Prognosis of Early-Stage Hepatocellular Carcinoma: Comparison between Trans-Arterial Chemoembolization and Radiofrequency Ablation

Yun, Byung Yoon; Lee, Hye Won; Min, In Kyung; Kim, Seung Up; Park, Jun Yong; Ahn, Sang Hoon

doi:10.3390/cancers12092527

Cited by 21 publications

(15 citation statements)

References 36 publications

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“…A total of 15 references were included in the analysis, including four randomized controlled trials [ 7 , 20 – 22 ] and two retrospective studies [ 12 , 23 ] in the 2- to 3-month group and three randomized controlled trials [ 24 – 26 ] and six retrospective studies [ 10 , 27 – 31 ] in the 3- to 4-month group. Of 1940 patients from the 15 included studies, 504 patients were classified into the 2- to 3-month group, and the rest of the 1436 patients were classified into the 3- to 4-month group.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, RFA potentially provides similar therapeutic effects to liver resection for tumors between 3 and 5 cm in randomized controlled trials [ 7 , 8 ]. However, up to 30% of patients develop tumor recurrence within two years following RFA with complete remission [ 9 , 10 ]. Therefore, surveillance for early detection of recurrence after RFA therapy is a significant approach for long-term survival and better quality of life [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Cost-Effectiveness Analysis of Follow-Up Schedule for Hepatocellular Carcinoma after Radiofrequency Ablation

Wei

et al. 2022

Journal of Oncology

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Background and Purpose. Follow-up intervals after radiofrequency ablation (RFA) varied in different international guidelines. This study aimed to compare the cost-effectiveness of different follow-up intervals for hepatocellular carcinoma (HCC) following RFA. Methods. A Markov model was established to evaluate the cost-effectiveness of every 2 months or 2-3 months (2- to 3-month group) versus every 3 months or 3-4 months (3- to 4-month group) posttreatment surveillance in the first two years for HCC after RFA. Transition probabilities and utility values were derived from the literature review. Costs of follow-up were estimated from our institution. The incremental cost-effectiveness ratio (ICER), which was less than $10888 per quality-adjusted life-year (QALY), was considered cost-effective. Sensitivity analyses were performed to determine the uncertainty of the model. Results. The 2- to 3-month group gained 1.196 QALYs at a cost of $2212.66, while the effectiveness and cost of the 3- to 4-month group were 1.029 QALYs and $1268.92, respectively. The ICER of the 2- to 3-month group versus the 3- to 4-month group was $5651.14 per QALY gained, which was less than the willingness-to-pay threshold of 1-time gross domestic product per capita of China ($10888/QALY). One-way sensitivity analysis showed that the model was most sensitive to the utility of progression-free survival. The probabilistic sensitivity analysis demonstrated that the 2- to 3-month group had a higher probability of being more cost-effective than the 3- to 4-month group when willingness to pay was over $1088.8. Conclusions. Every 2 months or 2-3 months of follow-up intervals were more cost-effective than 3 months or 3-4 months of follow-up intervals. Thus, the intensive follow-up interval in the first two years was recommended for Child-Pugh class A or B HCC patients within the Milan criteria following RFA.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Follow-Up Schedule for Hepatocellular Carcinoma after Radiofrequency Ablation

Wei

et al. 2022

Journal of Oncology

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“…TACE is the first-line treatment for patients with intermediate-stage HCC. 3 It has been recently reported that patients in their early stages of TACE-based treatment could potentially benefit from the method, 26 , 27 resulting in an improved survival rate. However, complete embolism could only be observed in approximately 20% of the patients with HCC who were subjected to conditions of TACE.…”

Section: Discussionmentioning

confidence: 99%

Effect of Transarterial Chemoembolization Plus Percutaneous Ethanol Injection or Radiofrequency Ablation for Liver Tumors

