Percutaneous Injection Therapy Research Articles

Rapid Decline of Estimated Glomerular Filtration Rate and its Effect on Mortality Risk of Patients with Hepatocellular Carcinoma

Background: In patients with Hepatocarcinoma (HCC), the association between the rapid decline of kidney function and clinical outcomes is still unknown, although kidney-liver crosstalk is comprehensively studied. Objectives: We aimed to investigate the prevalence and determinants of the rapid decline of kidney function and its potential prognostic role and influence on mortality in HCC patients treated by percutaneous injection therapy (PEIT). Methods: This prospective cohort included 114 HCC, with 64.9% males and a mean age of 65.17 years. The rapid decline of kidney function was defined according to kidney disease improving global outcome (KDIGO). The cancer of the liver Italian program (CLIP) score was calculated to predict survival. Multivariable logistic regression analysis for rapid estimated glomerular filtration rate (eGFR) decline was performed after evaluating individual covariates. Multivariable Cox regression models for rapid eGFR decline and mortality were analyzed. Results: During a median follow-up of 31 months, 43.85% of patients presented a rapid decline in eGFR. The baseline eGFR was significantly higher in the group with the rapid decline of kidney function: 86.08 ± 19.17 mL/min/1.73m2 vs. 75.53 ± 25.7 mL/min/1.73 m2 (P = 0.001). The CLIP score (hazard ratio [HR] = 2.55, 95% confidence interval [CI]: 1.70 - 3.84, P < 0.001) was independently associated with rapid eGFR decline. In Cox regression, rapid eGFR decline was independently associated with mortality (HR = 3.49, 95%CI: 1.28 - 9.56, P = 0.015). Conclusions: Nearly half of the HCC patients presented a rapid eGFR decline. The HCC severity evaluated by the CLIP score was an independent predictor of the rapid decline of kidney function. The rapid decline in eGFR was associated with a higher mortality risk in HCC patients, independent of other known risk factors.

Safety of ultrasound-guided percutaneous injection of alcohol as a scolicidal agent for the treatment of liver hydatid cysts

Background: Hydatid disease is a health problem in the developing world. Percutaneous therapy with various scolicidal agents has been described; however, there is a paucity of literature on the use of absolute alcohol injection without reaspiration as a sole scolicidal agent. The study carried out in a tertiary hospital aimed to prospectively evaluate the safety and outcomes of ultrasound-guided percutaneous injection of alcohol for liver hydatid cyst. Methodology: Consecutive patients with liver hydatid cysts were evaluated with ultrasound, classified according to the WHO classification between June 2012 and January 2020. Eligible patients underwent ultrasound-guided percutaneous therapy after three courses of oral albendazole. Patients having elevated cyst fluid bilirubin levels were excluded. Patients who underwent percutaneous alcohol injection were followed up clinically and with imaging. Data were entered in Microsoft Excel spreadsheet and analyzed. Results: Fifty-two consecutive patients with hydatid cyst were evaluated during the study. Among these, 27 patients underwent percutaneous alcohol injection. Follow-up data were available for 25 patients. There was a favorable imaging outcome in 21/25 (84%). One patient developed anaphylaxis during cyst access, which was managed medically with an uneventful recovery. No instances of cholangitis or sepsis following injection were observed. Conclusion: Percutaneous alcohol injection therapy for liver hydatid cysts is a minimally invasive, safe, and an effective procedure in selected group of patients.

Ultrasound-guided thrombin injection for the treatment of an iatrogenic hepatic artery pseudoaneurysm: a case report

