Percutaneous Microwave Coagulation Research Articles

MR-guided percutaneous microwave coagulation of small breast tumors

BackgroundTo evaluate the technical success and patient safety of magnetic resonance-guided percutaneous microwave coagulation (MR-guided PMC) for breast malignancies.MethodsFrom May 2018 to December 2019, 26 patients with breast tumors measuring 2 cm or less were recruited to participate in a prospective, single-institution clinical study. The primary endpoint of this study was the evaluation of treatment efficacy for each patient. Histochemical staining with α-nicotinamide adenine dinucleotide and reduced (NADH)-diaphorase was used to determine cell viability following and efficacy of PMC. The complications and self-reported sensations from all patients during and after ablation were also assessed. The technical success of the PMC procedure was defined when the area of the NADH-diaphorase negative region fully covered the hematoxylin–eosin (H&E) staining region in the tumor.ResultsAll patients had a complete response to ablation with no residual carcinoma on histopathological specimen. The mean energy, ablation duration, and procedure duration per tumor were 36.0 ± 4.2 kJ, 252.9 ± 30.9 S, and 104.2 ± 13.5 min, respectively. During the ablation, 14 patients underwent prolonged ablation time, and 1 patient required adjusting of the antenna position. Eleven patients had feelings of subtle heat or swelling, and 3 patients experienced slight pain. After ablation, one patient took two painkillers because of moderate pain, and no patients had postoperative oozing or other complications after PMC. Induration around the ablation area appeared in 16 patients.ConclusionMR-guided PMC of small breast tumors is feasible and could be applied in clinical practice in the future.Critical relevance statementMR-guided PMC of small breast tumors is feasible and could be applied in clinical practice in the future.Key points• MR-guided PMC of small breast tumors is feasible.• PMC was successfully performed for all patients.• All patients were satisfied with the final cosmetic result.Graphical

Percutaneous microwave ablation and transcatheter arterial chemoembolization for serum tumor markers and prognostics of middle-late primary hepatic carcinoma.

Primary hepatic carcinoma (PHC) has an insidious onset and is usually diagnosed in the middle and late stages. Although transcatheter arterial chemoembolization (TACE) is the preferred option for treating middle- and advanced-stage PHC, it has limited efficacy in killing tumor cells and poor long-term efficacy. TACE plus percutaneous microwave coagulation therapy (PMCT) is more effective than interventional therapy alone and can improve survival time. However, there are few reports on the effects of TACE and PMCT on serum marker levels and the prognosis of patients with advanced PHC. To investigate the effect of PMCT + TACE on serum tumor markers and the prognosis of middle-late PHC. This retrospective study included 150 patients with middle-late PHC admitted to Zhongshan People's Hospital between March 2018 and February 2021. Patients were divided into a single group (treated with TACE, n = 75) and a combined group (treated with TACE + PMCT, n = 75). Before and after treatment, the clinical efficacy and serum tumor marker levels [carbohydrate antigen 19-9 (CA19-9), alpha-fetoprotein (AFP), and carcinoembryonic antigen (CEA)] of both groups were observed. The 1-year survival rates and prognostic factors of the two groups were analyzed. The combined group had 21 and 35 cases of complete remission (CR) and partial remission (PR), respectively. The single group had 13 and 25 cases of CR and PR, respectively. After 4 wk of treatment, the serum CA19-9, CEA, and AFP levels in the single and combined groups decreased, with the decrease in the combined group being more significant (P < 0.05). The 1-year survival rate of the combined group (80.00%) was higher than that of the single group (60.00%) (P < 0.05). The average survival time within 1 year in the combined group was 299.38 ± 61.13 d, longer than that in the single group (214.41 ± 72.97 d, P < 0.05). COX analysis revealed that tumor diameter, tumor number, and the treatment method were prognostic factors for patients with middle-late PHC (P < 0.05). TACE + PMCT is effective in treating patients with mid-late PHC. It reduces the levels of tumor markers, prolongs survival, and improves prognosis.

Retracted: Percutaneous Microwave Coagulation Therapy: A Promising Therapeutic Method for Breaking the Barrier of the Intertumor Heterogeneity.

