中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 2
Feb.  2022
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(2): 365-371

Clinical efficacy and safety of percutaneous cryoablation combined with percutaneous ethanol injection in elderly patients with hepatocellular carcinoma aged 70 years or older

DOI: 10.3969/j.issn.1001-5256.2022.02.021
  • 1.

    Peking University 302 Clinical Medical School, Beijing 100039, China

  • 2.

    Faculty of Liver Disease, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China

Research funding:

National Science and Technology Major Project during the 13th Five-Year Plan Period (2018ZX10725506)

More Information
  • Corresponding author: YANG Yongping, yongpingyang@hotmail.com
  • Received Date: 2021-11-18
  • Accepted Date: 2021-12-20
  • Published Date: 2022-02-20
    Abstract
  •   Objective  To investigate the clinical efficacy and safety of percutaneous cryoablation combined with percutaneous ethanol injection (PEI) in elderly patients with early-stage hepatocellular carcinoma aged 70 years or older.  Methods  A retrospective analysis was performed for the clinical data of 92 elderly patients with hepatocellular carcinoma who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January 2014 to January 2018, among whom 46 underwent cryoablation alone (CRYO group) and 46 underwent cryoablation combined with PEI (combination therapy group). The two groups were compared in terms of clinical outcome, adverse reactions, and changes in liver function parameters after treatment, and the patients were followed up to observe tumor recurrence and survival. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used for comparison of survival curves. The Cox regression analysis was used to identify the independent risk factors for survival and prognosis.  Results  There was no significant difference in the response rate of initial ablation between the combination therapy group and the CRYO group (89.1% vs 73.9%, P > 0.05). There were no significant differences between the CRYO group and the combination therapy group in overall survival time and tumor-free survival rate after surgery (P > 0.05), and compared with the CRYO group, the combination therapy group had significantly lower 1-, 2-, and 3-year local tumor progression rates (20%/21%/21% vs 30%/46%/46%, χ2=4.187, P < 0.05). The multivariate Cox regression analysis showed that cryoablation alone might be an independent risk factor for local tumor progression(HR=2.206, 95%CI: 1.003-4.850, P=0.049). There was no significant difference in the incidence rate of adverse reactions between the two groups (P > 0.05), but 3 patients in the CRYO group experienced serious adverse reactions, while no patients in the combination therapy group experienced such reactions.  Conclusion  For elderly patients with early-stage hepatocellular carcinoma, cryoablation combined with PEI is safer and more effective than cryoablation alone and can significantly reduce local tumor progression rate.

     

    • FullText(HTML)
  • loading
    • References(28)
  • [1]
    LI X, LIANG P. Current status and advances in ultrasound-guided thermal ablation for hepatocellular carcinoma[J]. J Clin Hepatol, 2021, 37(3): 510-514. DOI: 10.3969/j.issn.1001-5256.2021.03.004.

    李鑫, 梁萍. 超声引导下肝癌热消融治疗的现状与进展[J]. 临床肝胆病杂志, 2021, 37(3): 510-514. DOI: 10.3969/j.issn.1001-5256.2021.03.004.
    [2]
    TOKUSHIGE K, HASHIMOTO E, HORIE Y, et al. Hepatocellular carcinoma based on cryptogenic liver disease: The most common non-viral hepatocellular carcinoma in patients aged over 80 years[J]. Hepatol Res, 2015, 45(4): 441-447. DOI: 10.1111/hepr.12372.
    [3]
    MIRICI-CAPPA F, GRAMENZI A, SANTI V, et al. Treatments for hepatocellular carcinoma in elderly patients are as effective as in younger patients: A 20-year multicentre experience[J]. Gut, 2010, 59(3): 387-396. DOI: 10.1136/gut.2009.194217.
    [4]
    ZHANG YX, ZHANG XH, YU XL, et al. Prognosis of microwave ablation for hepatocellular carcinoma: Does age make a difference?[J]. Int J Hyperthermia, 2020, 37(1): 688-695. DOI: 10.1080/02656736.2020.1778198.
    [5]
    ZHUO ET, ZHENG YC, FU GH, et al. Clinical effect of transcatheter arterial chemoembolization combined with percutaneous ethanol injection in elderly patients with primary liver cancer[J]. Chin J Gerontol, 2021, 41(14): 2956-2958. DOI: 10.3969/j.issn.1005-9202.2021.14.013.

