Therapeutic effect comparison of radiofrequency ablation guided by conventional ultrasound and contrast-enhanced ultrasound in patient with advanced primary liver cancer following transcatheter arterial chemoembolization_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LU Sicong ¹ , REN Qihong ² , HUANG Qing ² ,  LU Haiming ¹

1. Department of General Surgery Ⅱ, The Fourth Affiliated Hospital, Guangxi University of Medical Sciences, Liuzhou Workers Hospital, Liuzhou, Guangxi 545005, P. R. China;
2. Department of Ultrasound, The Fourth Affiliated Hospital, Guangxi University of Medical Sciences, Liuzhou Workers Hospital, Liuzhou, Guangxi 545005, P. R. China;

Corresponding author：

LU Haiming, Email: 35946677@qq.com

Keywords：

primary liver cancer; radiofrequency ablation; transcatheter arterial chemoembolization; contrast-enhanced ultrasound

DOI：

10.7507/1007-9424.201806009

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Objective To explore therapeutic effect of radiofrequency ablation (RFA) guided by contrast-enhanced ultrasound in patient with advanced primary liver cancer following transcatheter arterial chemoembolization (TACE). Methods The patients with advanced primary liver cancer treated with the TACE firstly from January to December 2014 in this hospital were prospectively collected, then were randomly divided into a conventional ultrasound guided RFA group (control group) and contrast-enhanced ultrasound guided RFA group (study group). The complete ablation rate, liver function, serum alpha-fetoprotein (AFP) level, and 1-, 2-, and 3-year survival rates were observed in the two groups. Results A total of 42 patients with advanced primary liver cancer treated with the TACE were enrolled in this study, there were 21 patients in each group. ① There were no significant differences in the baseline data such as the gender, age, BCLC stage, AFP level, and Child grade of liver function between the two groups (P>0.05). ② All the treatments were completed according to the plan, no serious complications or treatment-related death happened. The complete ablation rate of the study group was significantly higher than that of the control group (χ²=5.717, P=0.017), and the AFP level was significantly lower than that of the control group (t=2.618, P=0.012). There was no significant difference in the Child grade of liver function between the 2 groups (P>0.05). ③ The rate of repeat RFA in the study group was significantly lower than that in the control group (χ²=4.434, P=0.035), and there was no significant difference in the TACE treatment rate between the two groups (χ²=1.659, P=0.197). ④ The survival rate of the study group was significantly better than that of the control group by comparing the survival curves (χ²=3.999, P=0.046). Conclusion Contrast-enhanced ultrasound guided RFA is superior to conventional ultrasound guided RFA in treatment of advanced primary liver cancer following TACE.

Citation： LU Sicong, REN Qihong, HUANG Qing, LU Haiming. Therapeutic effect comparison of radiofrequency ablation guided by conventional ultrasound and contrast-enhanced ultrasound in patient with advanced primary liver cancer following transcatheter arterial chemoembolization. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(11): 1318-1322. doi: 10.7507/1007-9424.201806009 Copy