[This retracts the article DOI: 10.1155/2021/7773163.].

Percutaneous Microwave Coagulation Therapy: A Promising Therapeutic Method for Breaking the Barrier of the Intertumor Heterogeneity.

Intertumor heterogeneity is common in various cancers and has been widely accepted as the primary cause of the diversity and variation of the effect of the same treatment on patients with the same type of tumor. Percutaneous microwave coagulation therapy (PMCT) is a minimally invasive and effective approach for destroying tumors by microwave beam under image guidance, which has been applied in lung cancer. However, no previous study has investigated the capability of PMCT solving intertumor heterogeneity. Here, we performed a component analysis of four lung cancer patients' tumor microenvironment (TME) via single-cell RNA sequencing (scRNA-seq) and treated all four cases with PMCT. One patient's TME could be classified into a hot tumor, mainly proinflammatory cytokines, and T cell infiltration. The other three patients' TMEs were cold tumors, where immunosuppressive cells occupied a large proportion, including tumor-associated macrophages and cancer cells. Despite a high level of heterogeneity among their tumor microenvironment compositions, disease type and stage, and basic physical conditions, all four patients presented a stable disease (SD) without any cancer cell detected in the TME of cancer tissues after PMCT. In conclusion, this report uniquely contributed to the knowledge of the PMCT adaptation to tumor heterogeneity. Therefore, PMCT is promising to demonstrate a stable and robust antitumor efficacy in unresectable lung cancers with various TMEs.

Effect of Severity of Liver Cirrhosis on Surgical Outcomes of Hepatocellular Carcinoma After Liver Resection and Microwave Coagulation.

BackgroundLiver resection (LR) and percutaneous microwave coagulation therapy (PMCT) are both considered as radical treatments for small hepatocellular carcinoma (HCC). However, it is still unclear whether to select LR or PMCT in HCC patients with different degrees of liver cirrhosis. The purpose of this study was to compare the efficacy of LR and PMCT in the treatment of solitary and small HCC accompanied with different degrees of liver cirrhosis.MethodsIn this study, 230 patients with solitary HCC lesions ≤ 3 cm and Child-Pugh A liver function were retrospectively reviewed. Among these patients, 122 patients underwent LR, and 108 received PMCT. The short- and long-term outcomes were compared between these two procedures. Severity of liver cirrhosis was evaluated by using clinical scoring system (CSS) as previously published. Subgroup analysis based on CSS was performed to evaluate the effect of severity of liver cirrhosis on surgical outcomes after LR and PMCT.ResultsThere was no mortality within 90 days in both groups. Major complications were significantly more frequent in the LR group than in the PMCT group (18.8% vs. 4.6%, p<0.001). However, LR provided better surgical outcomes than PMCT. The 5-year overall survival (OS) rates for the LR and PMCT groups were 65.2% and 42%, respectively (p=0.006), and the corresponding disease-free survival (DFS) rates were 51.7% and 31.5%, respectively (p=0.004). Nevertheless, subgroup analysis showed that PMCT provided long-term outcomes that were similar to LR and lower surgical complications in HCC patients with CSS score≥4.ConclusionsLR may provide better OS and DFS rates than PMCT for patients with solitary HCC lesions ≤ 3 cm and Child-Pugh A liver function irrespective of liver cirrhosis. PMCT should be viewed as the optimal treatment for solitary and small HCC with severe cirrhosis.

Clinical Scoring Model Determines Surgical Modality for Solitary and Small Hepatocellular Carcinoma with Child-Pugh A Liver Function

Introduction: Previous study indicated that clinical scoring model (CSM) could accurately predict the severity of cirrhosis. This study aimed to compare the therapeutic efficacy of liver resection (LR) and percutaneous microwave coagulation therapy (PMCT) for solitary and small hepatocellular carcinoma (HCC) using CSM.