IntroductionPercutaneous transhepatic portal embolization is often performed to expand the indications for hepatic resection. Various etiologies of hepatic artery pseudoaneurysm have been reported, but regardless of the etiology, hepatic artery pseudoaneurysm is usually managed with an endovascular approach or open surgery, depending on the location and clinical symptomatology. However, it is difficult to manage hepatic artery pseudoaneurysm after percutaneous transhepatic portal embolization, since embolization of the hepatic artery may cause hepatic infarctionCase presentationA 58-year-old Japanese man with hilar bile duct cancer underwent percutaneous transhepatic portal embolization to expand the indication for hepatic resection. Two days after percutaneous transhepatic portal embolization, our patient suddenly complained of abdominal pain. Contrast-enhanced computed tomography confirmed a pseudoaneurysm arising from a segmental branch of his right hepatic artery. Since embolization of the hepatic arterial branches may cause hepatic infarction, ultrasound-guided thrombin injection therapy was successfully performed for the pseudoaneurysm.ConclusionWe performed a thrombin injection instead of arterial embolization to avoid hepatic infarction. The rationale of this choice may be insufficient. However, ultrasound-guided percutaneous thrombin injection therapy may be considered as an alternative to percutaneous transarterial embolization or surgical intervention for an iatrogenic hepatic artery pseudoaneurysm.

Percutaneous Intratumoral Injection With Pingyangmycin Lipiodol Emulsion for the Treatment of Recurrent Sacrococcygeal Chordomas

This study describes fluoroscopy-guided percutaneous intratumoral injection therapy (PIIT) with a pingyangmycin lipiodol emulsion in the management of recurrent sacrococcygeal chordomas after surgical excision. Seven patients underwent a total of 22 treatment sessions (3–4 sessions per patient); treatment responses were evaluated clinically, and lesion size was determined using computed tomography (CT). Over 10–26 months of follow-up, tumor sizes and visual analogue scale (VAS) scores of all patients were decreased. No patients had complications during the follow-up period. Preliminary results showed that PIIT with pingyangmycin lipiodol emulsion under fluoroscopic guidance is effective and safe and may be considered as a treatment option.

Clinical study of correlation of blood perfusion characteristics in liver cancer by contrast-enhanced ultrasonography and individualized interventional therapy

Objective To identify the blood perfusion characteristics of different kinds of liver cancer and individualize interventional treatment models by color Doppler ultrasound(CDUS) and contrast-enhanced ultrasonography (CEUS). Methods The blood perfusion characteristics of 315 patients with liver cancer comfirmed by pathology were analyzed and classified using CDUS and CEUS. Individual interventional therapy models were selected based on the classification. Therapeutic effects were evaluated by EUS,contrast-enhanced CT(CECT) and DSA simultaneously. Results Liver cancer can be classified by the blood perfusion characteristics from CEUS examination. The individualized interventional treatment models were selected and evaluated according to the characteristics:①Solitary small HCC of diameter ≤3 cm group were treated via percutaneous ethanol injection(PEI),radiofrequency(RF) or percutaneous microwave coagulation therapy(PMCT). Necrosis rates of the lesions were 95.0% - 97.9%, 1 and 3 years survival rates were 98.0% and 87.8% ,respectively. ②Diameter ≤5 cm and lesions ≤3 group were treated with RF or PMCT combined PEI. Necrosis rates of the lesions were 93.7% - 94.8% ,1 and 3 years survival rates were 89.8% and 81.4% ,respectively. ③Diameter ＞5 cm and hypervascular tumor main fed by the hepatic artery group were treated with TACE,PEI combined RF or PMCT. Necrosis rates of the lesions were 71.4% - 73.8%, 1 and 3 years survival rates were 66.2% and 47.6%, respectively. ④ Diameter ＞5 cm and hypervascular tumor fed by double blood supply or accompanied by portal vein tumor thrombus group were treated with selective portal vein embolization(SPVE) based on the above treatments. Necrosis rates of the lesions were 53.3% - 55.6%, 1 and 3 years survival rates were 64.7% and 40.0%, respectively. Conclusions Classifying the blood perfusion characteristics and choosing individualized interventional treatment models by CEUS are of important clinical significance in non-surgical treatment of liver cancer. Key words: Ultrasonography; Microbubbles; Liver neoplasms; Antineoplastic protocols

Combined haemostatic percutaneous injection therapy for renal trauma under guidance of contrast-enhanced ultrasonography