    卓恩挺, 郑扬慈, 符国宏, 等. 肝动脉化疗栓塞术联合无水酒精消融术在老年原发性肝癌中的临床效果[J]. 中国老年学杂志, 2021, 41(14): 2956-2958. DOI: 10.3969/j.issn.1005-9202.2021.14.013.
    [6]
    LI Z, ZHANG K, LIN SM, et al. Radiofrequency ablation combined with percutaneous ethanol injection for hepatocellular carcinoma: a systematic review and meta-analysis[J]. Int J Hyperthermia, 2017, 33(3): 237-246. DOI: 10.1080/02656736.2016.1237681.
    [7]
    HUANG H, LIANG P, YU XL, et al. Safety assessment and therapeutic efficacy of percutaneous microwave ablation therapy combined with percutaneous ethanol injection for hepatocellular carcinoma adjacent to the gallbladder[J]. Int J Hyperthermia, 2015, 31(1): 40-47. DOI: 10.3109/02656736.2014.999017.
    [8]
    WANG XZ, WANG ZX, YANG YP. The value of cryoablation combined with percutaneous ethanol injection in the treatment of liver cancer[J]. Hebei Med J, 2012, 34(15): 2274-2276. DOI: 10.3969/j.issn.1002-7386.2012.15.014.

    王新真, 王忠新, 杨永平, 等. 氩氦刀冷冻消融联合无水乙醇注射在肝癌治疗中的价值[J]. 河北医药, 2012, 34(15): 2274-2276. DOI: 10.3969/j.issn.1002-7386.2012.15.014.
    [9]
    WANG C, WANG H, YANG W, et al. Multicenter randomized controlled trial of percutaneous cryoablation versus radiofrequency ablation in hepatocellular carcinoma[J]. Hepatology, 2015, 61(5): 1579-1590. DOI: 10.1002/hep.27548.
    [10]
    WANG H, LITTRUP PJ, DUAN Y, et al. Thoracic masses treated with percutaneous cryotherapy: Initial experience with more than 200 procedures[J]. Radiology, 2005, 235(1): 289-298. DOI: 10.1148/radiol.2351030747.
    [11]
    DINDO D, DEMARTINES N, CLAVIEN PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg, 2004, 240(2): 205-213. DOI: 10.1097/01.sla.0000133083.54934.ae.
    [12]
    AHMED M, SOLBIATI L, BRACE CL, et al. Image-guided tumor ablation: Standardization of terminology and reporting criteria--a 10-year update[J]. Radiology, 2014, 273(1): 241-260. DOI: 10.1148/radiol.14132958.
    [13]
    KUDO M. Recent advances in systemic therapy for hepatocellular carcinoma in an aging society: 2020 update[J]. Liver Cancer, 2020, 9(6): 640-662. DOI: 10.1159/000511001.
    [14]
    European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma[J]. J Hepatol, 2018, 69(1): 182-236. DOI: 10.1016/j.jhep.2018.03.019.
    [15]
    RHO SY, LEE HW, KIM DY, et al. Current status of therapeutic choice and feasibility for patients with hepatocellular carcinoma aged ≥ 70 years: A nationwide cancer registry analysis[J]. J Hepatocell Carcinoma, 2021, 8: 321-332. DOI: 10.2147/JHC.S306507.
    [16]
    GALUN D, BOGDANOVIC A, ZIVANOVIC M, et al. Short- and long-term outcomes after hepatectomy in elderly patients with hepatocellular carcinoma: An analysis of 229 cases from a developing country[J]. J Hepatocell Carcinoma, 2021, 8: 155-165. DOI: 10.2147/JHC.S297296.
    [17]
    KIM JM, CHO BI, KWON CH, et al. Hepatectomy is a reasonable option for older patients with hepatocellular carcinoma[J]. Am J Surg, 2015, 209(2): 391-397. DOI: 10.1016/j.amjsurg.2013.06.010.
