Publications by authors named "Zhiyu Han"

83 Publications

Predicting ultrasound-guided thermal ablation benefit in primary hyperparathyroidism.

Eur Radiol 2022 Jun 16. Epub 2022 Jun 16.

Department of Interventional Ultrasound, The Fifth Medical Center, Chinese PLA General Hospital, NO. 28 Fuxing Road, Beijing, 100853, China.

Objectives: Ultrasound (US)-guided thermal ablation for primary hyperparathyroidism (PHPT) is a relatively novel minimally invasive treatment. The recurrence rate after ablation is between 10 and 15%. The characteristics of patients who can benefit from thermal ablation therapy are not clear yet. The aim of this research was to investigate the validity of a parathyroid hormone (PTH)-based classifier for stratifying patients with PHPT.

Methods: A total of 171 patients were screened, 148 (86.5%) of whom were eligible and were divided into development (n = 104) and external validation (n = 44) cohorts. The potential relationship between the PTH-based classifier and the cure rate of patients was initially assessed in the primary cohort and then validated in the external validation cohort. The nomogram was computed from the logistic regression model.

Results: A cut-off of PTH < 269.1 pg/mL or ≥ 269.1 pg/mL as the optimal prognostic threshold in the training cohort was generated to stratify the patients into low-risk and high-risk groups. Patients with PTH levels < 269.1 pg/mL in the training cohort had a higher cure rate than patients with PTH levels ≥ 269.1 pg/mL (p < 0.001). The PTH level remained the strongest predictor of the cure rate in all cohorts. Furthermore, a nomogram based on the PTH level was developed to predict the cure rate in the training cohort and it performed well in the external validation cohort (AUC: 0.816, 95%CI 0.703 to 0.930; AUC: 0.816, 95%CI 0.677 to 0.956).

Conclusions: The PTH-based classifier may help with individualised treatment planning for selecting patients who may benefit from thermal ablation.

Key Points: • This is the first analysis of predictors affecting the outcome of US-guided thermal ablation of primary hyperparathyroidism and the findings can be used to identify the potential beneficiary population of thermal ablation of primary hyperparathyroidism. • Parathyroid hormone (PTH) was confirmed as an independent prognostic factor, as it not only showed good accuracy in stratifying patients into high- and low-risk groups in the training and validation cohorts but also outperformed the clinical model. • This study developed and validated a model to predict the treatment success of thermal ablation of primary hyperparathyroidism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-022-08898-xDOI Listing
June 2022

Percutaneous microwave ablation under ultrasound guidance for renal cell carcinomas at clinical staging T1 in patients aged 65 years and older: A comparative study.

J Cancer Res Ther 2022 Apr;18(2):509-515

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.

Objectives: To ascertain the clinical outcomes of patients aged ≥65 years with clinical staging T1 (cT1) renal cell carcinoma (RCC) treated with percutaneous microwave ablation (MWA) under ultrasound control compared with those aged <65.

Materials And Methods: From September 2009 to December 2016, clinical data of two groups, Group O (≥ 65 years) consisting of 75 patients (76 RCCs) and Group Y (< 65 years) consisting of 91 patients (99 RCCs), who underwent MWA treatment for RCC with comparable mean diameters at baseline, were retrospectively evaluated. The methodological effectiveness, cumulative overall survival (OS) and disease-free survival (DFS), local tumor progression (LTP), major and minor complications, and renal performance, including serum creatinine (Cr) and blood urea nitrogen (BUN) between the two categories, were statistically assessed by SPSS.

Results: After excision, there were no significant differences between the two groups concerning technical efficacy, LTP, and major and minor complications. The cumulative OS and DFS rates at 1, 3, and 5 years in Group O versus Group Y were 100%, 92.6%, and 92.6% versus 98.6%, 96.9%, and 90.9% (P = 0.701), and 100%, 92.5%, and 92.5% versus 98.6%, 96.9%, and 90.4% (P = 0.697), respectively. There was no significant variance between serum Cr and BUN between the two groups before MWA and at the last follow-up.

Conclusion: Due to the corresponding clinical outcomes for the treatment of cT1 RCCs in patients aged <65 years and ≥65 years, the US-guided MWA is a safe and effective method and may be suggested as one of the first-line nonsurgical options for identified older patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jcrt.jcrt_531_22DOI Listing
April 2022

Comparison of percutaneous microwave ablation and surgical resection for hepatocellular carcinoma in the caudate lobe.

J Cancer Res Ther 2022 Apr;18(2):378-383

Department of Interventional Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.

Background: This study aims to compare the clinical efficacy and safety between ultrasound (US)-guided percutaneous microwave ablation (MWA) assisted with a three-dimensional (3D) visualization preoperative planning system and surgical resection (SR) for hepatocellular carcinoma (HCC) in the caudate lobe.

Materials And Methods: Forty-nine patients diagnosed with caudate lobe HCC, who underwent US-guided percutaneous MWA (29 patients) or SR (20 patients), were enrolled between November 2005 and December 2018. Follow-up was performed at 1, 3, 6, 12, 18, 24, and 36 months after ablation or resection. The follow-up endpoint was recurrence or patient death. Overall survival (OS) and progression-free survival (PFS) were the primary outcomes, whereas local tumor progression (LTP), intrahepatic recurrence, and extrahepatic metastasis were the secondary ones.

Results: The mean age of the two groups was 61.4 ± 9.1 (MWA) and 53.1 ± 6.8 (SR), respectively, with a significant difference (P < 0.01). There were no significant differences in OS (69.0% in the MWA group and 75.0% in the SR group) and PFS (62.1% in the MWA group and 35.3% in the SR group). LTP, intrahepatic recurrence, and extrahepatic recurrence were 6.9% (2/29), 31.0% (9/29), and 20.7% (6/29) in the MWA group and 5.0% (1/20), 60.0% (12/20), and 5.0% (1/20) in the SR group. The MWA group was more cost-effective and required less hospitalization time. No major complications were observed.

Conclusions: US-guided percutaneous MWA for HCC in the caudate lobe assisted with a 3D visualization preoperative planning system is an optional treatment with less expenses and shorter hospitalization than SR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jcrt.jcrt_1067_21DOI Listing
April 2022

Ultrasound-guided microwave and radiofrequency ablation for primary hyperparathyroidism: a prospective, multicenter study.

Eur Radiol 2022 May 20. Epub 2022 May 20.

Department of Interventional Ultrasound, The Fifth Medical Center, Chinese PLA General Hospital, NO.28 Fuxing Road, Beijing, 100853, China.

Objectives: To prospectively investigate the efficacy and safety of ultrasound (US)-guided microwave ablation (MWA) and radiofrequency ablation (RFA) for primary hyperparathyroidism (PHPT).

Methods: We performed a prospective multicenter study of MWA and RFA for PHPT between August 2017 and October 2020 at five centers. Laboratory testing was performed pre- and post-ablation and followed for at least 6 months. The primary outcome was the cure rate. Secondary outcomes were complications and dynamic changes in serum levels of PTH, calcium, phosphorus, and ALP after ablation.

Results: A total of 132 participants (mean age, 57.33 ± 13.90 years), with 141 parathyroid nodules (median maximal diameter, 1.55 cm) undergoing either MWA or RFA, were enrolled in the study. The technique success rate was 99.29% (140/141). The follow-up period was 6-36 months (median, 12 months). The cure rate was 80.30% (106/132). Pre-ablation PTH level was the independent factor associated with cure rate (Odds ratio (OR), 0.22; 95% CI, 0.07-0.69; p = 0.0090). There was no difference in cure rate between the MWA group and the RFA group (80.22% vs. 80.49%, p = 0.971). The only main complication was hoarseness (5.30%).