Chen¹,

Zhang²,

Sun³

et al. 2022

JHC

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Background The efficacy of the transarterial chemoembolization (TACE) process combined with percutaneous ethanol injection (PEI, TACE-P) or the radiofrequency ablation (RFA, TACE-R) process was found to be good when used for the treatment of patients suffering from early or intermediate hepatocellular carcinoma (eiHCC). The study was conducted to compare the efficacy and safety of the TACE-P with TACE-A processes followed during the treatment of patients with eiHCC. Methods A total of 241 patients suffering from eiHCC, subjected to TACE-P (147 patients) or TACE-R (94 patients) processes from January 1, 2014, to December 31, 2018, were retrospectively reviewed and included. The propensity score matching (PSM) method was used to reduce selection bias. Results The median overall survival (mOS) and progression-free survival (mPFS) of the TACE-P group were similar to those recorded for the TACE-R group ( P >0.05) before using the PSM technique. Similar results were obtained post the use of the PSM technique. In the subgroup analysis after PSM, patients with single tumor (dimension: ≤5 cm), who were subjected to TACE-P-based treatment methods, exhibited worse tumor response than patients subjected to TACE-R-based methods (HR: 1.804, 95% CI: 1.083–3.005, P =0.023). Seven adverse events were reported. A statistically significant difference for all grades of adverse events (and grade III or IV adverse events) between the two groups (all P >0.05) was not reported. Conclusion The benefits and advantages of using the TACE-P based method was similar was those obtained using the TACE-R in patients with eiHCC, especially for patients with a single large tumor or multiple tumors.

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“…HCC patients who are ineligible for surgery or liver transplantation may choose to undergo radiofrequency ablation (RFA) or microwave ablation (MWA), alternative therapies with a minimal invasiveness (3). RFA and MWA have similar therapeutic effects, complication rates, and rates of residual foci of untreated disease; however, RFA can be applied to tumor ablation with fewer sessions (4) and was recommended for safe and effective first-line treatment of early-stage HCC (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound single-phase CBE imaging for monitoring radiofrequency ablation of the liver tumor: A preliminary clinical validation

Wang

Zhou²,

Chang³

et al. 2022

Front. Oncol.

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Radiofrequency ablation (RFA) is an alternative treatment for early-stage hepatocellular carcinoma (HCC). The production of gas bubbles by RFA indicates threshold temperature of tissue necrosis and results in changes in backscattered energy (CBE) when ultrasound monitors RFA. In this study, ultrasound single-phase CBE imaging was used as a means of monitoring RFA of the liver tumor by analyzing the backscattering of ultrasound from gas bubbles in the liver. A total of 19 HCC patients were enrolled in the study. An ultrasound system was used during RFA to monitor the ablation process and acquire raw image data consisting of backscattered signals for single-phase CBE imaging. On the basis of single-phase CBE imaging, the area corresponding to the range of gas bubbles was compared with the tumor sizes and ablation zones estimated from computed tomography. During RFA, ultrasound single-phase CBE imaging enabled improved visualization of gas bubbles. Measured gas bubble areas by CBE were related to tumor size (the Spearman correlation coefficient rs = 0.86; p < 0.05); less dependent on the ablation zone. Approximately 95% of the data fell within the limits of agreement in Bland-Altman plots, and 58% of the data fell within the 95% CI. This study suggests that single-phase CBE imaging provides information about liver tumor size because of the abundant vessels in liver tumors that promote the generation of gas bubbles, which serve as natural contrast agents in RFAs to enhance ultrasound backscattering. Ultrasound single-phase CBE imaging may allow clinicians to determine if the required minimum RFA efficacy level is reached by assessing gas bubbles in the liver tumors.

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Prognosis of Early-Stage Hepatocellular Carcinoma: Comparison between Trans-Arterial Chemoembolization and Radiofrequency Ablation

Cited by 21 publications

References 36 publications

Cost-Effectiveness Analysis of Follow-Up Schedule for Hepatocellular Carcinoma after Radiofrequency Ablation

Cost-Effectiveness Analysis of Follow-Up Schedule for Hepatocellular Carcinoma after Radiofrequency Ablation

Effect of Transarterial Chemoembolization Plus Percutaneous Ethanol Injection or Radiofrequency Ablation for Liver Tumors

Ultrasound single-phase CBE imaging for monitoring radiofrequency ablation of the liver tumor: A preliminary clinical validation

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