    [18]
    YU B, DING Y, LIAO X, et al. Radiofrequency ablation versus surgical resection in elderly patients with early-stage hepatocellular carcinoma in the era of organ shortage[J]. Saudi J Gastroenterol, 2018, 24(6): 317-325. DOI: 10.4103/sjg.SJG_261_18.
    [19]
    EI S, HIBI T, TANABE M, et al. Cryoablation provides superior local control of primary hepatocellular carcinomas of > 2 cm compared with radiofrequency ablation and microwave coagulation therapy: An underestimated tool in the toolbox[J]. Ann Surg Oncol, 2015, 22(4): 1294-1300. DOI: 10.1245/s10434-014-4114-7.
    [20]
    DUNNE RM, SHYN PB, SUNG JC, et al. Percutaneous treatment of hepatocellular carcinoma in patients with cirrhosis: A comparison of the safety of cryoablation and radiofrequency ablation[J]. Eur J Radiol, 2014, 83(4): 632-638. DOI: 10.1016/j.ejrad.2014.01.007.
    [21]
    SATO M, TATEISHI R, YASUNAGA H, et al. Mortality and morbidity of hepatectomy, radiofrequency ablation, and embolization for hepatocellular carcinoma: A national survey of 54, 145 patients[J]. J Gastroenterol, 2012, 47(10): 1125-1133. DOI: 10.1007/s00535-012-0569-0.
    [22]
    SHⅡNA S, TATEISHI R, ARANO T, et al. Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors[J]. Am J Gastroenterol, 2012, 107(4): 569-577; quiz 578. DOI: 10.1038/ajg.2011.425.
    [23]
    LI Z, ZHANG C, LOU C, et al. Comparison of percutaneous cryosurgery and surgical resection for the treatment of small hepatocellular carcinoma[J]. Oncol Lett, 2013, 6(1): 239-245. DOI: 10.3892/ol.2013.1314.
    [24]
    ORLACCHIO A, BAZZOCCHI G, PASTORELLI D, et al. Percutaneous cryoablation of small hepatocellular carcinoma with US guidance and CT monitoring: initial experience[J]. Cardiovasc Intervent Radiol, 2008, 31(3): 587-594. DOI: 10.1007/s00270-008-9293-9.
    [25]
    TAKAHASHI H, MIZUTA T, KAWAZOE S, et al. Efficacy and safety of radiofrequency ablation for elderly hepatocellular carcinoma patients[J]. Hepatol Res, 2010, 40(10): 997-1005. DOI: 10.1111/j.1872-034X.2010.00713.x.
    [26]
    KAIBORI M, YOSHⅡ K, HASEGAWA K, et al. Treatment optimization for hepatocellular carcinoma in elderly patients in a Japanese Nationwide Cohort[J]. Ann Surg, 2019, 270(1): 121-130. DOI: 10.1097/SLA.0000000000002751.
    [27]
    HINSHAW JL, LEE FT Jr. Cryoablation for liver cancer[J]. Tech Vasc Interv Radiol, 2007, 10(1): 47-57. DOI: 10.1053/j.tvir.2007.08.005.
    [28]
    VANDENBROUCKE F, VANDEMEULEBROUCKE J, BULS N, et al. Can tumor coverage evaluated 24 h post-radiofrequency ablation predict local tumor progression of liver metastases?[J]. Int J Comput Assist Radiol Surg, 2018, 13(12): 1981-1989. DOI: 10.1007/s11548-018-1765-z.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(3)  / Tables(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (437) PDF downloads(39) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return