Cryotherapy for cirrhosis-based hepatocellular carcinoma: a single center experience from 1595 treated cases

Abstract

Cryoablation is a less prevalent percutaneous ablative therapy for hepatocellular carcinoma (HCC), and current evidence about its usefulness is limited. We report our experience in treating 1595 HCC cases with percutaneous cryoablation to give a comprehensive profile about the effectiveness, safety and long-term outcome of this therapy. From January 2003 to December 2013, 1595 patients with 2313 HCC nodules were ablated with 2945 cryoablation sessions in our center. Complete ablation was achieved in 1294 patients for 1893 nodules with a mean diameter of 3.4±2.2 cm. The complete ablation rate was 81.2%, 99.4%, 94.4%, and 45.6% in all tumors, tumors<3 cm, tumors<5 cm, and tumors>5 cm, respectively. Major complications were observed after 80 (3.4%) of the 2945 cryoablations and minor complications were observed after 330 cryoablations with no treatment-related deaths. After a median follow-up of 33.4 months, 937 patients developed different types of recurrence. The 5- and 10-year overall survival was 25.7% and 9.2%, respectively. Cryoablation showed reliable safety and efficacy and should be considered as a promising technique, particularly when a large zone of ablation is required.

Keywords

hepatocellular carcinoma / percutaneous cryoablation / efficacy / safety

References

[1] European Association For The Study Of The Liver1; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol2012; 56(4): 908-943

[2] Asham EH, Kaseb A, Ghobrial RM. Management of hepatocellular carcinoma. Surg Clin North Am2013; 93(6): 1423-1450

[3] Lencioni R. Loco-regional treatment of hepatocellular carcinoma. Hepatology2010; 52(2): 762-773

[4] Adam R, Majno P, Castaing D, Giovenardi R, Bismuth H. Treatment of irresectable liver tumours by percutaneous cryosurgery. Br J Surg1998; 85(11): 1493-1494

[5] Lee F, Bahn DK, McHugh TA, Onik GM, Lee FT Jr. US-guided percutaneous cryoablation of prostate cancer. Radiology1994; 192(3): 769-776

[6] Morris DL. Ablative therapy for liver cancer: which? Ann Surg Oncol2005; 12(3): 205-206

[7] Sheen AJ, Siriwardena AK. The end of cryotherapy for the treatment of nonresectable hepatic tumors? Ann Surg Oncol2005; 12(3): 202-204

[8] Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, Ammatuna M, Morabito A, Gennari L. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med1996; 334(11): 693-699

[9] Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology2005; 42(5): 1208-1236

[10] Lee HS, Kim JK, Cheong JY, Han EJ, An SY, Song JH, Jung YJ, Jeon SC, Jung MW, Jang EJ, Cho SW. Prediction of compensated liver cirrhosis by ultrasonography and routine blood tests in patients with chronic viral hepatitis. Korean J Hepatol2010; 16(4): 369-375

[11] Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis1999; 19(3): 329-338

[12] Wang C, Lu Y, Chen Y, Feng Y, An L, Wang X, Su S, Bai W, Zhou L, Yang Y, Xu D. Prognostic factors and recurrence of hepatitis B-related hepatocellular carcinoma after argon-helium cryoablation: a prospective study. Clin Exp Metastasis2009; 26(7): 839-848

[13] Yang Y, Wang C, Lu Y, Bai W, An L, Qu J, Gao X, Chen Y, Zhou L, Wu Y, Feng Y, Zhang M, Chang X, Lv J. Outcomes of ultrasound-guided percutaneous argon-helium cryoablation of hepatocellular carcinoma. J Hepatobiliary Pancreat Sci2012; 19(6): 674-684

[14] Zhou L, Wang CP, Lu YY, Bai WL, Qu JH, Lou M, Zeng Z, Wu Y, Chen Y, Wang H, Chang XJ, Yang YP. Decrease in size of non-treated lesions after cryoablation for hepatocellular carcinoma. Hepatogastroenterology2012; 59(113): 252-254

[15] Seifert JK, Morris DL. World survey on the complications of hepatic and prostate cryotherapy. World J Surg1999; 23(2): 109-113, discussion 113-114

