Cancer Management and Research (May 2020)
Computed Tomography-Guided Percutaneous Cryoablation for ‎ Subcardiac Hepatocellular Carcinoma: Safety, Efficacy, Therapeutic Results and Risk Factors for Survival Outcomes
Abstract
Chunhou Qi,1 Hongfei Gao,1 Qinghua Zhao,2 Lei Zhang3 1Department of Interventional Medicine, Linyi City Central Hospital, Yishui, Shandong, People’s Republic of China; 2Department of Emergency Medicine, Yishui County People’s Hospital, Yishui, Shandong, People’s Republic of China; 3Department of Interventional Radiology, Shandong Medical Imaging Research Institute, Affiliated to Shandong University, Jinan, Shandong, People’s Republic of ChinaCorrespondence: Lei ZhangDepartment of Interventional Radiology, Shandong Medical Imaging Research Institute, Affiliated to Shandong University, 324 Jingwu Road, Jinan, Shandong, People’s Republic of ChinaTel +86-531-68776767Fax +86-531-87938550Email [email protected]: To investigate the clinical safety, efficacy, therapeutic outcomes and risk factors of computed tomography-guided percutaneous cryoablation (CT-PCRA) for subcardiac hepatocellular carcinoma (HCC).Patients and Methods: In this study, patients with single HCC nodules located on the left lobe who subsequently underwent CT-PCRA were reviewed from July 2012 to August 2016. According to the definition of subcardiac HCC, the patients were grouped into the subcardiac HCC group (n=33) and the non-subcardiac HCC group (n=40). The technical success rates, tumour response rates, oncological outcomes including overall survival (OS) and recurrence-free survival (RFS) and complications were compared. Multivariate analysis was performed on clinicopathological variables to identify factors affecting long-term outcomes.Results: Seventy-three patients with subcardiac HCC were included in this study. After a median follow-up time of 37.8 months, 27.4% (20/73) of the patients died. The technical success and complete response rates were not significantly different between the two groups (p = 1.000; p = 0.590). The cumulative OS and RFS of the subcardiac HCC group were comparable to those of the non-subcardiac HCC group (p =0.820, p =0.922). Two major complications, intra-abdominal bleeding and right pleural effusion, were found at 2.2 and 3.1 months in the subcardiac HCC group, which were comparable with those in the non-subcardiac HCC group (p = 0.683). The multivariate analysis results showed that older age (hazard ratio [HR]: 2.382, 95% confidence interval [CI]: 1.884– 7.823; p = 0.038) and ALBI grade 2– 3 (HR: 3.398, 95% CI: 1.950– 6.058; p = 0.021) may be predictors of poor OS and that tumour size ≥ 3 cm in diameter (HR: 3.302, 95% CI: 2.232– 8.293; p = 0.012) may be a predictor of poor RFS.Conclusion: CT-PCRA for subcardiac HCC can be performed safely and efficiently and contribute to improving survival prognosis.Keywords: cryoablation, subcardiac location, hepatocellular carcinoma, therapeutic outcomes, risk factors