Objective To study feasibility of combined haemostatic percutaneous injection therapy guided by contrast-enhanced ultrasonography (CEUS) in treatment of renal injuries. Methods Eighteen New Zealand rabbits were inflicted with kidney injury imitating grades Ⅲ-Ⅳ blunt injuries. The animals were randomly and equally divided into three groups, Group A ( treated with hemocoagulase),Group B ( treated with hemocoagulase and Alpha-cyanoacrylate) and Group C ( control group, given normal saline). The hemostatic time, hemostatic effect, and perirenal hematoma were observed. Results A perirenal hematoma was observed one hour after treatment. The perirenal fluid thickness was (0.200 ±0.012) cm in Group A, (0.050 ±0.002) cm in Group B and (0.400 ±0.009) cm in Group C, with statistical significance between two test groups and Group C (P ＜ 0.05 ). At days 7 and 14 following treatment, lesion length and cross section was ( 1. 107 ±0. 143) cm and (0.433 ±0. 163) cm in Group A, (0.567 ±0.082) cm and (0. 160 ±0. 078) cm in Group B, and (0.980 ±0. 203) cm and (0.686 ± 0. 157) cm in Group C. There was statistical significance between the test groups (Groups A and B) and Group C (P＜0. 01) at day 14. The lesion size in Group A was lager than that in Group B (P ＜ 0.01 ). One month after treatment, a slight nephrohydrosis occurred in Group B. Conclusions Either injection of simple hemocoagulase or combined use of hemocoagulase and Alpha-cyanoacrylate guided by CEUS can attain positive hemostatic effect, but the latter one is more rapid and reliable. Key words: Kidney; Contusions; Surgical procedure,minimally invasive; Hemostasis; Contrast-enhanced,ultrasonography

Peripheral Pulmonary Arterial Pseudoaneurysms: Therapeutic Implications of Endovascular Treatment and Angiographic Classifications

To classify peripheral pulmonary arterial pseudoaneurysms (PAPs) associated with infectious lung diseases according to angiographic findings and to determine treatment options for PAPs on the basis of angiographic classifications. The institutional review board approved this study. A total of 24 patients with massive hemoptysis had PAPs that were detected at pulmonary computed tomographic (CT) angiography; underlying diseases were pulmonary tuberculosis (n = 16), a fungus ball (n = 5), lung abscess (n = 2), and pneumonia (n = 1). All patients underwent bronchial and nonbronchial systemic collateral arterial angiography and pulmonary and selective pulmonary angiography. On the basis of the angiographic findings, PAPs were classified into four types: PAPs visualized at nonselective right or left pulmonary angiography were defined as type A (n = 5), PAPs visualized at selective segmental or subsegmental pulmonary angiography were defined as type B (n = 10), PAPs apparent at bronchial and nonbronchial systemic collateral arterial angiography by means of a bronchopulmonary arterial shunt but not at selective pulmonary angiography were classified as type C (n = 5), and PAPs apparent at pulmonary CT angiography alone but not at catheter-directed angiography were classified as type D (n = 4). For type A or B PAPs, bronchial and nonbronchial systemic collateral arteries and pulmonary arteries were successively embolized. Hemoptysis was controlled for all type A and type B PAPs. For type C or type D PAPs, embolization alone of bronchial and nonbronchial systemic collateral arteries and follow-up pulmonary CT angiography were performed. Hemoptysis was not controlled in three of the nine patients: In those patients, percutaneous injection therapy (n = 2) and surgical resection (n = 1) were performed. Classification of PAPs on the basis of angiographic findings and determination of treatment options according to these findings are useful for the endovascular management of PAPs associated with massive hemoptysis.

Effectiveness of Weekly Percutaneous Maxacalcitol Injection Therapy in Patients With Secondary Hyperparathyroidism

Percutaneous injection therapy with vitamin D has been applied in the treatment of hyperparathyroidism (HPT); however, the application of percutaneous injection therapy with vitamin D lacks established guidelines regarding the volume of injected solution and the frequency of injection. We have developed an outpatient treatment regimen using percutaneous maxacalcitol injection therapy (PMIT) on a weekly basis for 4-6 weeks following dialysis without major complications. Intact parathyroid hormone decreased from 797 +/- 178 pg/mL to 253 +/- 25 pg/mL, and the parathyroid gland volume initially increased during the first week, but thereafter, it gradually decreased with weekly PMIT (wPMIT). Finally, the parathyroid gland volume decreased from 1.27 +/- 1.06 cm(3) to 0.24 +/- 0.15 cm(3) after wPMIT. The benefits of our method were confirmed on weekly ultrasonographic examinations, which detailed the gradual reduction in gland size following an initial increase after the first injection. Therefore, we conclude that our carefully implemented PMIT method would be an effective treatment against refractory secondary HPT.