Transarterial chemoembolization versus percutaneous microwave coagulation therapy for recurrent unresectable intrahepatic cholangiocarcinoma: Development of a prognostic nomogram

BackgroundTransarterial chemoembolization (TACE) and percutaneous microwave coagulation therapy (PMCT) are commonly used to treat intrahepatic recurrent liver cancers. However, there is no information regarding their effectiveness in patients with recurrent intrahepatic cholangiocarcinoma (ICC) after resection. MethodsA total of 275 patients with localized recurrent ICC who received either TACE (n = 183) or PMCT (n = 92) were studied. A propensity score matching analysis was performed to compare prognostic impact of TACE and PMCT. Prognostic factors for TACE and PMCT were identified respectively. Predictive nomograms for each TACE and PMCT were developed using the Cox independent prognostic factors and were validated in independent patient groups by receiver operating characteristic curves and area under curve values. ResultsBoth TACE and PMCT provided curativeness in partial patients (5-year overall survival: 21.4% and 6.1%, respectively), but TACE provided better survival benefit in both overall patients (hazard ratio [HR] = 0.71; 95% confidence interval [CI]: 0.50–0.97; P = 0.034) and propensity score matching analysis (HR = 0.69; 95% CI: 0.47–0.98; P = 0.041). Independent prognostic factors for TACE were tumor size >5 cm, poor differentiation, and major resection, whereas poor differentiation, hepatitis B virus infection, cholelithiasis, and lymph node metastasis were identified for PMCT. Both predictive nomograms for TACE and PMCT were validated to be effective with area under curve values of 0.77 and 0.70, respectively. ConclusionsTACE provided better survival benefits compared to PMCT. However, there was a disparity in prognostic factors, suggesting evaluation of the two nomograms may be supportive in modality selection. Further prospective validation studies are required for the results to be applied in clinical medicine.

Comparison of anesthetic effects of dexmedetomidine and tramadol, respectively, combined with propofol in percutaneous microwave coagulation therapy for hepatocellular carcinoma

Anesthetic effects and safety of dexmedetomidine and tramadol, respectively, combined with propofol in ultrasound-guided percutaneous microwave coagulation therapy (PMCT) for hepatocellular carcinoma (HCC) were compared. One hundred and seventy-six patients with HCC, treated by ultrasound-guided PMCT in The Affiliated Hospital of Qingdao University from January 2014 to December 2016, were retrospectively analyzed and divided into two groups: dexmedetomidine group (anesthetized with dexmedetomidine combined with propofol, n=91) and tramadol group (anesthetized with tramadol combined with propofol, n=85). Changes in heart rate (HR), mean arterial pressure (MAP), and oxygen saturation (SpO2) were recorded before oxygen inhalation (T1), intraoperationally (T2), and at 30 min postoperatively (T3), and the recovery time (recorded from the moment the use of anesthetic drugs stopped), hospital stay, visual analogue scale (VAS) score at 48 h after surgery, as well as the adverse reactions in the perioperative period were compared between the two groups. HR and SpO2 in the dexmedetomidine group at T2 and T3 were significantly lower than those in the tramadol group (P<0.05). HR and SpO2 at T2 were significantly lower than those at T1 and T3, and HR at T3 was lower than that at T1 (P<0.05). MAP in the dexmedetomidine group at T2 was significantly lower than that in the tramadol group (t=3.836, P<0.001). MAP at T2 was significantly lower than those at T1 and T3, and MAP at T3 was lower than that at T1 (P<0.05). The number of patients with shivering in the dexmedetomidine group was significantly higher than that in the tramadol group (P<0.05). Both tramadol and dexmedetomidine, respectively combined with propofol in PMCT for HCC surgery can achieve satisfactory anesthetic effects. However, tramadol combined with propofol is more effective in stabilizing the vital signs with less side-effects, and is more suitable for PMCT in patients with HCC than dexmedetomidine combined with propofol, which is worth popularizing and applying in clinic.