Conclusions: US-guided MWA and RFA for PHPT is an effective and safe procedure in the treatment of PHPT. Pre-ablation PTH level is the key factor affecting the cure rate after MWA and RFA.

Key Points: • To our knowledge, this is the first prospective multicenter clinical trial with ultrasound-guided MWA and RFA for primary hyperparathyroidism. • There was no difference in cure rate between the MWA and RFA groups for primary hyperparathyroidism. The overall cure rate was 80.30%. • Pre-ablation PTH level was the independent factor associated with cure rate (odds ratio (OR), 0.22; 95% CI, 0.07-0.69; p = 0.0090).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-022-08851-yDOI Listing
May 2022

Dynamic changes in liver volume calculated using a three-dimensional visualisation system after microwave ablation of hepatocellular carcinomas.

Med Phys 2022 Jul 28;49(7):4613-4621. Epub 2022 Apr 28.

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.

Objectives: To investigate the changes in liver volume and function after microwave ablation (MWA) of hepatocellular carcinomas (HCCs).

Materials And Methods: We retrospectively analysed 76 patients with 106 nodules who underwent MWA for HCCs ≤5 cm between January 2015 and September 2017. Liver and ablation volumes were calculated using a three-dimensional visualisation system on MRI. Multiple regression analysis was used to estimate the association between the ablation volume and liver volume changes. Deformable image registration (DIR) was performed to confirm the influence of liver volume changes on curative effect evaluation after ablation.

Results: The initial liver and tumour volumes were 1262.1 ± 259.91 cm (range: 864.9-1966.8) and 2.5 cm (interquartile range [IQR]: 1.3-8.8), respectively. Compared to the initial liver volumes, the entire live volume (ELV) increased by 10.1% ± 8.93% (range: -4.9% to 46.68%) on the 3rd day after ablation. Subsequently, it recovered to initial level at the 3rd month and maintained its level during the 1-year follow-up. The median total ablation volume was 34.9 cm (IQR: 20.4-65.4) on the 3rd day after ablation, which decreased by 71.2% (IQR: 57.4%-78.1%) 1 year after ablation. Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (T-Bil) peaked within 3 days after MWA and recovered to normal within 1 month. The ablation volume proportion of the ELV was an independent risk factor for the increase in the ELV and AST, ALT and T-Bil levels within 3 days after ablation. When DIR was conducted to fuse ablation zone and tumour, the reshaped tumour volumes were enlarged by 40% because of the increase in ELV.

Conclusions: MWA of HCCs based on the Milan criteria could induce temporary increases in ELV and RLV within 3 days after ablation, but both parameters recovered to initial levels 3 months after ablation. This indicates that MWA of early-stage HCCs would not lead to liver volume loss and could potentially protect liver function. The liver cannot be treated as an incompressible organ after ablation, and the appropriate deformation constraint should be designed for DIR to evaluate ablation margin accurately.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/mp.15641DOI Listing
July 2022

Risk factors influencing cure of ultrasound-guided microwave ablation for primary hyperparathyroidism.

Int J Hyperthermia 2022 ;39(1):258-264

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.

Objective: To evaluate the potential risk factors influencing cure rate of ultrasound-guided microwave ablation (MWA) for primary hyperparathyroidism (PHPT).

Materials And Methods: Seventy five patients (25 males and 50 females; mean age, 56.80 ± 12.34; age range, 26-85) with PHPT undergoing MWA under ultrasound guidance were enrolled between May 2017 and December 2020. The cure rate and complications were evaluated after treatment. The potential factors influencing cure rate of ultrasound-guided MWA for PHPT were analyzed by univariate and multivariate binary logistic regression.

Results: Fifty six of 75 patients had normal PTH and serum calcium levels after at least 6 months after one session MWA, and the cure rate was 74.7% (56/75). 6 uncured patients received the second session MWA during follow-up, and the cure rate achieved 81.3% (61/75) after the second session MWA. Voice changes occurred in 4 patients (5.33%) and recovered within 3 months after ablation without special treatment. Nodule volume was the independent risk factor associated with cure in PHPT patients undergoing MWA, whether after one session ( = 0.0224; odds ratio, 0.67) or the second session MWA ( = 0.0408; odds ratio, 0.74). The cutoff value for nodule volume in predicting the cure was 0.96 cm (one session: sensitivity, 76.8%; specificity, 73.7%; the second session: sensitivity, 72.1%; specificity, 71.4%).

Conclusion: In conclusion, parathyroid nodule volume was the independent risk factor associated with cure in PHPT patients undergoing MWA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02656736.2022.2029957DOI Listing
April 2022

Long-term efficacy of microwave ablation in the treatment of subcapsular hepatocellular carcinomas of ≤3 cm in diameter: a multicenter, propensity score-matched study.

Int J Hyperthermia 2022 ;39(1):209-216

Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China.

Objective: To compare the long-term efficacy of microwave ablation (MWA) for subcapsular and non-subcapsular hepatocellular carcinomas (HCCs) using propensity score matching (PSM).

Materials And Methods: Using a multicenter database, we enrolled 430 patients (347 men, 83 women; age range, 15-71 years) with HCCs who received percutaneous ultrasound-guided MWA, between January 2012 and December 2018. The patients were grouped as follows, based on whether the tumor was adjacent to the capsule: subcapsular group ( = 142) and non-subcapsular group ( = 142). To evaluate the correlation between subcapsular position and efficacy of MWA, a Cox proportional hazards model was used to calculate disease-free survival (DFS) and overall survival (OS) based on PSM data.

Results: In total, 142 pairs of patients were matched. In the PSM cohort, the 1-year, 3-year, and 5-year DFS rates of the subcapsular and non-subcapsular groups were 84%, 61%, and 47%, respectively, and 85%, 67%, and 58%, respectively, while the 1-year, 3-year, and 5-year OS rates were 98%, 90%, and 84%, respectively, and 98%, 90%, and 88%, respectively. In the PSM cohort, subcapsular position was not an independent risk factor for DFS (hazard ratio [HR] = 1.291,  = 0.196) or OS (HR = 0.926,  = 0.866). Additionally, there were no significant differences in the incidence of local tumor progression, major complications, technical success rate, number of puncture needles, and postoperative hospital stay between the two groups ( > 0.05).

Conclusion: There were no significant differences in DFS, OS, incidence of local tumor progression, and major complications between patients with subcapsular and non-subcapsular HCCs treated with MWA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02656736.2021.2023228DOI Listing
April 2022

CEUS Versus MRI in Evaluation of the Effect of Microwave Ablation of Breast Cancer.

Ultrasound Med Biol 2022 04 19;48(4):617-625. Epub 2022 Jan 19.