Contrast-enhanced ultrasound: The evolving applications

Contrast-enhanced ultrasound (CEUS) is a major breakthrough for ultrasound imaging in recent years. By using a microbubble contrast agent and contrast-specific imaging software, CEUS is able to depict the micro- and macro-circulation of the targeted organ, which in turn leads to improved performance in diagnosis. Due to the special dual blood supply system in the liver, CEUS is particularly suitable for liver imaging. It is evident that CEUS facilitates improvement for characterization of focal liver lesions (FLLs), detection of liver malignancy, guidance for interventional procedures, and evaluation of treatment response after local therapies. CEUS has been demonstrated to be equal to contrast-enhanced computed tomography or magnetic resonance imaging for the characterization of FLLs. In addition, the applicability of CEUS has expanded to non-liver structures such as gallbladder, bile duct, pancreas, kidney, spleen, breast, thyroid, and prostate. The usefulness of CEUS in these applications is confirmed by extensive literature production. Novel applications include detecting bleeding sites and hematomas in patients with abdominal trauma, guiding percutaneous injection therapy and therefore achieving the goal of using interventional ultrasonography in managing splenic trauma, assessing the activity of Crohn's disease, and detecting suspected endoleaks after endovascular abdominal aneurysm repair. Contrast-enhanced intraoperative ultrasound (US) and intracavitary use of CEUS have been developed and clinically studied. The potential use of CEUS involves sentinel lymph node detection, drug or gene delivery, and molecular imaging. In conclusion, the advent of CEUS has greatly enhanced the usefulness of US and even changed the status of US in clinical practice. The application of CEUS in the clinic is continuously evolving and it is expected that its use will be expanded further in the future.

Percutaneous Injection Therapy for Blunt Splenic Trauma Guided by Contrast-Enhanced Ultrasonography

The purpose of this study was to investigate the application of contrast-enhanced ultrasonography (CEUS) in managing blunt splenic trauma and the effectiveness of CEUS-guided percutaneous injection therapy. Six patients with grade 3 or 4 splenic injuries as determined by CEUS and contrast-enhanced computed tomography were given hemocoagulase atrox and absorbable cyanoacrylate percutaneously, which were injected into the injury region and active bleeding site, respectively, under CEUS guidance. Immediately after the procedure and 1 and 3 days, 1 and 2 weeks, and 1 and 6 months after the procedure, follow-up CEUS up was performed in all patients. Among the 6 patients, 4 cases of CEUS-guided hemostatic injection were successful without complications. Rehemorrhage occurred in 1 patient, and a traumatic arteriovenous fistula occurred in another; repeated injection therapy in these 2 patients was effective. During the follow-up, there were no complications, and spleen perfusion recovered gradually. Contrast-enhanced ultrasonography can be used to guide percutaneous injection therapy and therefore achieve the goal of using interventional ultrasonography in managing splenic trauma.

Percutaneous Injection Therapy for a Peripheral Pulmonary Artery Pseudoaneurysm After Failed Transcatheter Coil Embolization

Coil embolization to occlude the feeding artery of a pseudoaneurysm is an effective treatment to control hemoptysis. However, a feeding artery of the pseudoaneurysm may not be identified at pulmonary angiography, resulting in a failure to obtain embolization. We describe here two cases of a Rasmussen aneurysm that was successfully treated with percutaneous injection of thrombin (case 1) and N-butyl cyanoacrylate (case 2) under ultrasonographic and fluoroscopic guidance after failed transcatheter coil embolization.