Clinical scoring model determines surgical modality for solitary and small hepatocellular carcinoma with Child-Pugh A liver function

Introduction: Previous study indicated that clinical scoring model(CSM) could accurately predict the severity of cirrhosis. This study aimed to compare the therapeutic efficacy of liver resection (LR) and percutaneous microwave coagulation therapy(PMCT) for solitary and small hepatocellular carcinoma (HCC) using CSM. Method: In this study, 228 patients with single HCC ≤3 cm and Child-Pugh A liver function were retrospectively reviewed. Among these patients, 131 patients underwent LR, and 97 patients received PMCT. The short and long-term outcomes were compared between the two procedures. Result: There was no 90-days mortality in either group. Major complications were significantly more frequent in the LR group compared to the PMCT group (18.8% vs 4.6%, p=0.003). The 1-, 3-, and 5-year overall survival(OS) rates for the LR group and PMCT group were 97.2%, 91.6%, 65.2% and 90.1%, 72.4%, 42%, respectively ( p=0.006). The 1-, 3-, and 5-year disease-free survival (DFS) rates for the LR group and PMCT group were 95.4%, 74.5%, 51.7% and 83.4%, 51.2%, 31.5%,respectively (p=0.004). Nevertheless, subgroup analyses suggested that HCC patients with CSM score ≥4, PMCT may provide long-term outcomes that are similar to LR and lower complications. Conclusion: LR may provide better OS and DFS rates than PMCT for solitary HCC≤ 3 cm and Child-Pugh A liver function. PMCT should be optimal choice for HCC patients with CSM score ≥4.

Transcatheter arterial chemoembolization monotherapy vs combined transcatheter arterial chemoembolization-percutaneous microwave coagulation therapy for massive hepatocellular carcinoma (≥10 cm).

BackgroundThe prognosis of massive hepatocellular carcinomas (MHCCs; ≥10 cm) remains worse.PurposeThe aim of this study was to evaluate the clinical benefits of transcatheter arterial chemoembolization (TACE) or TACE combined with percutaneous microwave coagulation therapy (PMCT) and the long-term survival rate of MHCC patients treated with these techniques.Patients and methodsA retrospective study was performed using data involving 102 MHCC patients admitted to the Second Hospital of Nanjing from September 2010 to August 2015. The median interval between treatments and overall survival (OS) was hierarchically analyzed using log-rank tests. Multivariate analysis was done using Cox regression model analysis.ResultsThe median survival time of MHCC patients was 3 months (range, 1–10 months) in the palliative group, 3 months (range, 1–39 months) in the TACE group, and 7.5 months (range, 3–30 months) in the TACE–PMCT group (P=0.038). The 6-, 12-, and 18-month OS rates for MHCC patients were 15%, 0%, and 0% in the palliative group, 30%, 25.63%, and 17.97% in the TACE group, and 50%, 41.67%, and 16.67% in the TACE–PMCT group, respectively (P=0.0467). In addition, TACE sessions had positive correlation with the survival time of MHCC patients (rho = 0.462, P<0.001). TACE treatment more than three times (HR =0.145, P<0.001) was an independent predictor of the survival of MHCC patients, which was identified by the Cox regression model analysis.ConclusionsThese results indicated that TACE–PMCT treatment in MHCC patients had advantages in prolonging OS and improving liver function. Multiple TACE treatments might be a suitable treatment for the MHCC patients.