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China. Electronic address:

Percutaneous microwave ablation (MWA) is a new minimally invasive technique for breast cancer treatment. The aim of this research was to compare the differences in performance between contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) with respect to the curative effect of MWA in the treatment of breast cancer. Between 2015 and 2019, 26 patients with breast cancer underwent ultrasound-guided MWA. All patients underwent both CEUS and MRI within 3 d after ablation. If either of the two imaging modalities revealed suspicious enhancement of the ablation zone and the ultrasound-guided biopsy confirmed residual tumor in the suspicious area, supplementary MWA was applied. The diagnostic efficacy of CEUS and MRI within 3 d after ablation was evaluated based on a >6-mo follow-up of 26 patients. Two cases were diagnosed with residual tumors by ultrasound that were missed by MRI. Three cases were diagnosed with residual tumors by MRI that were missed by CEUS. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CEUS in the diagnosis of complete ablation were 100%, 40%, 87.5%, 100% and 88.5%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of MRI in the diagnosis of complete ablation were 100%, 60%, 91.3%, 100% and 92.3%, respectively. Within 3 d, both CEUS and MRI can efficiently assess the efficacy of MWA of breast cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ultrasmedbio.2021.11.012DOI Listing
April 2022

Cause Analysis and Diagnosis and Treatment of Intestinal Fistulas After Ultrasound-Guided Microwave Ablation of Abdominopelvic Lesions.

Front Surg 2021 19;8:675585. Epub 2021 Nov 19.

Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China.

To determine the cause and high-risk factors for the development of intestinal fistulas (IFs) after ultrasound-guided microwave ablation (MA) of abdominopelvic lesions, and to identify effective prophylactic and therapeutic actions. Clinical data were collected from patients with an IF after ultrasound-guided MA of abdominopelvic lesions in our hospital from January 1, 2010 to December 31, 2018. The cause, diagnosis, and treatment of IFs in these patients were analyzed. Among 8,969 patients who underwent ultrasound-guided MA of abdominopelvic lesions, eight patients developed IF after MA, Seven patients were discharged after being cured and one died. Abdominopelvic lesions are close to the intestines, so histories of surgery, radiotherapy, and abdominopelvic infection are high-risk factors for IF development after MA of these lesions. Surgical treatment should be provided as soon as an IF is identified.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fsurg.2021.675585DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8639506PMC
November 2021

Survival benefits analyses of T1a renal cell carcinoma patients treated with microwave ablation.

Eur J Radiol 2021 Nov 17;144:109951. Epub 2021 Sep 17.

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China. Electronic address:

Purpose: The individual decision-making reference of Microwave ablation (MWA) for T1a RCC treatment is not clear, and it may not benefit all the patients equally. Therefore, we quantitatively evaluated the distinct survival benefits of patients with T1a RCC stratified by survival predictors.

Materials And Methods: A total of 237 patients with T1a RCC who underwent MWA over the last 16 years were retrospectively reviewed for survival benefit analysis. Cox proportional hazard models were used to control for the prognostic variables of OS, CSS, and PFS. Survival rates were calculated using the Kaplan-Meier method and compared by log-rank analysis. Linear extrapolation was used to compute median survival periods.

Results: The OS benefit was significantly dependent on age (HR:2.499, 95% CI: 1.245-5.016, p = 0.010) and age-adjusted Charlson comorbidity index (CCI) score (HR:3.956, 95% CI, 1.409-11.110, p = 0.009). OS in patients aged <75 years or with an age-adjusted CCI score <7 was significantly prolonged (44.68, 65.55 months) compared to OS in patients aged ≥75 years or with CCI score ≥7 (p < 0.001 for both). PFS benefit was significantly dependent on age-adjusted CCI (HR:3.325, 95% CI, 1.390-7.956, p = 0.007), patient type (HR:0.4, 95% CI, 0.214-0.745, p = 0.004), and tumour growth pattern (HR:12.562, 95% CI, 1.552-101.696, p = 0.018). PFS in incipient patients was significantly prolonged (33.75 months) compared to that in the relapsed patients (p = 0.037). Patients with an age-adjusted CCI score <7 or without tumour protruding into the renal pelvis, lived free from recurrence or metastasis (55.69 or 101.61 months) longer than that in patients with an age-adjusted CCI score ≥7 or with tumour protruding into the renal pelvis (p < 0.01 for both). None of the variables was associated with CSS benefit.

Conclusions: The OS and PFS benefits from MWA were not equal for all T1a RCC patients. Age ≥75 years and age-adjusted CCI ≥ 7 significantly shortened OS. Age-adjusted CCI ≥ 7, relapsed RCC, and RCC protruding into the renal pelvis significantly shortened the PFS period. For a better survival prognosis, appropriate patient triage is still needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejrad.2021.109951DOI Listing
November 2021

Microwave ablation surgical resection for treatment naïve hepatocellular carcinoma within the Milan criteria: a follow-up of at least 5 years.

Cancer Biol Med 2021 Sep 30. Epub 2021 Sep 30.

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China.

Objective: Thermal ablation poses challenges in the surgical resection (SR) of small hepatocellular carcinoma (HCC), and its therapeutic outcomes for larger lesions remain debated.

Methods: This retrospective study evaluated 729 patients with HCC meeting the Milan criteria, who were treated with curative SR or microwave ablation (MWA) between 2008 and 2014. Overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and local tumor progression (LTP) were compared after propensity score matching (PSM). Co-variates associated with OS, CSS, LTP, and DFS were identified. The risk of death and tumor progression were compared.

Results: During the median follow-up of 78.6 months, 253 patients were included in each group after PSM. For tumors ≤ 3.0 cm and 3.1-4.0 cm, MWA achieved comparable results in terms of OS, CSS, DFS, and LTP. For tumors 4.1-5.0 cm, MWA had lower OS, CSS, and DFS rates (all < 0.05) than SR. Higher LTP rates were observed in the MWA group for tumors 4.1-5.0 cm, although the difference was not significant ( = 0.18). Complication rates ( = 0.41) were similar, but MWA led to less estimated blood loss ( < 0.01) and shorter postoperative hospitalization times ( < 0.01).

Conclusions: MWA achieved comparable long-term oncologic outcomes with SR for ≤ 4 cm HCC, with lower complication rates and faster recovery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20892/j.issn.2095-3941.2020.0625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9334764PMC
September 2021

Microwave ablation of benign thyroid nodules: 3-year follow-up outcomes.

Head Neck 2021 11 30;43(11):3437-3447. Epub 2021 Aug 30.

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.

Purpose: To evaluate the effectiveness of microwave ablation (MWA) for the treatment of thyroid nodules according to nodule composition.

Materials And Methods: This study evaluated 171 patients with 180 benign thyroid nodules (BTNs) that had been treated with ultrasound-guided MWA. The volume reduction rate (VRR) of thyroid nodules and factors, which had an influence on the VRR, were assessed. Therapeutic success was defined as a >50% volume reduction at the 12-month follow-up. Multivariate regression analysis was used to identify independent predictors of VRR for BTNs after MWA treatment.

Results: The mean diameter and volume of the nodules were 4.3 ± 1.3 cm and 18.9 ± 2.1 ml, respectively. The VRRs at the 1-, 3-, 6-, 12-, 24-, and 36-month follow-ups were 47.1%, 68.2%, 79.7%, 87.4%, 90.1%, and 93.2%, respectively. Of the 180 BTNs, there were 87 solid, 74 predominantly solid, and 19 predominantly cystic nodules. Solid nodules showed significantly lower VRRs compared with the predominantly solid and predominantly cystic nodules at the 1-, 3-, and 6-month follow-ups. For the multivariate regression analysis, the cyst component was an active prognostic factor for the VRR at the 1-, 3-, and 6-month follow-ups; the cyst component was not significantly associated with the VRR at the 12-, 24-, and 36-month follow-ups.

Conclusion: Our study suggested that ultrasound-guided MWA is an effective and safe procedure for the treatment of BTNs. Solid nodules indicate a lower VRR and less efficient than predominant solid nodules and predominant cystic nodules after MWA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hed.26842DOI Listing
November 2021

Ultrasound-guided percutaneous microwave ablation of bilateral renal cell carcinomas: Focus upon safety and efficacy.