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2.	Liu PH, Hsu CY, Hsia CY, et al. Surgical resection versus radiofrequency ablation for single hepatocellular carcinoma ≤2 cm in a Propensity Score Model. Ann Surg, 2016, 263(3): 538-455.
3.	Feng K, Yan J, Li X, et al. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol, 2012, 57(4): 794-802.
4.	Xu Q, Kobayashi S, Ye X, et al. Comparison of hepatic resection and radiofrequency ablation for small hepatocellular carcinoma: a meta-analysis of 16 103 patients. Sci Rep, 2014, 4: 7252.
5.	Peng ZW, Zhang YJ, Chen MS, et al. Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma: a prospective randomized trial. J Clin Oncol, 2013, 31(4): 426-432.
6.	Morimoto M, Numata K, Kondou M, et al. Midterm outcomes in patients with intermediate-sized hepatocellular carcinoma: a randomized controlled trial for determining the efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization. Cancer, 2010, 116(23): 5452-5460.
7.	Lencioni R, de Baere T, Soulen MC, et al. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data. Hepatology, 2016, 64(1): 106-116.
8.	Yang M, Fang Z, Yan Z, et al. Transarterial chemoembolisation (TACE) combined with endovascular implantation of an iodine-125 seed strand for the treatment of hepatocellular carcinoma with portal vein tumour thrombosis versus TACE alone: a two-arm, randomised clinical trial. J Cancer Res Clin Oncol, 2014, 140(2): 211-219.
9.	Si ZM, Wang GZ, Qian S, et al. Combination therapies in the management of large (≥5 cm) hepatocellular carcinoma: microwave ablation immediately followed by transarterial chemoembolization. J Vasc Interv Radiol, 2016, 27(10): 1577-1583.
10.	Du J, Li HL, Zhai B, et al. Radiofrequency ablation for hepatocellular carcinoma: utility of conventional ultrasound and contrast-enhanced ultrasound in guiding and assessing early therapeutic response and short-term follow-up results. Ultrasound Med Biol, 2015, 41(9): 2400-2411.
11.	中华人民共和国卫生部. 原发性肝癌诊疗规范 (2011 年版). 临床肿瘤学杂志, 2011, 16(10): 929-946.
12.	Hasegawa K, Aoki T, Ishizawa T, et al. Comparison of the therapeutic outcomes between surgical resection and percutaneous ablation for small hepatocellular carcinoma. Ann Surg Oncol, 2014, 21(Suppl 3): S348-S355.
13.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
14.	柯山, 孙文兵. 射频消融治疗肝癌的历史、现状与展望. 中国临床医生, 2010, 38(10): 5-7.
15.	Peng T, O’Neill D, Payne S. Mathematical study of the effects of different intrahepatic cooling on thermal ablation zones. Conf Proc IEEE Eng Med Biol Soc, 2011, 2011: 6866-6869.
16.	Cammà C, Schepis F, Orlando A, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology, 2002, 224(1): 47-54.
17.	Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology, 2003, 37(2): 429-442.
18.	冯凯, 马宽生, 别平. 射频消融在肝细胞肝癌根治性治疗中的临床价值. 中国普外基础与临床杂志, 2014, 21(2): 150-155.
19.	Li L, Zhang J, Liu X, et al. Clinical outcomes of radiofrequency ablation and surgical resection for small hepatocellular carcinoma: a meta-analysis. J Gastroenterol Hepatol, 2012, 27(1): 51-58.
20.	Huang J, Yan L, Cheng Z, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg, 2010, 252(6): 903-912.
21.	Miyamoto N, Hiramatsu K, Tsuchiya K, et al. Contrast-enhanced sonography-guided radiofrequency ablation for the local recurrence of previously treated hepatocellular carcinoma undetected by B-mode sonography. J Clin Ultrasound, 2010, 38(7): 339-345.
22.	严昆, 陈敏华, 张秀梅, 等. 超声造影指导射频消融治疗小肝癌的应用价值. 中华超声影像学杂志, 2011, 20(1): 18-21.
23.	王绮, 吴刚, 杨龙, 等. 肝细胞性肝癌超声造影分型与血管生成相关性研究. 中华超声影像学杂志, 2010, 19(1): 25-28.
24.	Andreana L, Kudo M, Hatanaka K, et al. Contrast-enhanced ultrasound techniques for guiding and assessing response to locoregional treatments for hepatocellular carcinoma. Oncology, 2010, 78(Suppl 1): 68-77.
25.	Taouli B, Ehman RL, Reeder SB. Advanced MRI methods for assessment of chronic liver disease. AJR Am J Roentgenol, 2009, 193(1): 14-27.