PCN117 - HEALTHCARE EXPENDITURES FOR THE TREATMENT OF PATIENTS WITH HEPATOCELLULAR CARCINOMA IN JAPAN

Hepatocellular carcinoma (HCC) has a low survival rate, and accounts for approximately 30,000 mortalities each year in Japan. This study aimed to estimate the healthcare expenditures of HCC patients. Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), we randomly extracted a sample comprising 25% of all Japanese citizens who had been hospitalized at least once from April 2009 to December 2016. Patients with a recorded diagnosis of HCC were identified, and the month of the initial diagnosis was designated the index month. Patients with other cancers during the study period or without data for one year before the index month were excluded from analysis. The index month and the three preceding months were designated the initial phase, the six-month period preceding death was designated the terminal phase, and the period between these phases was designated the continuing phase. Healthcare expenditures were estimated according to the following treatment types: (1) hepatectomy; (2) locoregional therapy (LRT), including percutaneous ethanol injection, percutaneous microwave coagulation therapy, and radiofrequency ablation; (3) transcatheter arterial chemoembolization (TACE); (4) transcatheter arterial embokization (TAE); and (5) molecular targeted drugs (MTD). The mean monthly expenditures were calculated for each phase and treatment type. We identified 7782 HCC patients during the study period. There were 3105, 1882, 2142, 396 and 251 patients who received monotherapy of hepatectomy, LRT, TACE, TAE, and MTD, respectively. The monthly healthcare expenditures during the initial/continuing/terminal phases for hepatectomy, LRT, TACE, TAE and MTD were $4931/$911/$6416, $2269/$1435/$3687, $2793/$1577/$4300, $2886/$1304/$5170 and $1914/$1295/$4428, respectively. We estimated the healthcare expenditures of HCC patients for various phases and treatment types using the NDB. These estimates may have downstream applications in cost-effectiveness analyses of HCC screening programs and treatment approaches.

Impact of local tumor lesion treatments and preoperative indicators on the survival of patients with small hepatocellular carcinomas.

The prognosis for small hepatocellular carcinomas (SHCC) remains uncertain. The aim of the present study was to compare three local tumor lesion treatments and identify the prognostic factors in patients with SHCC by analyzing preoperative indicators. A retrospective study was performed using data from 206 patients with SHCC from 2006–2015. All of the patients had undergone transarterial chemoembolization (TACE) alone, TACE plus percutaneous microwave coagulation therapy (PMCT) or surgical resection (SR). The Kaplan-Meier method was used to calculate the survival rates. Multivariate analysis was conducted using Cox regression analysis. The median survival time of patients with SHCC was 27 (range, 14–49) months in the TACE group, 29.5 (range, 16–52) months in the TACE-PMCT group and 36.5 (range, 26–52) months in the SR group (P=0.091). The 1, 3 and 5-year survival rates for patients with SHCC were 82.4, 64.9 and 46.8% in the TACE group; 89.0, 72.6 and 58.3% in the TACE-PMCT group and 88.8, 72.3 and 58.6% in the SR group (P=0.181), respectively. Analysis from the Cox regression model demonstrated that preoperative α-fetoprotein (AFP; <400 ng/ml vs. ≥400 ng/ml; HR=0.548; P=0.036) was an independent predictor of the survival time of patients with SHCC. Analysis of patients with preoperative AFP levels of ≥400 ng/ml revealed that the median survival time in the SR group was 36 (range, 28.25–52) months, significantly longer than the TACE (17 months; range, 12–44 months) and TACE-PMCT group (27 months; range, 14–55 months; P=0.035). The 1, 2 and 3-year survival rates for patients with SHCC with ≥400 ng/ml AFP were: 70.8, 55.5 and 49.9% in the TACE group; 83.7, 68.0 and 60.8% in the TACE-PMCT group; and 90.9, 81.8 and 61.0% in SR group, respectively (P=0.664). However, there was no significant difference among the three groups in the survival time of patients with SHCC with <400 ng/ml preoperative AFP. The observations indicated that SR is not significantly different for overall survival time in the patients with SHCC between the two groups; this method can be employed for patients with SHCC. This was based on the median survival time of patients with ≥400 ng/ml AFP in the SR group who had a longer survival time and a higher survival rate than in the TACE and TACE-PMCT group.

Clinical outcome in elderly Chinese patients with primary hepatocellular carcinoma treated with percutaneous microwave coagulation therapy (PMCT)