Successful treatment of large-size advanced hepatocellular carcinoma by transarterial chemoembolization followed by the combination therapy of percutaneous ethanol-lipiodol injection and radiofrequency ablation

We report a case of large-size hepatocellular carcinoma (HCC) successfully treated with transarterial chemoembolization (TACE) followed by the combination therapy of percutaneous ethanol-lipiodol injection and radiofrequency ablation (PELI-RFA) and percutaneous ethanol-lipiodol injection (PELI) therapy. In the present case, the patient had a large-size advanced HCC, 7 cm in diameter, located in the S8 region of the liver. In addition, the hepatic reserve of the patient was severely poor. In order not to impair the poor hepatic reserve, we chose PELI-RFA and PELI, originally developed in our department and reported as milder treatment modalities than others. After TACE , PELI-RFA and PELI were performed several times, the HCC was totally destroyed and early enhancement shown by helical dynamic computed tomography disappeared completely after treatment. The hepatic reserve of the patient was not impaired by the series of treatments. Serum levels of tumor markers, alpha-fetoprotein and Des-gamma-carboxy prothrombin, were rapidly decreased to almost normal levels. PELI-RFA and PELI may be effective for the treatment of large-size HCC of patients with poor hepatic reserve.

Comparison of Three Different Needles for Percutaneous Injections

Comparison of Three Different Needles for Percutaneous Injections

Fever and Infectious Complications After Percutaneous Acetic Acid Injection Therapy for Hepatocellular Carcinoma: Incidence and Risk Factor Analysis

Ultrasound-guided percutaneous acetic acid injection (PAI) therapy is effective for hepatocellular carcinoma (HCC). Posttreatment fever (>37.5 degrees C) may occur owing to acetic acid-induced tumor necrosis, but its incidence and clinical significance are not clear. A total of 402 treatment sessions in 127 consecutive patients undergoing PAI for HCC were prospectively studied. The incidence and risk factors associated with post-PAI fever were analyzed. There were 37 (9.2%) episodes of fever occurring in 29 HCC patients after PAI. Patients who developed fever more often had large-sized (3.5+/-1.3 cm vs. 2.7+/-1.2 cm, P=0.0002) tumor and a higher injection volume (2.6+/-0.1 mL vs. 2.2+/-0.1 mL, P=0.001) of acetic acid compared with those without fever. Multivariate logistic regression analysis showed that tumor size >3 cm was the only significant predictor associated with occurrence of posttreatment fever (odds ratio: 4.4, 95% confidence interval: 2.2-8.9, P<0.001). Three patients, all of whom had HCC diameter >3 cm, had 4 episodes of bacteremia after treatment; one of them developed liver abscess that required percutaneous drainage. Fever after PAI is not an uncommon event. Patients with tumor size >3 cm have a higher risk of posttreatment fever. Bacteremia and significant infectious complication could occur in a minority of patients. Prophylactic antibiotics before treatment may be necessary for high-risk patients.

The Sequential Changes of the Model for End-stage Liver Disease Score Correlate With the Severity of Liver Cirrhosis in Patients With Hepatocellular Carcinoma Undergoing Locoregional Therapy

The model for end-stage liver disease (MELD) has been used to prioritize cirrhotic patients awaiting liver transplantation. It is not clear whether MELD correlates with liver functional reserve that changes over time. This study investigated the correlation of sequential changes between MELD and Child-Turcotte-Pugh (CTP) scores in patients with hepatocellular carcinoma (HCC). A total of 192 HCC patients undergoing transarterial chemoembolization or percutaneous injection therapy were studied. The MELD and CTP scores of study patients at pretreatment, early (median, 2 wk) and late (median, 8 wk) stage after treatment were 10.1+/-3.5, 12.9+/-3.2, and 11.7+/-3.1, and 6.2+/-1.1, 7.5+/-1.1, and 6.9+/-1.2, respectively. There was a significant correlation of the serial changes for the period between pretreatment and early stage (rho=0.605, P<0.001), and between early to late stage (rho=0.512, P<0.001) after treatment. The corresponding increase and decrease of MELD score was 2.1 and 2.0, respectively, per unit change of the CTP score. The correlation was still significant in the stratified analysis according to various clinical parameters. In the Cox multivariate model, tumor size >5 cm [relative risk (RR)=2.58, P<0.001], multiple HCCs (RR=1.78, P=0.013), CTP class B or C (RR=3.06, P<0.001), and MELD score >15 (RR=2.17, P=0.023) were independent poor prognostic predictors. Serial determinations of the MELD score well correlate with the changes of CTP score. The MELD score may be useful in measuring liver functional reserve and outcome prediction in HCC patients undergoing locoregional therapy.