J Cancer Res Ther 2021 Jul;17(3):803-807

Department of Interventional Ultrasound, Chinese PLA Medical School, Beijing, China.

Objective: To retrospectively review the safety and efficacy of ultrasound (US)-guided percutaneous microwave ablation (MWA) of bilateral renal cell carcinomas (BRCCs).

Patients And Methods: In this study, eight patients of BRCCs with 20 lesions seen from November 2012 to October 2018 were enrolled retrospectively. The patients were treated with US -guided percutaneous MWA and were followed up with contrast-enhanced US and computed tomography or magnetic resonance imaging.

Results: Technical success was achieved 20 tumors. The 18 lesions were performed to ablate 90%; 2 lesions were repeated because of detecting residual ablated tumor. Except six patients were noted fever, no severe complications occurred. The median follow-up time was 24 months (range 7-59 months). Among the eight patients, there was no local tumor recurrence in 6 of 8 completely ablated tumor lesions. One patient was retreated by MWA 6 months after ablation, and another was retreated after 19 months due to local tumor recurrence. No patients have obvious change of renal function and lost their life.

Conclusion: US-guided percutaneous MWA is a beneficial treatment for BRCC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jcrt.jcrt_1906_20DOI Listing
July 2021

BCL6B hypermethylation predicts metastasis and poor prognosis in early-stage hepatocellular carcinoma after thermal ablation.

J Cancer Res Ther 2021 Jul;17(3):644-651

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.

Aims: The aim of this study was to evaluate the role of BCL6B methylation in the progression of early-stage hepatocellular carcinoma (HCC) after thermal ablation.

Settings And Design: This is a retrospective study and written informed consent was obtained from all patients or their legal guardians.

Subjects And Methods: Between October 2008 and December 2013, 73 patients with early-stage HCC within the Milan criteria, who received thermal ablation, were recruited.

Statistical Analysis Used: Based on methylation-specific polymerase chain reaction, the relationship between BCL6B methylation and patient characteristics and prognosis was analyzed using univariate, multivariate, and Kaplan-Meier analysis.

Results: The median follow-up period was 56 (8-110) months. For the BCL6B unmethylated group, the 1-, 3- and 5-year metastasis and overall survival (OS) rates after thermal ablation were 10.0%, 10.0%, and 40.0% and 100%, 100% and 90.0%, respectively. The 1-, 3-, and 5-year metastasis and OS rates of the methylated group were 23.8%, 66.7% and 88.9% and 66.2%, 71.4% and 41.3%, respectively. Levels of absolute count lymphocyte, serum cholinesterase and albumin in the BCL6B unmethylated group were higher than those in the methylated group (P = 0.020, 0.000, and 0.009, respectively). Kaplan-Meier analysis revealed that BCL6B methylation was related to metastasis and poor prognosis (P = 0.001 and 0.018, respectively). Univariate analysis revealed that BCL6B methylation was a risk factor for metastasis and poor prognosis (odds ratio [OR]: 5.663; 95% confidence interval [CI], 1.745-18.375, P = 0.004 and OR: 3.734; 95% CI, 1.151-12.110, P = 0.028, respectively). Multivariate analysis revealed that BCL6B methylation was an independent risk factor for metastasis (OR: 3.736; 95% CI, 1.000-13.963,P = 0.05) and not for prognosis (OR: 2.780; 95% CI, 0.835-9.250,P = 0.096).

Conclusions: BCL6B methylation could be a valuable prognostic factor for metastasis and poor prognosis in early-stage HCC after thermal ablation, which is an independent risk factor for metastasis. Our findings provide insights for combining ablation and epigenetic therapy for patients with HCC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jcrt.JCRT_1504_20DOI Listing
July 2021

Percutaneous microwave ablation versus robot-assisted hepatectomy for early hepatocellular carcinoma: A real-world single-center study.

Dig Liver Dis 2022 Feb 7;54(2):243-250. Epub 2021 Jul 7.

Department of Interventional Ultrasound, The First Center of Chinese PLA General Hospital, Address:28 Fuxing Road, Beijing, 100853 China. Electronic address:

Background: Both microwave ablation and robot-assisted hepatectomy are representative minimally invasive treatments for early hepatocellular carcinoma. Our study compares the practicability and medium-term therapeutic efficacy between them.

Methods: Patients with early HCC treated by MWA or RH from 2013 to 2019 were included. Propensity score matching (PSM) and inverse probability of treatment weight (IPTW) were used to minimize baseline imbalance. Operation trauma, postoperative recovery, complications, cost and oncological efficacy were compared.

Results: 401 patients with a median follow-up of 28 months were included (MWA n = 240; RH n = 161). After PSM, 3-year recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) of MWA group and RH group were 52.2% vs 65.8%, 91.5% vs 91.3% and 91.5% vs 91.3%, respectively. OS and CSS were comparable (p = 0.44 and 0.96), while RFS of MWA was slightly lower but not significant (p = 0.097). The above results after IPTW followed the same trend. After PSM, MWA showed advantages in operation time and blood loss, while RH performed better in postoperative liver function. There was no significant difference in incidence of severe complications between two groups.

Conclusions: For early HCC parents, both treatments can achieve good, safe and comparable medium-term therapeutic effects. MWA is more minimally invasive, while RH has better accuracy and causes less damage to liver parenchyma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dld.2021.04.008DOI Listing
February 2022

[Simultaneous determination of six haloacetonitriles in finished water for drinking by purge and trap-gas chromatography-triple quadrupole mass spectrometry].

Se Pu 2021 Jul;39(7):758-763

Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 100013, China.

Haloacetonitriles (HANs) are widely used in finished water as unregulated disinfection by-products. HANs may pose much threat to human health, and there is no relevant standard examination method for these compounds. A method was established for the simultaneous determination of six HANs (chloroacetonitrile (CAN), dichloroacetonitrile (DCAN), trichloroacetonitrile (TCAN), bromoacetonitrile (BAN), bromochloroacetonitrile (BCAN), and dibromoacetonitrile (DBAN)) in finished water by using purge and trap-gas chromatography-triple quadrupole mass spectrometry (GC-MS/MS). The purge and trap technology helps realize automatic determination of samples after collection, without using any harmful reagent. The cost and analytical efficiency of this method were superior to those of solid phase microextraction (SPME). Considering the instability of HANs, the analysis must be carried out as soon as possible after sampling, in order to avoid significant changes in their concentration during storage. In particular, the use of an appropriate quenching agent was critical to sample collection. In this study, ascorbic acid was chosen as the quenching agent. The stabilities of the spiked samples at the levels of 0.1 (TCAN), 0.2 (CAN), 1.0 (DCAN), 1.0 (BAN), 1.0 (BCAN), 4.0 (DBAN) μg/L were tested. The effect of sample storage time (0, 0.5, 1, 2, 3, 4, and 6 h) on the responses of the target component was evaluated. The stability results showed that within 6 h, the relative standard deviations of the responses for the six HANs ranged from 2.32% to 6.98%. To validate the method, first, different traps, viz. 7# (Tenax), 10# (Teanx/silica gel/cms), 11# (VOCARB), and 12# (BTEXTRAP) were optimized. Second, various chromatographic columns (VF-5, Rxi-624, DB-VRX, and HP-INNOWAX) were compared to investigate their influence on the peak shape. Under the optimal detection conditions, the six HANs in finished water were extracted with the 10# trap. The volume of the water sample was used 25 mL, with purging at 35 ℃ for 11 min, and desorbed at 190 ℃ for 1 min. Chromatographic separation was performed on a Rxi-624Sil MS chromatographic column (60 m×0.25 mm×1.40 μm). Gas chromatographic conditions were obtained under the following conditions: split ratio, 1∶10; linear velocity, 30 cm/s. The triple quadrupole mass spectrometer was operated in the electron impact (EI) mode. The target compounds were detected in the multiple reaction monitoring (MRM) mode. Quantitation was carried out using the external standard method. The results showed that the matrix effects of the six HANs ranged from 0.85 to 1.09. Good linearities were obtained in the range of the standard curves. The correlation coefficients () were greater than 0.9991. The limits of detection (LODs, =3) were 0.8-120.0 ng/L. The limits of quantification (LOQs, =10) were 1.5-300.0 ng/L. The average recoveries of the six HANs ranged from 84.2% to 106%, and the RSDs were in the range of 1.81%-10.7%. In August 2020, 38 samples of finished water were tested. All of the six HANs were found in the finished water. The concentrations of the HANs were in the range of 0.0101-1.28 μg/L, and the total detection rate was 92.1%. The detection rates of the individual components followed the order DCAN>BCAN>CAN>TCAN>BAN>DBAN. The developed method is efficient, sensitive, and environmentally friendly. It provides a high-quality technical choice for monitoring and health risk assessment of the emerging disinfection by-products of HANs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3724/SP.J.1123.2020.08026DOI Listing
July 2021

