Suppression of Local Tumor Progression in Perivascular Hepatocellular Carcinoma by Combination Therapy with Radiofrequency Ablation and Percutaneous Ethanol Injection: A Propensity Score Matching Analysis

Abstract

Background and Aims Radiofrequency ablation (RFA) has replaced percutaneous ethanol injection (PEI) as the treatment of choice for hepatocellular carcinoma (HCC); however, control of local tumor progression (LTP) remains a challenge in perivascular HCC. The aim of this study is to determine whether PEI added to RFA can reduce the LTP rate in perivascular HCC patients. Methods We retrospectively analyzed 167 patients, with 197 newly diagnosed HCC nodules with peritumoral vessels, who underwent either RFA plus PEI or RFA monotherapy as the first-line treatment between June 2001 and April 2015. Ethanol was injected inside the tumor close to the peritumoral vessels in the combination therapy group. Patients were matched 1:1 according to their propensity scores to reduce selection bias; cumulative LTP was then analyzed using log-rank tests and Cox proportional hazard regression analyses. Results The two matched groups comprised 62 tumors each. The overall median follow-up period was 34 months (range, 1–140 months). In the RFA plus PEI group, the cumulative LTP rates were 5.7%, 15.5%, and 20.4% at 1, 3, and 5 years, respectively; in the RFA monotherapy group, the rates were 13.2%, 32.0%, and 40.2%, respectively. The rates were significantly lower in the RFA plus PEI group (P = 0.032). Cox proportional hazard regression analysis showed that PEI combination treatment was significantly associated with a reduced risk of local HCC recurrence (hazard ratio, 0.44; 95% confidence interval, 0.19–0.93; P = 0.031). Discussion/Conclusion The risk of LTP after RFA for perivascular HCC can be significantly reduced by injecting ethanol close to the peritumoral vessels.

Prognostic Analysis on Different Tumor Sizes for 14634 Hepatocellular Carcinoma Patients

“…At present, the main local treatment options include percutaneous ethanol injection, radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation [35]. A propensity score matching analysis [36] revealed that the injection of ethanol near peritumoral vessels signifcantly reduced the risk of local tumor progression following peritumoral radiofrequency ablation of HCC. Radiofrequency ablation with 67-84% of 3year OS, 3.2-28.5% of 3-year local recurrence rates, and 90-98.5% of complete response for tumors < 3 cm was the most commonly used medical technology [35].…”

Impact of particle size of multivesicular liposomes on the embolic and therapeutic effects in rabbit VX2 liver tumor

“…When diagnosed, only a small percentage of patients can be treated by surgical resection or liver transplantation to obtain a relatively ideal therapeutic effect (Tsai et al., 2019 ). The majority of patients with intermediate or advanced-stage HCC diseases are only eligible for parenchyma-sparing local therapies because of inadequate hepatic reserve or other medical comorbidities, including transcatheter arterial chemoembolization (TACE) (Bargellini et al., 2021 ), transcatheter arterial embolization (Hidaka et al., 2021 ), radiofrequency ablation (RFA) (Lu et al., 2022 ), ethanol injection (Takata et al., 2022 ), and transcatheter arterial infusion chemoembolization (TACBE) (Imamura et al., 2021 ). Although there have not been sufficient clinical data demonstrating the superiority of one therapy over the others, TACE is usually considered more efficacious by combining the effects of chemotherapy with embolization (Fan et al., 2021 ).…”