Zoledronate induces apoptosis in cells from fibro-cellular membrane of unicameral bone cyst (UBC)

Unicameral bone cyst (UBC) is a benign cystic lesion in children which is prone to fracture. Various treatments are available, but recurrence after different types of percutaneous injection therapy can cause bone destruction and pathologic fracture. The potential therapeutic effects of anti-resorptive agents, such as bisphosphonates, have not been investigated for UBC. The objective of this study was to characterize the cells from the fibro-cellular membrane of unicameral bone cyst (UBC cells) and to determine whether zoledronate, a nitrogen-containing bisphosphonate, could induce apoptosis in UBC cells. Flow cytometry and immunoblotting were performed in order to determine whether zoledronate induced apoptosis. Cells derived from normal human trabecular bones were used as controls against UBC cells to compare the effect of zoledronate in inducing apoptosis. Immunohisto/cytochemistry (IHC/ICC) and mini-array analyses were performed on tissues and cultured cells. Isolated peripheral blood mononuclear cells were incubated with conditioned media from the UBC cells to determine whether they are capable of inducing osteoclastogenesis. UBC membrane is composed of cells staining positively with CD68, SDF-1, STRO-1 and RANKL, but in vitro cells showed no staining with antibodies to CD68 and STRO-1, suggesting that there was a clonal selection of stromal cells during cell culture. UBC cells also express RUNX2 (runt-related transcription factor-2, core binding factor-1), a key transcription factor for osteoblastic differentiation. In addition, media collected from UBC cells induced a generation of multi-nucleated osteoclast-like cells of peripheral blood mononuclear cells. Zoledronate induced apoptosis of UBC cells in a dose-dependent manner. Apoptosis was evidenced by induction of the active cleaved form of caspase-3. The baseline apoptotic fractions were similar in UBC cells and trabecular bone cells. However, in the overall apoptotic fractions in this study, trabecular bone cells showed 17.2% of apoptosis, significantly lower than 24.2% of UBC cells ( p-value = 0.007). With the various zoledronate concentrations, mean apoptotic fractions of trabecular bone cells was 19.2%, significantly lower than 27.8% of UBC cells ( p-value = 0.040). With GGOH co-treatment in various zoledronate concentrations, 15.1% apoptosis was shown in trabecular bone cells, which was not significantly lower than 20.6% of UBC cells ( p-value = 0.076). This data suggests that zoledronate causes apoptosis in both UBC and trabecular bone cells by inhibition of the mevalonate pathway. In addition to the known anti-osteoclastogenic effect of bisphosphonates, the GGOH inhibitory effects of zoledronate were more prominent in UBC cells than trabecular bone cells, indicating their potential therapeutic role in UBC.

肝癌 肝細胞癌に対する経皮的マイクロ波凝固療法の治療成績

JIS scores, an integrated staging system for hepatocellular carcinoma (HCC) that combines degree of tumor advancement and the reserve capability of the liver, and said to excel in stratifying patient prognoses. In this study, we used 867 HCC patients to compare, according to their JIS scores, the prognosis among patients given percutaneous microwave coagulation therapy (PMCT), hepatic resection, and percutaneous ethnaol injection therapy (PEIT). The results showed that, among subjects whose JIS score was 0 points, those who underwent PMCT (n = 28) had a 5-year survival rate of 85% ; the rate for those who underwent liver resection (n = 35) was 72% ; and the rate for those who underwent PEIT (n = 36) was 82%, showing no differences. However, the 5-year non-recurrence rate was 49% for the liver resection group, 39% for the PMCT group, and 7% for the PEIT group, showing better rates for the liver resection group (p < 0.01) and the PMCT group (p < 0.05) than the PEIT group. Based on the above, it was suggested that Stage I HCC patients were good candidates for PMCT.

Percutaneous injection therapy for hepatocellular carcinoma in patients with chronic renal insufficiency.