Is partial ablation appropriate for benign thyroid nodules? A retrospective study with long-term follow-up after microwave ablation.

Int J Hyperthermia 2021 ;38(1):923-930

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, P. R. China.

Objective: This retrospective study aimed to investigate the efficacy and safety of partial ablation (PA) for benign thyroid nodules (BTNs) using microwave ablation (MWA) in a long-term follow-up.

Materials And Methods: Between February 2015 and April 2019, 236 patients with 236 BTNs (maximum diameter ≥2 cm) treated with ultrasound-guided MWA were enrolled. Contrast-enhanced ultrasound (CEUS) was performed within 3 d after ablation to determine whether there was residual tissue according to which the patients were assigned PA or complete ablation (CA). The volume reduction ratio (VRR) and complications were evaluated during follow-up.

Results: Eighty-two patients were enrolled in the PA group, and 154 were enrolled in the CA group. Both groups achieved continuous reductions in nodule volume and increases in VRR within 2 years after ablation. Although the VRR of the PA group at 4 years was lower than that of the CA group (65.54 vs. 95.08%; <.05), PA still achieved 'technical efficacy' with a volume reduction of more than 50%. The complication and side effect rates between the two groups showed no significant difference (.05).

Conclusions: Both PA and CA were safe and effective in reducing the volumes of BTNs in the long-term follow-up. For nodules with a large initial volume and dangerous location, PA with a small amount of residual tissue may be acceptable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02656736.2021.1936217DOI Listing
July 2021

Percutaneous Microwave Ablation Versus Open Surgical Resection for Colorectal Cancer Liver Metastasis.

Front Oncol 2021 11;11:638165. Epub 2021 May 11.

People's Liberation Army General Hospital, Beijing, China.

Purpose: To compare the therapeutic outcomes between open surgical resection (OSR) and percutaneous microwave ablation (PMWA) for colorectal liver metastasis (CRLM) ≤3 cm.

Methods: In this retrospective study, 200 consecutive patients with 306 CRLMs were reviewed. Overall survival (OS), disease-free survival (DFS), local tumour progression (LTP), intrahepatic distant recurrence, and extrahepatic metastasis were analysed to compare the therapeutic efficacy. Cox proportional hazards regression analysis was used to identify the prognostic factors for OS and DFS. Major complications and postoperative hospital stay were also assessed.

Result: The 1-, 3-, and 5-year OS rates were 91.6%, 64.1%, and 46.3%, respectively, in the PMWA group and 89.7%, 62.4% and 44.7%, respectively, in the OSR group (P=0.839). The 1-, 3-, and 5-year DFS rates were 61.9%, 44.8%, and 41.3%, respectively, in the PMWA group and 58.1%, 24.4%, and 18.3%, respectively, in the OSR group (P =0.066). The two groups had comparable 5-year cumulative rates of intrahepatic distant recurrence (P=0.627) and extrahepatic metastasis (P=0.884). The 5-year cumulative LTP rate was lower in the OSR group than in the PMWA group (P=0.023). The rate of major complications was higher in the OSR group than in the PMWA group (P =0.025), and the length of hospital stay after treatment was shorter in the PMWA group (P<0.001).

Conclusion: There were no significant differences in OS or DFS between the two groups. PMWA was associated with increased LTP, fewer postoperative days and fewer major complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fonc.2021.638165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144705PMC
May 2021

Volume reduction for ≥2 cm benign breast lesions after ultrasound-guided microwave ablation with a minimum 12-month follow-up.

Int J Hyperthermia 2021 ;38(1):341-348

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.

Objective: To prospectively evaluate the efficacy of microwave ablation (MWA) for benign breast lesions (BBLs) ≥2 cm and explore the possible factors associated with the volume reduction rate (VRR) of ablated lesions.

Materials And Methods: From November 2013 to December 2017, a total of 80 patients with 104 biopsy-proved BBLs larger than 2 cm in size underwent MWA. After the procedure, patients were followed up physical and imaging examination consisting of contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI). Possible factors associated with 12-month VRR were assessed, including basic patient characteristics, index lesions and parameters of ablation technique.

Results: The mean tumor size was 2.6 ± 0.6 cm (ranging 2.0-6.3 cm). Of the 104 lesions, 70 were fibroadenomas, 27 adenosis and 7 fibrocystic changes. Post-procedure CEUS or contrast-enhanced MRI showed that all lesions were completely ablated. No immediate or delayed complications were observed. All patients were followed up for more than 12 months (median follow-up 12.5 months). After MWA, the ablated lesion volume decreased significantly by 12 months ( < 0.001), with a mean volume reduction of 80.2 ± 13.1%. Multiple linear regression analysis showed that location adjacent to areola ( = 7.5, 95%CI: 1.0-13.9,  = 0.025) and location adjacent to skin ( = -7.4, 95%CI: -12.7 to -13.9,  = 0.007) were independent factors respectively associated with the increased and decreased 12-month VRR.

Conclusion: For BBLs larger than 2 cm, US-guided MWA is a favorable treatment modality, with BBLs adjacent to the areola being associated with more significant 12-month VRR after MWA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02656736.2020.1845401DOI Listing
July 2021

Risk Factors of Ureteral Stenosis After Percutaneous Microwave Ablation of Renal Tumor, a Single-Center Experience.

Front Oncol 2020 18;10:521349. Epub 2020 Sep 18.

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.

Background: Ureteral stenosis after percutaneous microwave ablation (MWA) of renal tumor is a rare but severe complication, and its risk factors are not apparent.

Purpose: This study aimed to investigate the risk factors for stenosis of ureter after MWA treatment of the renal tumor that is a rare complication.

Materials And Methods: Data of 211 patients who underwent MWA for the treatment of renal tumor were retrospectively analyzed from September 2006 to August 2019. Demographic characteristics, clinical features, ablation parameters, and outcomes were analyzed to find out the potential risk factors of this complication. < 0.05 is considered significant.

