nitrogen(BUN) and creatinine(Cr) in serum were tested at 1 d before microwave ablation and 3 and 7 d after operation. RESULTS In vivo ablation thermal injury to the adjacent diaphragm was evaluated in the control, saline and 22.5% P407 gel groups(P = 0.001-0.040). However, there was no significant difference in the volume of ablation zone among the three groups(P > 0.05). Moreover, there were no statistical differences among the preoperative and postoperative gel groups according to the levels of ALT, AST, BUN and Cr in serum(all P > 0.05).CONCLUSION Twenty-two point five percent P407 gel could be a more effective choice during microwave ablation of hepatic tumors adjacent to the diaphragm. Further studies for clinical translation are warranted.
基金Supported by Guangdong Provincial Science and Technology FundGuangdong Provincial Scientifi c Project Grant
文摘AIM:To discuss the safety,feasibility and regularity of destruction to porcine spleen in vivo with congestion and tumescence by microwave ablation(MWA).METHODS:Ligation of the splenic vein was used to induce congestion and tumescence in vivo in five porcine spleens,and microwave ablation was performed 2-4 h later.A total of 56 ablation points were ablated and the ablation powers were 30-100 W.The ablation time(1,2,3,4,5,6,7,8,9 and 10 min)was performed at a power of 60 W.After ablation,the ablation size was measured in pigs A,C,D and E and spleen resection.In pig B,the ablation size was measuredand 2 ablation points were sent for pathology analysis and all tissues were sutured following ablation.Pig B was killed 1 wk later and the ablation points were sent for pathology analysis.Bleeding,tissue carbonization surrounding electrodes,and pathological changes were observed,and the effect on destruction volume relative to different ablation powers,times and positions was analyzed.RESULTS:The incidence of bleeding(only small amounts,<20 mL)in the course of ablation was 5.4%(3/56)and was attributed to tissue carbonization surrounding electrodes,which also exhibited an incidence of 5.4%(3/56).The destruction volume was influenced by different ablation powers,times and points.It showed that the ablation lesion size increased with increased ablation time,from 1 to 10 min,when the ablation power was 60 W.Also,the ablation lesion size increased with the increase of ablation power,ranging from 30 to 100 W when the ablation time was set to 3 min.A direct correlation was seen between the destruction volume and ablation time by the power of 60 W(r=0.97542,P<0.0001),and also between the destruction volume and ablation powers at an ablation time of 3 min(r=0.98258,P<0.0001).The destruction volume of zoneⅡ(the extra-2/3 part of the spleen,relative to the fi rst or second class vascular branches),which was near the hilum of the spleen,was noteably larger than the destruction volume of zoneⅠ(the intra-1/3 part of the spleen)which was distal from the hilum of the spleen(P=0.0015).Pathological changes of ablation occurring immediately and 1 wk after MWA showed large areas of coagulation.Immediately following ablation,intact spleen tissues were observed in the areas of coagulation necrosis,mainly around arterioles,and there were no obvious signs of hydropsia and inflammation,while 1 wk following the ablation,the coagulation necrosis was well distributed and complete,as many nuclear fragmentations were detected,and there were obvious signs of hydropsia and inflammation.CONCLUSION:In vivo treatment of congestion and tumescence in the spleen using microwave ablation of water-cooled antenna is a safe and feasible method that is minimally invasive.
基金Supported by the Military Medical Science and Technology Committee of China,No.14MS095the Quanzhou Science and Technology Planning Project,No.2017Z018.
文摘BACKGROUND Microwave ablation(MWA)is an effective treatment option for patients with primary liver cancer.However,it has been reported that the MWA procedure induces a hepatic inflammatory response and injury,which may negatively affect the efficacy of MWA.As such,the discovery of reliable markers to monitor the patient’s response to MWA is needed.Golgi protein 73(GP73)has been shown to be associated with chronic liver disease.To date,the potential value of serum GP73 in the dynamic monitoring during MWA of liver cancer remains unclear.AIM To examine the effects of MWA on the serum levels of GP73 in patients with primary liver cancer.METHODS A total of 150 primary liver cancer patients with a single small lesion(≤3 cm in diameter)were retrospectively enrolled spanning the period between January 2016 and October 2018.All of the patients received MWA for the treatment of primary liver cancer.Serum GP73,alpha-fetoprotein(AFP),and widely used liver biochemical indicators[serum albumin,total bilirubin(TBIL),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)]were compared before MWA and at different time points,including 1,2,and 4 wk following the ablation procedure.RESULTS Complete tumor ablation was achieved in 95.33%of the patients at 1 mo after MWA.The 1-,2-,and 3-year disease-free survival rates were 74.67%,59.33%,and 54.00%,respectively.The serum AFP levels were significantly decreased at 1,2,and 4 wk after MWA;they returned to the normal range at 12 wk after MWA;and they remained stable thereafter during follow-up in those cases without recurrence.In contrast,the serum GP73 levels were significantly increased at 1 and 2 wk after MWA.The serum GP73 levels reached the peak at 2 wk after MWA,started to decline after hepatoprotective treatment with glycyrrhizin and reduced glutathione,and returned to the pretreatment levels at 12 and 24 wk after MWA.Notably,the changes of serum GP73 in response to MWA were similar to those of TBIL,ALT,and AST.CONCLUSION Serum GP73 is markedly increased in response to MWA of liver cancer.Thus,serum GP73 holds potential as a marker to monitor MWA-induced inflammatory liver injury in need of amelioration.
基金supported by the National Key R&D Program of China (Grant No. 2017YFC0112000)the National Natural Science Foundation of China (Grants No. 81627803, 91859201, and 81871374)the State Key Project on Infectious Disease of China (Grant No. 2018ZX10723204)
文摘Objective:To construct a nomogram based on the albumin-bilirubin(ALBI)grade to provide prognostic value for hepatitis C virus(HCV)-related hepatocellular carcinoma(HCC)patients who underwent ultrasound-guided percutaneous microwave ablation(US-PMWA).Methods:From April 2005 to January 2018,183 treatment-naIve patients with 251 HCV-related HCCs according to the Milan criteria received US-PMWA subsequently.The overall survival(OS)and recurrence-free survival(RFS)were compared between groups classified by ALBI grade.Cox proportional hazard regression model based on risk factors for survival and recurrence was used to construct the nomogram.Results:The cumulative OS rates at 1-,3-,5-and 10-year were 97.7%,73.6%,54.5%and 34.5%,respectively.Stratified according to ALBI grade,the 1-,3-,and 5-year OS in the ALBI grade 1 group and grade 2 group were 99.2%,92.4%,77.9% and 97.7%,52.3%,38.6%,respectively,with significant statistical difference(P<0.001).No significant statistical difference was detected in the1-,3-,and 5-year RFS rates in the ALBI grade 1 group and grade 2 group(P=0.220).The major complication rate was 1.6%.Multivariate analysis results showed age,α-fetoprotein level,tumor number,platelet count,location,Child-Turcotte-Pugh(CTP)and ALBI grade were associated with OS,which generated the nomograms.Internal validation with 1000 bootstrapped sample sets had good concordance index of 0.769(95%CI 0.699-0.839)in OS.Conclusions:This nomogram based on ALBI grade was a visualization risk model,which could provide personalized prediction of long-term outcomes for HCV-related HCC patients after US-PMWA.