Percutaneous injection therapy using acetic acid or pure ethanol is effective for hepatocellular carcinoma (HCC). However, its efficacy in HCC patients with coexisting chronic renal insufficiency (CRI), defined as a serum creatinine level of 1.5 mg/dl or above, is not known. This study compared the survival in HCC patients with and without CRI undergoing percutaneous injection therapy. A total of 172 patients (129 male; age 67 +/- 10 years) during a 4-year period were included. Thirty-five of these patients had CRI (creatinine level 2.7 +/- 1.8 mg/dl) before treatment Fourteen patient- and tumour-related parameters were included for survival analysis. The mean follow-up period was 24 +/- 9 (range 4-40) months. Seven (20%) and 39 (28%) patients in the groups with and without CRI, respectively, died. There was no significant survival difference in patients with and without CRI. The cause of death was related to renal failure in two (29%) patients in the former group and one (3%) patient in the latter group. For the patients with CRI, the presence of ascites and a serum creatinine level of 2.3 mg/dl or above were poor prognostic factors in the univariate analysis; the latter was the only independent factor predicting a poor survival by the Cox multivariate proportional model. CRI does not affect overall survival in HCC patients undergoing percutaneous injection therapy. However, a serum creatinine level of 2.3 mg/dl or above is an independent poor prognostic predictor among patients with existing CRI.

Selective prognostic impact of serum α-fetoprotein level in patients with hepatocellular carcinoma: Analysis of 543 patients in a single center

The prognostic impact of serum alpha-fetoprotein (AFP) level in patients with hepatocellular carcinoma (HCC) is controversial. This study aimed to investigate the predictive ability of serum AFP in HCC patients. A total of 543 patients undergoing surgical resection (258 patients) and non-surgical treatment (285 patients) including transarterial chemoembolization and percutaneous injection therapy were retrospectively studied. Overall, AFP level >400 ng/ml was an independent poor prognostic predictor [relative risk (RR): 1.4, 95% confidence interval (CI): 1.0-1.9, p=0.049]. Stratified analysis showed that there was a sharp contrast of predictive power of AFP level in treatment strategy and tumor size. In surgical patients, serum AFP >400 ng/ml was a tumor size-independent predictor of tumor recurrence (RR: 1.7, 95% CI: 1.2-2.5, p=0.006) and survival (RR: 2.3, 95% CI: 1.3-3.8, p=0.002). However, there was no association between AFP level and survival in the non-surgical group (p=0.597). Alternatively, among the 157 patients with large (>5 cm) HCCs, AFP >400 ng/ml independently predicted a poor survival (RR: 1.9, 95% CI: 1.2-2.5, p=0.012), whereas no clear relationship between AFP level and survival was found among the 386 patients with small (< or =5 cm) HCCs (p=0.685). There was no differential prognostic impact of serum AFP levels in other variables. In conclusion, serum AFP level is a weak prognostic predictor in HCC patients. Its predictive ability is highly selective and dependent on treatment strategy and tumor size. Incorporation of serum AFP level into any prognostic prediction model should be based on its distinctive selective prognostic power.

Percutaneous ethanol and lipiodol injection therapy for hepatocellular carcinoma

Radiofrequency ablation (RFA) therapy is of great significance in the treatment of hepatocellular carcinoma (HCC) or metastatic liver tumors. RFA is able to achieve widely coagulated necrosis in a few sessions without major complications. However, HCC cases exist that are resistant to RFA therapy for several reasons. In the present study, we performed injection of the mixture of ethanol and lipiodol (percutaneous ethanol-lipiodol injection therapy: PELIT) for HCCs that lacked clear visuality of the entire shape of the tumor by ultrasonography (US) or computed tomography (CT), or that were difficult to treat with RFA alone due to their locations in the liver or due to severe liver dysfunction of the patients. Local recurrence rates of HCC treated with PELIT were shown to be low in patients followed up for at least 4 months. In all patients treated with PELIT, lipiodol was accumulated in the entire region of the tumor after several trials of PELIT and the accumulation was kept for many months. The biopsy examination from the tumor treated with PELIT showed that HCC cells were totally destroyed by the PELIT. Although RFA therapy serves as a central role for the treatment of HCCs, PELIT, considered to be milder therapy, is likely to be important as a supportive treatment for HCCs and useful for the treatment of HCCs that are difficult to treat with RFA.