Results: Six of 211 patients developed ureter stenosis, and the rate of this complication is 2.84%. The median time of emergence of hydronephrosis was 226 (range, 3-390) days. Univariate analysis shows the distance between ureter and tumor ( = 0.225) or ablation zone ( = 0.089) is not related to this complication. Postoperative urine routine (red blood cell, = 0.001; white blood cell, = 0.035) and R.E.N.A.L. score ( < 0.001) is related to this complication. But after multivariate logistic analysis, only R.E.N.A.L. score ( = 0.004) is associated with this complication. The location and growth pattern of tumor and the energy of ablation were not related to this complication independently.

Conclusion: The stenosis of the ureter after MWA of renal tumor is not associated with the tumor size, location, or the distance between the ureter and tumor and ablation site independently. But R.E.N.A.L. score is associated with ureter stenosis after MWA for the treatment of renal tumor, which combines the information of location, depth, and size of tumor. Preoperative evaluation of the tumor is necessary for avoiding ureter stenosis. Further studies should focus on these risk factors of this complication.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fonc.2020.521349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531279PMC
September 2020

Assessment of the Outcomes of Intrahepatic Cholangiocarcinoma After Ultrasound-Guided Percutaneous Microwave Ablation Based on Albumin-Bilirubin Grade.

Cardiovasc Intervent Radiol 2021 Feb 14;44(2):261-270. Epub 2020 Oct 14.

School of Medicine, Nankai University, Tianjin, 300071, China.

Objective: To determine whether albumin-bilirubin (ALBI) grade could be used to predict the outcomes of patients with intrahepatic cholangiocarcinoma (ICC) who underwent ultrasound-guided percutaneous microwave ablation (MWA).

Materials And Methods: This retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. We studied 52 treatment-naïve patients with 74 ICC lesions according to the Milan criteria who subsequently underwent MWA from April 2011 to March 2018. Overall survival (OS) and recurrence-free survival (RFS) were compared in groups classified by Child-Pugh score and ALBI grade, which were statistically analyzed with the log-rank test. Cox proportional hazard regression analyses were used to determine the prognostic factors for survival in patients with ICC.

Results: The median follow-up time was 21.2 months (3.2-78.7 months). Seventeen patients died during this period. After MWA, the cumulative 1-, 3-, and 5-year OS rates were 87.4%, 51.4%, and 35.2%, respectively, and the cumulative 1-, 3-, and 5-year RFS rates were 68.9%, 56.9%, and 56.9%, respectively. The major complication rate was 3.8% (2/52). Stratified according to ALBI grade, the cumulative 1-, 3-, and 5-year OS rates were 95.5%, 72.4%, and 72.4% for patients with ALBI grade 1 and 62.5%, 40.6%, and 36.3% for patients with ALBI grade 2, respectively, showing a significant difference (P = 0.006). Multivariate analysis results showed that older age (hazard ratio [HR]: 1.67, 95% confidence interval [CI]: 1.11-2.82; P = 0.002), tumor size ≥ 3 cm in diameter (HR: 11.33, CI: 2.24-34.52; P = 0.021) and ALBI grade (HR: 8.23, CI: 1.58-58.00; P = 0.004) may be predictors of poor OS.

Conclusion: ALBI grade was validated as a significant biomarker for predicting survival in ICC patients within the Milan criteria who underwent MWA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00270-020-02637-9DOI Listing
February 2021

Risk Factor Analysis of Acute Kidney Injury After Microwave Ablation of Hepatocellular Carcinoma: A Retrospective Study.

Front Oncol 2020 4;10:1408. Epub 2020 Sep 4.

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.

Acute kidney injury (AKI) is a recently observed side effect in patients after microwave ablation (MWA) of hepatocellular carcinoma (HCC) and is associated with negative outcomes. The aim of this study is to explore the risk factors of affecting the occurrence of AKI (stages 1b, 2, and 3), because they have a higher mortality rate than patients with AKI (stage 1a) and without AKI. In this retrospective study, a total of 1,214 patients with HCC who were treated with MWA under ultrasound (US) guidance in our department between January 2005 and November 2017 were enrolled. We evaluated the influence of 20 risk factors. Univariate and multivariate analysis were used for statistical analysis. The possible risk factors of AKI after MWA for HCC were summarized. AKI, AKI (stage 1a), and AKI (stages 1b, 2, and 3) after MWA were found in 34, 15, and 19 patients (2.80, 1.24, and 1.57%), respectively. Among 34 patients with AKI, 10 cases with AKI (stage 1a) and 6 cases with AKI (stages 1b, 2, and 3) recovered before their discharge without any treatment for AKI and 9 cases with AKI (stages 1b, 2, and 3) with further treatment. Four cases who had chronic renal failure before MWA of liver accepted renal dialysis. By univariate analysis, the number of antenna insertions ( = 0.027, OR = 3.3), MWA time ≥20 min ( = 0.029, OR = 4.3), creatinine (Cr)-pre above the upper limit of the reference value ( < 0.001, OR = 35.5), albumin (Alb)-pre ( = 0.030, OR = 0.9), and red blood cell (RBC)-pre ( < 0.001, OR = 0.3) were significant risk factors. By multivariate analysis, Cr-pre ≥ 110 μmol/L ( < 0.001, OR = 31.4) and MWA time ≥20 min ( = 0.043 OR = 9.9) were the independent risk factors. AKI (stages 1b, 2, and 3) is a relatively serious complication after MWA for HCC, which is related to MWA time and Cr-pre. It requires attention by clinicians. So it is of great necessity to assess the Cr-pre level and reduce the MWA time to <20 min to minimize the risk of AKI after MWA for HCC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fonc.2020.01408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498714PMC
September 2020

Evaluating the efficacy and safety of ultrasound-guided percutaneous microwave ablation for the treatment of adrenal metastasis.

J Cancer Res Ther 2020 Sep;16(5):1088-1092

Department of Interventional Ultrasound, State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing 100853, China.

Context: Microwave ablation (MWA) has been proven as a promising method to treat solid tumors.

Aims: This study aims to evaluate the efficacy and safety of ultrasound (US)-guided MWA for treating adrenal metastasis and to explore the factors affecting survival.

Settings And Design: This was a retrospective study performed on patients treated at our department.

Subjects And Methods: A total of 43 patients with adrenal metastasis (22 hepatocellular carcinoma, eight renal cell carcinoma, five non-small cell lung cancer, four colorectal cancer, three liposarcoma, and one malignant fibrous histiocytoma) were enrolled. All patients were treated at our department at least once. The treatment protocol for each patient, the technique used, and the survival details were recorded.

Statistical Analysis Used: Statistical analyses were performed using SPSS 26.0 software.

Results: Technical success was achieved in all cases. MWA was a safe technique for treating all types of metastasis. No major complications were observed. The pathology of adrenal lesions was the significant risk factor contributing to overall survival (OS) (P = 0.040). The 1-year and 3-year OS rates for all patients were 0.828 and 0.389, respectively.

Conclusions: Percutaneous US-guided MWA is safe and effective in terms of local control and survival of adrenal metastasis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jcrt.JCRT_1119_19DOI Listing
September 2020

Transarterial chemoembolization combined with microwave ablation versus microwave ablation only for Barcelona clinic liver cancer Stage B hepatocellular carcinoma: A propensity score matching study.

J Cancer Res Ther 2020 Sep;16(5):1027-1037

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.