[16] Hutchinson M, Shyn P, Silverman S. Cryoablation of Liver Tumors. In: Dupuy DE, Fong Y, McMullen WN. Image-Guided Cancer Therapy: New York: Springer, 2013: 491-503

[17] Orlacchio A, Bazzocchi G, Pastorelli D, Bolacchi F, Angelico M, Almerighi C, Masala S, Simonetti G. Percutaneous cryoablation of small hepatocellular carcinoma with US guidance and CT monitoring: initial experience. Cardiovasc Intervent Radiol2008; 31(3): 587-594

[18] Shimizu T, Sakuhara Y, Abo D, Hasegawa Y, Kodama Y, Endo H, Shirato H, Miyasaka K. Outcome of MR-guided percutaneous cryoablation for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg2009; 16(6): 816-823

[19] Chen HW, Lai EC, Zhen ZJ, Cui WZ, Liao S, Lau WY. Ultrasound-guided percutaneous cryotherapy of hepatocellular carcinoma. Int J Surg2011; 9(2): 188-191

[20] Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma<or=4 cm. Gastroenterology2004; 127(6): 1714-1723

[21] Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Ierace T, Solbiati L, Gazelle GS. Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology2000; 214(3): 761-768

[22] Rossi S, Ravetta V, Rosa L, Ghittoni G, Viera FT, Garbagnati F, Silini EM, Dionigi P, Calliada F, Quaretti P, Tinelli C. Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: a long-term cohort study. Hepatology2011; 53(1): 136-147

[23] Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut2005; 54(8): 1151-1156

[24] Ogihara M, Wong LL, Machi J. Radiofrequency ablation versus surgical resection for single nodule hepatocellular carcinoma: long-term outcomes. HPB (Oxford)2005; 7(3): 214-221

[25] Shiina S, Tateishi R, Arano T, Uchino K, Enooku K, Nakagawa H, Asaoka Y, Sato T, Masuzaki R, Kondo Y, Goto T, Yoshida H, Omata M, Koike K. Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol2012; 107(4): 569-577, quiz 578

[26] Kim YS, Lim HK, Rhim H, Lee MW, Choi D, Lee WJ, Paik SW, Koh KC, Lee JH, Choi MS, Gwak GY, Yoo BC. Ten-year outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: analysis of prognostic factors. J Hepatol2013; 58(1): 89-97

[27] Wong J, Lee KF, Lee PS, Ho SS, Yu SC, Ng WW, Cheung YS, Tsang YY, Ling E, Lai PB. Radiofrequency ablation for 110 malignant liver tumours: preliminary results on percutaneous and surgical approaches. Asian J Surg2009; 32(1): 13-20

[28] Llovet JM, Vilana R, Brú C, Bianchi L, Salmeron JM, Boix L, Ganau S, Sala M, Pagès M, Ayuso C, Solé M, Rodés J, Bruix J; Barcelona Clínic Liver Cancer (BCLC) Group. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology2001; 33(5): 1124-1129

[29] Wang CP, Wang H, Qu JH, Lu YY, Bai WL, Dong Z, Gao XD, Rong GH, Zeng Z, Yang YP. Tumour seeding after percutaneous cryoablation for hepatocellular carcinoma. World J Gastroenterol2012; 18(45): 6587-6596

[30] Wang CP, Yang YP. Percutaneous argon-helium cryoablation for hepatocellular carcinoma: safety and efficacy. Infect Dis Info2012; 25: 312-316

[31] Zhou L, Fu JL, Lu YY, Fu BY, Wang CP, An LJ, Wang XZ, Zeng Z, Zhou CB, Yang YP, Wang FS. Regulatory T cells are associated with post-cryoablation prognosis in patients with hepatitis B virus-related hepatocellular carcinoma. J Gastroenterol2010; 45(9): 968-978

[32] Zeng Z, Shi F, Zhou L, Zhang MN, Chen Y, Chang XJ, Lu YY, Bai WL, Qu JH, Wang CP, Wang H, Lou M, Wang FS, Lv JY, Yang YP. Upregulation of circulating PD-L1/PD-1 is associated with poor post-cryoablation prognosis in patients with HBV-related hepatocellular carcinoma. PLoS ONE2011; 6(9): e23621

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