TY - JOUR
T1 - Microwave ablation in intermediate hepatocellular carcinoma in cirrhosis: An italian multicenter prospective study
AU - Giorgio, Antonio
AU - Gatti, Pietro
AU - Montesarchio, Luca
AU - Merola, Maria Gabriella
AU - Amendola, Ferdinando
AU - Calvanese, Andrea
AU - Iaquinto, Gaetano
AU - Fontana, Massimiliano
AU - Ciracì, Emanuela
AU - Semeraro, Stefano
AU - Santoro, Bruno
AU - Coppola, Carmine
AU - Matteucci, Paolo
AU - Matteucci, Pietro
AU - Giorgio, Valentina
PY - 2018
Y1 - 2018
N2 - Background and Aims: To report long-term results in treatment of intermediate hepatocellular carcinoma (HCC) in cirrhotics using new high-powered microwaves (MWS) ablation alone. Methods: This multicenter study included 215 cirrhotics (age range: 67–84 years; 137 males; 149 Child A, 66 Child B) who underwent percutaneous ultrasound-guided high-powered MWS ablation instead of transarterial chemoem-bolization. Among the patient population, 109 had a single nodule (Ø 5.3–8 cm)[groupA],70had2nodules(Ø3–6 cm) [group B] and 36 had 3–5 nodules(Ø1.5–6.8 cm) [group C]. MWS ablation efficacy was evaluated using enhanced-computed tomography and/or magnetic resonance imaging. Primary end-point was 5-year cumulative overall survival (OS). Results: On enhanced-computed tomography and/or magnetic resonance imaging, complete ablation rates were 100% for 1.5–3.5 cm nodules. In nodules >3.5–5 cm, it was 89% for the first ablation and 100% for the second. For lesions >5–8 cm, ablation was up to 92%. Overall, 1-, 3-and 5-year survival rates were 89, 60, and 21%, respectively. The cumulative OS rate of group A was 89%, 66% and 34% at 1, 3 and 5 years.The cumulative OSrate of group B was 88%,60% and 11% at 1, 3 and 5 years. The cumulative OS rate of group C was 86%, 55% and 0%. The 5-year survival rate was significantly different among the groups (p <0.001). One patient died from rupture of HCC. Upon multivariate analysis, preablation total bilirubin >1.5 mg/dL was an independent factor for predicting lower survival. Conclusions: Percutaneous MWS ablation of intermediate HCC is safe and effective in inducing large volume of necrosis in intermediate HCC nodules, providing long-term survival rates similar to transarterial chemoembolization. Pre-ablation total bilirubin >1.5 mg/dL as expression of liver function reserve is the main factor predicting a worse outcome.
AB - Background and Aims: To report long-term results in treatment of intermediate hepatocellular carcinoma (HCC) in cirrhotics using new high-powered microwaves (MWS) ablation alone. Methods: This multicenter study included 215 cirrhotics (age range: 67–84 years; 137 males; 149 Child A, 66 Child B) who underwent percutaneous ultrasound-guided high-powered MWS ablation instead of transarterial chemoem-bolization. Among the patient population, 109 had a single nodule (Ø 5.3–8 cm)[groupA],70had2nodules(Ø3–6 cm) [group B] and 36 had 3–5 nodules(Ø1.5–6.8 cm) [group C]. MWS ablation efficacy was evaluated using enhanced-computed tomography and/or magnetic resonance imaging. Primary end-point was 5-year cumulative overall survival (OS). Results: On enhanced-computed tomography and/or magnetic resonance imaging, complete ablation rates were 100% for 1.5–3.5 cm nodules. In nodules >3.5–5 cm, it was 89% for the first ablation and 100% for the second. For lesions >5–8 cm, ablation was up to 92%. Overall, 1-, 3-and 5-year survival rates were 89, 60, and 21%, respectively. The cumulative OS rate of group A was 89%, 66% and 34% at 1, 3 and 5 years.The cumulative OSrate of group B was 88%,60% and 11% at 1, 3 and 5 years. The cumulative OS rate of group C was 86%, 55% and 0%. The 5-year survival rate was significantly different among the groups (p <0.001). One patient died from rupture of HCC. Upon multivariate analysis, preablation total bilirubin >1.5 mg/dL was an independent factor for predicting lower survival. Conclusions: Percutaneous MWS ablation of intermediate HCC is safe and effective in inducing large volume of necrosis in intermediate HCC nodules, providing long-term survival rates similar to transarterial chemoembolization. Pre-ablation total bilirubin >1.5 mg/dL as expression of liver function reserve is the main factor predicting a worse outcome.
KW - Cirrhosis
KW - HCC
KW - Hepatocellular carcinoma
KW - Intermediate stage
KW - Microwaves ablation
KW - Cirrhosis
KW - HCC
KW - Hepatocellular carcinoma
KW - Intermediate stage
KW - Microwaves ablation
UR - http://hdl.handle.net/10807/206986
U2 - 10.14218/JCTH.2018.00013
DO - 10.14218/JCTH.2018.00013
M3 - Article
SN - 2225-0719
VL - 6
SP - 251
EP - 257
JO - Journal of Clinical and Translational Hepatology
JF - Journal of Clinical and Translational Hepatology
ER -