Efficacy of Percutaneous Thermal Ablation Combined With Transarterial Embolization for Recurrent Hepatocellular Carcinoma After Hepatectomy and a Prognostic Nomogram to Predict Survival

Abstract

Aim:This study aimed to evaluate the efficacy of percutaneous thermal ablation combined with transarterial embolization for recurrent hepatocellular carcinoma after hepatectomy and establish a prognostic nomogram to predict survival.Methods:One hundred seventeen patients with recurrent hepatocellular carcinoma receiving ablation from 2009 to 2014 were included in primary cohort to establish a prognostic nomogram. Between 2014 and 2016, 51 patients with recurrent hepatocellular carcinoma treated by ablation were enrolled in the validation cohort to validate the predictive accuracy of the nomogram. All patients underwent locoregional ablation. Overall survival was the primary end point, and progression-free survival was the second end point. The performance of the nomogram was assessed through concordance index and calibration curve and compared with 5 conventional hepatocellular carcinoma staging systems.Results:The 1-, 3-, and 5-year overall survival rates of primary cohort were 88.4%, 70.7%, and 64.1%, respectively. The 1-, 3-, and 5-year progression-free survival rates of primary cohort were 44%, 14%, and 8.7%, respectively. The results of multivariate analysis showed that tumor size (P = .0469; hazard ratio, 1.020; 95% confidence interval, 1.0004-1.040), preoperative extrahepatic disease (P = .0675; hazard ratio, 2.604; 95% confidence interval, 0.933-7.264), and close to hepatic hilum <2 cm (P = .0053; hazard ratio, 3.691; 95% confidence interval, 1.474-9.240) were predictive factors for overall survival. The study established a nomogram to predict survival (concordance index, 0.752; 95% confidence interval, 0.656-0.849). According to the predicted overall survival, patients with recurrent hepatocellular carcinoma were divided into 3 risk classes (P < .05): low-risk group (total score <55; predicted 5-year overall survival rate, 82.9%), intermediate-risk group (55 ≤ total score < 99; predicted 5-year overall survival rate, 52.8%), and high-risk group (hazard ratio, total score ≥99; predicted 5-year overall survival rate, not available).Conclusion:Percutaneous thermal ablation appears to be an effective procedure for the treatment of recurrent hepatocellular carcinoma after hepatectomy. The proposed nomogram provides a mechanism to accurately predict survival and could stratify risk among patients with recurrent hepatocellular carcinoma treated by ablation therapy.

An Integrating Immune-Related Signature to Improve Prognosis of Hepatocellular Carcinoma

“…Surgical resection and liver transplantation remain the main cure measures for the HCC, and the 5-year survival in few patients could be improved to 40-70% following surgery or liver transplantation, whereas relapse or metastasis following surgery occurs in about 80% of patients [ 8 – 10 ]. Patients who underwent ablation have fewer complications and quick recovery, while efficacy largely depends on the tumor size and metastatic status, showing no superiority over surgery in disease-free survival [ 11 – 13 ]. Due to this scenario, most HCC patients have a poor prognosis.…”

Computed tomography-guided radiofrequency ablation combined with transarterial embolization assisted by a three-dimensional visualization ablation planning system for hepatocellular carcinoma in challenging locations: a preliminary study

“…TAE and RFA are both minimally invasive options that provide the appropriate balance between tumor treatment efficacy and preservation of quality of life. There are several advantages to performing TAE before RFA [20][21][22]. First, iodized oil can be used to demarcate the range of the tumor(s).…”

Optimized nerve block techniques while performing percutaneous hepatic ablation: Literature review and practical use

“…The adoption of these techniques when performing the increasingly popular embolization/ablation combined procedures (commonly referred to as ‘double hit’ therapy), 22 , 23 , 24 , 25 in our experience, has resulted in decreased overall pain during and after the ablation segment of the procedure. Slow infusion of 50 ​mg lidocaine diluted into 50 ​cc of normal saline, administered in the target vascular bed over 2–4 ​min, mitigates the potential for pain during the initial infusion thought to be due to the acidic/low pH of lidocaine at room temperature.…”

“…The use of intraarterial lidocaine before and after liver directed chemoembolization and embolization procedures has demonstrated safety and efficacy with respect to subjective pain both during and after therapy, resulting in a significant decrease in narcotic requirements when undergoing embolization. 22 , 23 , 24 , 25 Due to the innervation and arterial anatomy of the liver, the intraarterial administration of local anesthetic results in permeation into the subcapsular (and viscerally innervated) portion of the liver and exposure of anesthetic to the liver parenchyma, as well as the segmental portal triads and hepatic veins.…”