1. 中华人民共和国卫生和计划生育委员会医政医管局. 原发性肝癌诊疗规范 (2017 年版). 中华消化外科杂志, 2017, 16(7): 635-647.
2. Liu PH, Hsu CY, Hsia CY, et al. Surgical resection versus radiofrequency ablation for single hepatocellular carcinoma ≤2 cm in a Propensity Score Model. Ann Surg, 2016, 263(3): 538-455.
3. Feng K, Yan J, Li X, et al. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol, 2012, 57(4): 794-802.
4. Xu Q, Kobayashi S, Ye X, et al. Comparison of hepatic resection and radiofrequency ablation for small hepatocellular carcinoma: a meta-analysis of 16 103 patients. Sci Rep, 2014, 4: 7252.
5. Peng ZW, Zhang YJ, Chen MS, et al. Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma: a prospective randomized trial. J Clin Oncol, 2013, 31(4): 426-432.
6. Morimoto M, Numata K, Kondou M, et al. Midterm outcomes in patients with intermediate-sized hepatocellular carcinoma: a randomized controlled trial for determining the efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization. Cancer, 2010, 116(23): 5452-5460.
7. Lencioni R, de Baere T, Soulen MC, et al. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data. Hepatology, 2016, 64(1): 106-116.
8. Yang M, Fang Z, Yan Z, et al. Transarterial chemoembolisation (TACE) combined with endovascular implantation of an iodine-125 seed strand for the treatment of hepatocellular carcinoma with portal vein tumour thrombosis versus TACE alone: a two-arm, randomised clinical trial. J Cancer Res Clin Oncol, 2014, 140(2): 211-219.
9. Si ZM, Wang GZ, Qian S, et al. Combination therapies in the management of large (≥5 cm) hepatocellular carcinoma: microwave ablation immediately followed by transarterial chemoembolization. J Vasc Interv Radiol, 2016, 27(10): 1577-1583.
10. Du J, Li HL, Zhai B, et al. Radiofrequency ablation for hepatocellular carcinoma: utility of conventional ultrasound and contrast-enhanced ultrasound in guiding and assessing early therapeutic response and short-term follow-up results. Ultrasound Med Biol, 2015, 41(9): 2400-2411.
11. 中华人民共和国卫生部. 原发性肝癌诊疗规范 (2011 年版). 临床肿瘤学杂志, 2011, 16(10): 929-946.
12. Hasegawa K, Aoki T, Ishizawa T, et al. Comparison of the therapeutic outcomes between surgical resection and percutaneous ablation for small hepatocellular carcinoma. Ann Surg Oncol, 2014, 21(Suppl 3): S348-S355.
13. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
14. 柯山, 孙文兵. 射频消融治疗肝癌的历史、现状与展望. 中国临床医生, 2010, 38(10): 5-7.
15. Peng T, O’Neill D, Payne S. Mathematical study of the effects of different intrahepatic cooling on thermal ablation zones. Conf Proc IEEE Eng Med Biol Soc, 2011, 2011: 6866-6869.
16. Cammà C, Schepis F, Orlando A, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology, 2002, 224(1): 47-54.
17. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology, 2003, 37(2): 429-442.
18. 冯凯, 马宽生, 别平. 射频消融在肝细胞肝癌根治性治疗中的临床价值. 中国普外基础与临床杂志, 2014, 21(2): 150-155.
19. Li L, Zhang J, Liu X, et al. Clinical outcomes of radiofrequency ablation and surgical resection for small hepatocellular carcinoma: a meta-analysis. J Gastroenterol Hepatol, 2012, 27(1): 51-58.
20. Huang J, Yan L, Cheng Z, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg, 2010, 252(6): 903-912.
21. Miyamoto N, Hiramatsu K, Tsuchiya K, et al. Contrast-enhanced sonography-guided radiofrequency ablation for the local recurrence of previously treated hepatocellular carcinoma undetected by B-mode sonography. J Clin Ultrasound, 2010, 38(7): 339-345.
22. 严昆, 陈敏华, 张秀梅, 等. 超声造影指导射频消融治疗小肝癌的应用价值. 中华超声影像学杂志, 2011, 20(1): 18-21.
23. 王绮, 吴刚, 杨龙, 等. 肝细胞性肝癌超声造影分型与血管生成相关性研究. 中华超声影像学杂志, 2010, 19(1): 25-28.
24. Andreana L, Kudo M, Hatanaka K, et al. Contrast-enhanced ultrasound techniques for guiding and assessing response to locoregional treatments for hepatocellular carcinoma. Oncology, 2010, 78(Suppl 1): 68-77.
25. Taouli B, Ehman RL, Reeder SB. Advanced MRI methods for assessment of chronic liver disease. AJR Am J Roentgenol, 2009, 193(1): 14-27.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Therapeutic effect comparison of radiofrequency ablation guided by conventional ultrasound and contrast-enhanced ultrasound in patient with advanced primary liver cancer following transcatheter arterial chemoembolization

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