Purpose: We aimed to compare the outcomes of microwave ablation (MWA) alone with those of transarterial chemoembolization combined with MWA (TACE-MWA) for Barcelona clinic liver cancer (BCLC) Stage B hepatocellular carcinoma (HCC) and to identify the prognostic factors associated with the two treatments.

Materials And Methods: This retrospective study was conducted in 150 BCLC Stage B HCC patients from April 2006 to November 2017. Of these, 88 patients were treated with MWA alone while 62 with TACE-MWA. Propensity score matching (PSM) was conducted to adjust for imbalances in clinical parameters. Procedure-related complications, local tumor progression (LTP), recurrence-free survival (RFS), and overall survival (OS) were analyzed.

Results: Before PSM, the maximal tumor diameters were 6.0 ± 1.0 cm and 6.7 ± 1.3 cm in the TACE-MWA and MWA groups, respectively, with a significant difference (P = 0.002); a significant difference was also detected in α-fetoprotein level (P = 0.013). After PSM, no difference was found in the two parameters (P = 0.067, 0.470). Before and after PSM, no difference was detected in the procedure-related complications (P = 0.803 vs. 1.000, P = 1.000 vs. 1.000), RFS (P = 0.786 vs. 0.689), and OS (P = 0.684 vs. 0.929). Tumor size and α-fetoprotein level were independent influencing factors for OS before and after PSM (P = 0.009, 0.023), while tumor size (D > 7) was an independent risk factor for poor OS (P = 0.011). Tumor number was an independent risk factor for RFS before and after PSM (P = 0.007 vs. P = 0.008). A significant difference was detected in LTP between the two groups with single tumor before and after PSM (P = 0.059 vs. P = 0.006).

Conclusions: The MWA alone group had RFS and OS comparable to that of the TACE-MWA group. TACE-MWA was effective in controlling LTP in patients with a single tumor.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jcrt.JCRT_380_19DOI Listing
September 2020

Cholecystectomy is associated with higher risk of recurrence after microwave ablation of hepatocellular carcinoma: a propensity score matching analysis.

Cancer Biol Med 2020 05;17(2):478-491

School of Medicine, Nankai University, Tianjin 300071, China.

To explore the association between cholecystectomy and the prognostic outcomes of patients with hepatocellular carcinoma (HCC) who underwent microwave ablation (MWA). Patients with HCC ( = 921) who underwent MWA were included and divided into cholecystectomy ( = 114) and non-cholecystectomy groups ( = 807). After propensity score matching (PSM) at a 1:2 ratio, overall survival (OS) and disease-free survival (DFS) rates were analyzed to compare prognostic outcomes between the cholecystectomy ( = 114) and non-cholecystectomy groups ( = 228). Univariate and multivariate Cox analyses were performed to assess potential risk factors for OS and DFS. Major complications were also compared between the groups. After matching, no significant differences between groups were observed in baseline characteristics. The 1-, 3-, and 5-year OS rates were 96.5%, 82.1%, and 67.1% in the cholecystectomy group, and 97.4%, 85.2%, and 74.4% in the non-cholecystectomy group ( = 0.396); the 1-, 3-, and 5-year DFS rates were 58.4%, 34.5%, and 26.6% in the cholecystectomy group, and 73.6%, 44.7%, and 32.2% in the non-cholecystectomy group ( = 0.026), respectively. The intrahepatic distant recurrence rate in the cholecystectomy group was significantly higher than that in the non-cholecystectomy group ( = 0.026), and the local tumor recurrence and extrahepatic recurrence rates did not significantly differ between the groups ( = 0.609 and = 0.879). Multivariate analysis revealed that cholecystectomy (HR = 1.364, 95% CI 1.023-1.819, = 0.035), number of tumors (2 1: HR = 2.744, 95% CI 1.925-3.912, < 0.001; 3 1: HR = 3.411, 95% CI 2.021-5.759, < 0.001), and γ-GT levels (HR = 1.003, 95% CI 1.000-1.006, < 0.024) were independent risk factors for DFS. The best γ-GT level cut-off value for predicting median DFS was 39.6 U/L (area under the curve = 0.600, < 0.05). A positive correlation was observed between cholecystectomy and γ-GT level ( = 0.108, 95% CI -0.001-0.214, = 0.047). Subgroup analysis showed that the DFS rates were significantly higher in the non-cholecystectomy group than the cholecystectomy group when γ-GT ≥39.6 U/L ( = 0.044). The 5-, 10-, 15-, 20-, and 25-year recurrence rates from the time of cholecystectomy were 2.63%, 21.93%, 42.11%, 58.77%, and 65.79%, respectively. A significant positive correlation was observed between cholecystectomy and the time from cholecystectomy to recurrence ( = 0.205, 95% CI 0.016-0.379, = 0.029). There were no significant differences in complications between groups ( = 0.685). Patients with HCC who underwent cholecystectomy were more likely to develop intrahepatic distant recurrence after MWA, an outcome probably associated with increased γ-GT levels. Moreover, the recurrence rates increased with time.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20892/j.issn.2095-3941.2019.0246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309471PMC
May 2020

Improving B-mode ultrasound diagnostic performance for focal liver lesions using deep learning: A multicentre study.

EBioMedicine 2020 Jun 28;56:102777. Epub 2020 Apr 28.

Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China. Electronic address:

Background: The diagnosis performance of B-mode ultrasound (US) for focal liver lesions (FLLs) is relatively limited. We aimed to develop a deep convolutional neural network of US (DCNN-US) for aiding radiologists in classification of malignant from benign FLLs.

Materials And Methods: This study was conducted in 13 hospitals and finally 2143 patients with 24,343 US images were enrolled. Patients who had non-cystic FLLs with pathological results were enrolled. The FLLs from 11 hospitals were randomly divided into training and internal validations (IV) cohorts with a 4:1 ratio for developing and evaluating DCNN-US. Diagnostic performance of the model was verified using external validation (EV) cohort from another two hospitals. The diagnosis value of DCNN-US was compared with that of contrast enhanced computed tomography (CT)/magnetic resonance image (MRI) and 236 radiologists, respectively.

Findings: The AUC of Model for FLLs was 0.924 (95% CI: 0.889-0.959) in the EV cohort. The diagnostic sensitivity and specificity of Model were superior to 15-year skilled radiologists (86.5% vs 76.1%, p = 0.0084 and 85.5% vs 76.9%, p = 0.0051, respectively). Accuracy of Model was comparable to that of contrast enhanced CT (both 84.7%) but inferior to contrast enhanced MRI (87.9%) for lesions detected by US.

Interpretation: DCNN-US with high sensitivity and specificity in diagnosing FLLs shows its potential to assist less-experienced radiologists in improving their performance and lowering their dependence on sectional imaging in liver cancer diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ebiom.2020.102777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262550PMC
June 2020

US-guided percutanous microwave ablation for early-stage hepatocellular carcinoma in elderly patients is as effective as in younger patients: A 10-year experience.

J Cancer Res Ther 2020 ;16(2):292-300

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.

Objective: To compare the overall survival (OS), disease-free survival (DFS) and liver-cancer-specific survival (LCSS) of elderly (≥65 years) and younger patients (< 65 years) with early-stage hepatocellular carcinoma (HCC) using ultrasound-guided percutaneous microwave ablation (US-PMMA).

Materials And Methods: From January 2002 to December 2017, 510 elderly and 1053 younger patients were diagnosed with early-stage HCC according to the Milan criteria. All of these patients were treatment-naïve to US-PMMA. Baseline characteristics were collected to identify any risk factors to determine the survival outcomes. OS, DFS, and LCSS probabilities were calculated with the Kaplan-Meier method and compared using the Log-rank test.

