Abstract
BackgroundHepatocellular carcinomas (HCC) arising in the caudate lobe is rare and the treatment is difficult. The aim of this study is to summarize the experience of ultrasound-guided percutaneous ablation therapy for HCC located in the caudate lobe and to investigate the predictive factors of the treatment outcomes.MethodsFrom August 2006 to June 2017, 73 patients (63 males and 10 females; mean age, 54.9 ± 11.6 years; age range, 25–79 years) with 73 caudate lobe HCCs (mean size, 2.6 ± 1.1 cm; size range, 1.0–5.0 cm) were treated with percutaneous ablation, including 33 patients with radiofrequency ablation (RFA), 23 patients with ethanol ablation (EA), and 17 patients with combination of RFA and EA. The treatment outcome and survival after ablation for caudate lobe HCC were assessed and the predictive factors were calculated by univariate and multivariate analyses.ResultsA total of 72 patients achieved complete ablation after the first or second session of ablation. The treatment effectiveness was 98.6% (72/73). During the follow-up, 16 tumors developed local tumor progression (LTP) and a total of 61 patients (61/73, 83.6%) were detected distant recurrence (DR). According to univariate and multivariate analyses, tumor size > 2 cm (hazard ratio[HR] = 3.667; 95% confidence interval[CI], 1.043–12.889; P = 0.043) was a significant prognostic factor of LTP after ablation for HCC in the caudate lobe, while tumor number (HR = 2.245; 95%CI, 1.168–4.317; P = 0.015) was a significant prognostic factor of DR. The mean overall survival time after ablation was 28.7 ± 2.8 months, without independent predictive factors detected. Four patients (4/73, 5.5%) were detected treatment-related major complications, without independent predictive factor detected.ConclusionUltrasound-guided percutaneous ablation is a feasible treatment for a selected case with HCC in the caudate lobe. Tumor size > 2 cm increases the risk of LTP and intrahepatic tumor number is associated with DR after ablation.
Highlights
Hepatocellular carcinomas (HCC) arising in the caudate lobe is rare and the treatment is difficult
Percutaneous ablation as a minimally invasive technique is recommended for small HCCs in patients with preserved liver function reserve, according to the guidelines established by American Association for the Study of Liver Disease (AASLD) and European Association for the Study of Liver (EASL) [3]
The aim of our study is to summarize our experience of ultrasound-guided percutaneous ablation therapy for HCC located in the caudate lobe and investigate the predictive factors of treatment outcomes
Summary
Hepatocellular carcinomas (HCC) arising in the caudate lobe is rare and the treatment is difficult. The aim of this study is to summarize the experience of ultrasound-guided percutaneous ablation therapy for HCC located in the caudate lobe and to investigate the predictive factors of the treatment outcomes. Hepatocellular carcinoma (HCC) in the caudate lobe is rare. The treatment of it is difficult, because the caudate lobe is located deeply between the hepatic hilum and the inferior vena cava. Ethanol ablation (EA) is an effective treatment that has been widely used in patients with small tumors, especially for those at high-risk locations [7]. The combination of RFA and EA (RFA-EA) can overcome the limitations of RFA alone [8] and EA alone [9], resulting in improved overall survival (OS) and reduced the risk of local tumor progression (LTP) without increasing major complications [10]
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