Percutaneous microwave ablation therapy (PMCT) has been recommended for elderly hepatocellular carcinoma (HCC) patients who cannot tolerate surgery due to their age or presence of comorbidities. Few studies have investigated efficacy and treatment outcomes for PMCT treatment in these patients, especially in China, where patients are more often diagnosed and treated early in life. This study evaluated the safety and efficacy of ultrasound-guided PMCT in treatment-naive elderly HCC patients, and analyzed risk factors associated with poor treatment outcomes.The 65 HCC patients in this retrospective study were divided into 2 groups: <65 years old or ≥65 years old. Patients received PMCT every month until tumor was unobservable and were then followed for 1 month after ablation. The primary clinical endpoint was the rate of complete tumor ablation, and secondary endpoints were progression-free survival and overall survival.Patients ≥65 years old had significantly poorer performance status than younger patients, but similar rates of complete ablation. Multiple tumors and hypertension were associated with a significantly higher risk of death, while higher postoperative alanine aminotransferase levels were associated with a significantly lower risk of death. Patients with tumor sizes >5 to ≤ 10 cm were at a significantly higher risk for disease progression than patients with tumor sizes >1 to ≤ 3 cm. Complete ablation significantly lowered the risk of disease progression.PMCT is safe and effective for patients ≥65 years of age, achieving total ablation in more than 90% of patients. Age and comorbidities did not affect clinical outcome.

What is the best combination treatment with transarterial chemoembolization of unresectable hepatocellular carcinoma? a systematic review and network meta-analysis.

ObjectiveTo assess the comparative efficacy and safety of combination treatment with transarterial chemoembolization (TACE) for patients with unresectable hepatocellular carcinoma (HCC) through a systematic review and network meta-analysis and to identify what is the best combination treatment with TACE.Materials and MethodsA network meta-analysis was used to identify evidence from relevant randomized controlled trials. We searched databases for publications up to June 2017. The prespecified primary efficacy outcomes were treatment response and 6-month to 3-year overall survival (OS), while the secondary efficacy outcomes were 1- and 2-year disease-free survival (DFS); safety outcomes were advance effects of combination treatment. We conducted pairwise meta-analyses using a random-effects model and then performed random-effects network meta-analyses.ResultsA total of 48 trials were eligible (50 analyses), involving 5627 patients and 19 treatment arms. In comparison with other types of combination therapy arms, network meta-analysis disclosed that TACE + three-dimensional conformal radiotherapy, TACE + percutaneous ethanol injection, TACE + percutaneous microwave coagulation therapy, TACE + percutaneous acetic acid injection, and TACE + sorafenib were the more effective methods in treatment response, 6-month to 3-year OS, and 1–2 year DFS; the adverse effects of TACE + sorafenib were serious. The study was registered with PROSPERO, number CRD42017071102.ConclusionsWhen considering the efficacy, combination therapy with TACE seemed to offer clear advantages for patients with unresectable HCC. TACE + Three-dimensional conformal radiotherapy, TACE + Percutaneous ethanol injection, TACE + Percutaneous microwave coagulation therapy, and TACE + Percutaneous acetic acid injection are likely the best options to consider in the application of combination treatment.

The effect of lipiodol deposition in HCC after TACE on the necrosis range of PMCT.

ObjectiveTo study the impact of lipiodol deposition in the lesion of hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) on the necrosis area of percutaneous microwave coagulation therapy (PMCT).Materials and methodsA total of 44 patients with HCC with 56 nodules, with a size ranging from 1.5 to 3.5 cm, was selected in our study. About 23 patients (26 nodules) underwent PMCT treatment only as Group A and 21 patients (30 nodules) were treated by PMCT-combined TACE as Group B. All patients underwent PMCT with single-electrode and one-point ablation. Paired t-test was used to analyze pre- and postoperatively the volume of tumor and the necrosis volume after PMCT. Independent t-test was used to compare the difference in the necrosis area between two groups (α=0.05).ResultsAll patients underwent PMCT or PMCT combined with TACE successfully. The tumor and necrosis size of Group A was 16.29±19.23 cm3 and 17.98±18.49 cm3 (P=0.650), and 11.95±12.78 cm3 and 16.60±11.70 cm3 of Group B (P=0.017). There was no significant difference on necrosis volume between the two groups (P=0.581). The necrosis area of Group B was larger than the size of the tumor (P=0.017), but the ablation area of the two groups was smaller than the theoretic area (P=0.001). (The theoretic area means that the necrosis area of ablation should be 1.0 cm larger than the tumor in diameter.)ConclusionPMCT combined with TACE could enlarge the ablation area, but will not lead to an ideal necrosis area than the PMCT alone. The lipiodol deposition in the tumor lesion may hinder the expansion of the heating field. Therefore, further research was needed.