Results: Complete ablation was achieved in all patients. Elderly patients were more likely to be, hepatitis C virus infection, comorbidities, cirrhosis, larger tumors, poor liver functional reservation, more ablation points, longer ablation time, longer hospital stays, and higher hospitalization costs (P < 0.05). Over the follow-up period (12-156 months), no significant differences were detected in OS, DFS, and LCSS between the two groups ( P = 0.092, 0.318, and 0.183). r-GT, ALB and ablation session were significant factors for OS, r-GT and ALB for LCSS, and cirrhosis, tumor number, AFP and ablation points for RFS in the multivariate analysis, respectively. No treatment-related deaths occurred in the two groups. Any complications were treated as appropriate.

Conclusions: Although advanced age and comorbidities are intrinsic factors in elderly HCC patients, similar survival outcomes were obtained in elderly and younger HCC patients treated by US-PMWA, despite elderly patients having more comorbidities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jcrt.JCRT_1021_19DOI Listing
September 2020

Acute kidney injury after nephron sparing surgery and microwave ablation: focus on incidence, survival impact and prediction.

Int J Hyperthermia 2020 ;37(1):470-478

School of Medicine, Nankai University, Tianjin, China.

To compare acute kidney injury (AKI) incidence between nephron sparing surgery (NSS) and microwave ablation (MWA) for T1a RCC patients, reveal the effect of AKI on survival prognosis, construct AKI nomogram and use Law of Total Probability for survival probability (SP) prediction. Patients were studied retrospectively after NSS ( = 1267) or MWA ( = 210) from January 1, 2011 to June 30, 2017. Using one to one Propensity Score Matching (PSM), 158 pairs of patients were identified for the cohort study. AKI incidence, risk factors and impact on survival outcomes were analyzed using Chi-square test, logistic and cox regression analysis. AKI risk and SP were predicted by nomogram and Law of Total Probability. The performance of the nomogram was assessed with respect to its discrimination, calibration, and clinical usefulness. AKI occurred more commonly in NSS (27.85%) cohort, when compared to MWA (17.72%) cohort ( = 0.032), but treatment modality was not independently predictive of AKI occurrence (odds ratio [OR]: 0.598; 95% confidence interval [CI]: 0.282-1.265;  = 0.178). The 5-yr overall survival (OS) was lower in AKI patients (73.5%) compared with non-AKI patients (94.8%;  < 0.001). AKI was an independent risk factor for all-cause mortality in RCC patients (hazard ratio [HR]: 2.820; 95% confidence interval [CI]: 1.110-7.165;  = 0.029). Predictors for both NSS- and MWA-related AKI included tumor diameter, baseline eGFR and CCI score. RENAL score and tumor blood supply can predict AKI after NSS and MWA, respectively. The AKI normograms demonstrated good discrimination, with AUCs >0.86, excellent calibration and net benefits at the decision curve analysis with probabilities ≥5%. SP predicted by Law of Total Probability was comparable to actual OS. AKI was an early indicator for poor overall survival in RCC patients. It can be predicted by several oncological parameters. Nomogram and Law of Total Probability can accurately predict AKI risk and SP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02656736.2020.1752944DOI Listing
November 2020

Ultrasound-guided percutaneous microwave ablation of hepatocellular carcinoma in challenging locations: oncologic outcomes and advanced assistive technology.

Int J Hyperthermia 2020 ;37(1):89-100

Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, PR China.

To assess the oncologic outcomes of the hepatocellular carcinoma (HCC) patients in challenging locations (CLs) underwent ultrasound-guided percutaneous microwave ablation (US-PMWA) and the efficacy and safety of the advanced assistive technology (AAT). Data for 489 treatment-naïve patients with HCC who met Milan criteria and subsequently underwent US-PMWA were reviewed from March 2012 to November 2016. According to the distance (<5 mm) between the tumor and surrounding structures, the patients were divided into two groups: a CL group and a non-CL group. Regarding MWA assisted by AAT, the CL group was further subdivided into two groups: an AAT group and a non-AAT group. Technique effectiveness, complications and survival outcomes (i.e., overall survival [OS] and recurrence-free survival [RFS]) were compared between CL and non-CL groups. Local tumor progression (LTP) was compared between AAT and non-AAT groups. Technique effectiveness and complications in the CL group were similar to those in the non-CL group ( = .873 and  = .828, respectively). The OS and RFS in six types of CL groups were comparable with those in non-CL group ( = .131-.117) including adjacent vital structures, gallbladder, hepatic hilar regions, major vessels, diaphragm and capsule, respectively. The LTP rates in the AAT group were significantly higher than those in the non-AAT group ( = .001). US-PMWA assisted by AAT to treat HCC lesions in CLs was safe and effective; also, this technique had comparable success and survival outcomes with those of patients in non-CL.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02656736.2019.1711203DOI Listing
October 2020

Percutaneous Microwave Ablation versus Laparoscopic Partial Nephrectomy for cT1a Renal Cell Carcinoma: A Propensity-matched Cohort Study of 1955 Patients.

Radiology 2020 03 21;294(3):698-706. Epub 2020 Jan 21.

From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.).

Background Percutaneous microwave ablation (MWA) and laparoscopic partial nephrectomy (LPN) are two modalities indicated for early-stage renal cell carcinoma (RCC) with low extent of invasion. Purpose To compare the long-term results of percutaneous MWA and LPN in the treatment of cT1a RCC. Materials and Methods This retrospective study included 1955 patients with cT1a RCC treated with percutaneous MWA or LPN between April 2006 and November 2017. Propensity score matching was used. Oncologic outcomes were analyzed by using the Fine-and-Gray competing risk models. Results A total of 185 patients underwent percutaneous MWA (mean age, 63.2 years ± 15.2 [standard deviation]) and 1770 underwent LPN (mean age, 50.9 years ± 13.2). During the follow-up (median, 40.6 months), after propensity score matching, no difference was observed between local tumor progression (3.2% vs 0.5%, = .10), cancer-specific survival (2.2% vs 3.8%, = .24), and distant metastases (4.3% vs 4.3%, = .76). Patients who underwent percutaneous MWA had worse overall survival (hazard ratio, 2.4; 95% confidence interval: 1.0, 5.7; = .049 vs LPN) and disease-free survival (82.9% vs 91.4%, = .003). Percutaneous MWA led to smaller drop in estimated glomerular filtration rate at discharge (6.2% vs 16.4%, < .001), smaller estimated blood loss (4.5 mL ± 1.3 vs 54.2 mL ± 69.2), lower cost ($3150 ± 2970 vs $6045 ± 1860 U.S. dollars), shorter operative time (0.5 minute ± 0.1 vs 1.8 minutes ± 0.6), and shorter postoperative hospitalization time (5.1 days ± 2.6 vs 6.9 days ± 2.8) (all < .001 vs LPN). There were fewer cases of fever in the percutaneous MWA group (16.2% vs 73.0%, < .001). Conclusion There were no significant differences regarding oncologic outcomes and complications between percutaneous microwave ablation and laparoscopic partial nephrectomy for patients with cT1a renal cell carcinoma. Percutaneous microwave ablation led to smaller renal function change and lower blood loss. For patients who cannot be subjected to the risks of more invasive laparoscopic partial nephrectomy, percutaneous microwave ablation could be an alternative less invasive treatment option. © RSNA, 2020
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2020190919DOI Listing
March 2020
-->