Hepatic perivascular epithelioid cell neoplasm: A clinical and pathological experience in diagnosis and treatment.

Hepatic perivascular epithelioid cell neoplasm (PEComa) is a rare type of neoplasm derived from mesenchymal tumors that is often misdiagnosed as hepatocellular carcinoma (HCC), hepatic hemangioma or other liver malignancies. The clinical and histological characteristics of PEComa have yet to be fully documented. To optimize the diagnosis and treatment of the disease, a retrospective analysis was performed to investigate the clinicopathological characteristics of 7 patients diagnosed with hepatic PEComa in the Sun Yat-Sen Memorial Hospital between January 2004 and December 2015. Briefly, all the patients lacked specific symptoms, and a serological examination provided no further useful information. Additionally, non-specific imaging manifestations were observed. Microscopically, detection of epithelioid or spindle-shaped cells with adipocytes was suggestive of the disease, and an analysis of biomarkers, including the monoclonal antibody HMB-45, the melanocytic differentiation marker, Melan-A, and smooth muscle α-actin (SMA), helped to confirm the diagnosis. Regarding the treatment, 6 patients (85.7%) received surgical resection procedures, and 1 patient (14.3%) was admitted for tumor arterial embolization and percutaneous microwave coagulation therapy. After a follow-up period of 12–20 months, no recurrence was observed. Taken together, hepatic PEComa should be suspended in patients with a liver tumor with asymptomatic manifestation and normal serological test results. In imaging studies, hepatic PEComa was able to mimic HCC, hepatic hemangioma and metastatic tumor, although the mass did not invade the adjacent organs and vessel. The definitive diagnosis was made on the basis of the typical morphological features and notable markers of the tumor tissue. It is recommended that patients with PEComa in a benign pattern deserve serial imaging follow-up, but surgery is indicated in patients suffering from large tumors (>5 cm), or progressive enlargement or malignant tendency.

Therapeutic efficacy of percutaneous microwave coagulation versus liver resection for single hepatocellular carcinoma ≤3 cm with Child-Pugh A cirrhosis

AimsThis study aimed to compare the therapeutic efficacy of liver resection (LR) and percutaneous microwave coagulation therapy (PMCT) for single hepatocellular carcinoma ≤3 cm (HCC) in cirrhotic livers. MethodsIn this study, 190 patients with single HCC ≤3 cm and Child-Pugh A cirrhosis were retrospectively reviewed. Among these patients, 122 patients underwent LR, and 68 patients received PMCT. The therapeutic efficacy and complications were compared between the two procedures. ResultsThere was no treatment-related hospital mortality in either group. Major complications were significantly more frequent in the LR group compared to the PMCT group (22.1% vs 5.9%, p = 0.004). The 1-, 3-, and 5-year OS rates for the LR group and PMCT group were 98.4%, 93.6%, 55.2% and 97.1%, 87.7%, 51%, respectively. There was no significant difference in OS rates between the LR group and PMCT group (p = 0.153). The 1-, 3-, and 5-year DFS rates were 96.7%, 70.5% and 43.7%, respectively, in the LR group, which were significantly higher compared to the PMCT group (92.6%, 50.5% and 26.3%, p = 0.006). Subgroup analyses revealed that HCC patients with portal hypertension (PH), OS and DFS were similar between the two groups. ConclusionsLR may provide better DFS and lower recurrence rates than PMCT for single HCC ≤3 cm and Child-Pugh A cirrhosis. For HCC patients with PH, PMCT may provide therapeutic effects that are similar to LR.

Outcomes after noncurative locoregional treatment in patients with unresectable metastatic colorectal carcinoma.

654 Background: A curative hepatic or pulmonary metastasectomy for colorectal carcer is a generally accepted procedure. However, the value of noncurative locoregional therapy for unresectable metastatic colorectal carcer was not well defined. Methods: Of 1,174 patients with unresectable colorectal cancer from 2003 to 2014 retrospectively reviewed, 62 patients received curative regional treatment, 290 patients received locoregional therapy, and 822 patients received standard chemotherapy. Propensity score matching was used to adjust the balance of baseline data between locoregional therapy arm and chemotherapy arm. Kaplan-Meier survival analyses were based on data after propensity score matching. Factors possibly influencing survival were evaluated by univariate and subsequently by multivariate analyses. Results: After propensity score matching, 544 patients were included in this study, 272 in locoregional therapy arm and 272 in chemotherapy arm, respectively. Locoregional therapy included metastasectomy, radiofrequency ablation, percutaneous microwave coagulation therapy and radioactive particle implantation. The addition of locoregional therapy to chemotherapy significantly improved the overall survival with median overall survival 38.73 months (95%CI 34.93-42.54 months) in locoregional therapy arm versus 19.8 months (95%CI 18.06-21.54 months) in chemotherapy arm, respectively, p&lt;0.001. 9 factors were associated with overall survival by univariate analysis, which include primary tumor site, initial stage at first diagnosis, pathological grading, target organ of regional treatment, CA199 and LDH at diagnosis of advanced disease, CEA, CA199 and LDH before regional treatment. Furthermore, CEA (&gt;5ng/ml) and LDH (&gt;245U/L) before regional treatment were identified as independent poor prognostic factors by multivariate analysis. Median overall survival according to the presence of 0, 1, or 2 factors was 49.4 months, 35.7 months, and 27 months. Conclusions: Unresectable metastatic colorectal cancer also benefited from locoregional therapy. Two pre-locoregional treatment risk factors could select the patients most likely to benefit from this strategy.

Percutaneous Microwave Coagulation for the Treatment of Small Solitary Focal Nodular Hyperplasia of Liver

Background: Whether percutaneous microwave coagulation (PMC) is safe and effective for the treatment of symptomatic focal nodular hyperplasia (FNH) of the liver remains unknown. Methods: Between January 2006 and September 2015, sixteen patients with solitary symptomatic FNHs in the liver (the largest diameter less than 5 cm) were treated by PMC. The safty and effectiveness were analyzed. Results: There were 4 males and 12 females. All these patients suffered from upper abdominal pain. The FNHs ranged in size from 3.2 cm to 5.0 cm (3.9 cm ± 0.12 cm). All the PMC procedures were performed successfully. All 16 patients had symptomatic improvement after the treatment with no procedure-related morbidity or mortality. Among 16 patients, 15 (93.8%) patients with FNHs were assessed to be ablated completely by CT examination performed within four weeks after PMC treatment. One patient failed to follow up regularly, but showed up 2 years and 7 months later for suffering upper abdominal pain again with original FNH enlargement, and the patient received surgical resection of the FNH and achieved asymptomatic aftermath. Conclusion: PMC is safe and effectiveness for symptomatic liver FNHs. PMC should be considered to be an alternative modality for those solitary FNHs with less than 5 cm in diameter.

Effects of combining transarterial chemoembolization with percutaneous microwave coagulation therapy for hepatocellular carcinoma abutting the diaphragm

Objective: This study aims to explore the clinical effectiveness of a combination therapy of transarterial chemoembolization (TACE) and percutaneous microwave coagulation therapy (PMCT) in treating hepatocellular carcinoma (HCC) abutting the diaphragm. Material and methods: Six cases with HCC were treated with TACE followed by PMCT one month later with the aid of artificial pneumothorax. Results: CT/MRI revealed complete necrosis in the tumor lesions and the treated tumor margins (≥5 mm). Serum alpha-fetoprotein (AFP) levels markedly declined in patients who originally had higher serum AFP levels. Postoperative complications such as fever, mild hepatic dysfunction and pleural effusion were alleviated within a short period of time. All patients were closely monitored through follow-up; all patients survived, except for one patient who received a liver transplantation. Conclusions: As lesions are either invisible or poorly visible in sonography, determining an effective treatment for HCC abutting the diaphragm remains a particular challenge. TACE and PMCT combined therapy with the aid of artificial pneumothorax proved to be an available treatment option.