The efficacy of radiofrequency ablation versus cryoablation in the treatment of single hepatocellular carcinoma: A population‐based study

Abstract

Background Radiofrequency ablation (RFA) is an effective treatment for single hepatocellular carcinoma (HCC), but it is difficult to use against tumors in some locations and often leads to incomplete ablation as a result of the heat‐sink effect. This study was conducted to evaluate the efficacy of cryoablation compared with that of RFA in the treatment of single HCC. Methods This retrospective study was conducted based on the Surveillance, Epidemiology, and End Results (SEER) database. From 2004 to 2015, patients aged 40 to 79 diagnosed with HCC were included in the study. A propensity score matching (PSM) model was used to reduce selection biases. Results Before PSM, the median overall survival (mOS) and median cancer‐specific survival (mCSS) in the RFA group were slightly longer than those in the cryoablation group (p > 0.05). In the subgroup analysis, the mOS and mCSS of patients with tumor sizes <3, 3–5, and >5 cm who received RFA treatment were longer than those of patients given cryoablation treatment, but there was no significant difference (p > 0.05). Similar results were presented in patients at American Joint Committee on Cancer (AJCC) stages I and II. After PSM, the mOS and mCSS were slightly better in the RFA group than the cryoablation group but without significant differences. Univariate and multivariate analysis showed that cryoablation treatment was not an unfavorable factor for OS and CSS before or after PSM (p > 0.05). In the multivariable competing risk model, non‐cancer‐specific death was taken as a competing factor and cryoablation was also not unfavorable for the survival of patients before and after PSM (p > 0.05). Conclusion Cryoablation is non‐inferior to RFA therapy for single HCC patients without lymph node invasion or distant metastasis.

Anti-PD-L1 antibody enhances curative effect of cryoablation via antibody-dependent cell-mediated cytotoxicity mediating PD-L1highCD11b+ cells elimination in hepatocellular carcinoma

“…Recently, accumulating evidence has revealed that cryoablation (CRA) can trigger antitumor activity by releasing tumor antigens from frozen tumor cells and activating CTLs. However, CRA is limited in effectively treating HCC, compared to other thermal ablations, such as MWA and RFA 2 , 10 , 11 , 12 . Based on our clinical samples, we found PD-L1 + CD11b + cells were significantly increased, especially in MWA, whereas the number of PD-L1 + tumor cells were more increased in CRA than in MWA.…”

“…The combination of ablation and checkpoint block inhibitors (CBI), such as anti-PD-1 or anti-CTLA-4 antibodies, can efficiently induce the abscopal effect and increase the prognosis of colorectal cancer, breast cancer, and prostate cancer 8 , 9 . However, some studies have revealed that CRA does not significantly improve the overall survival of HCC patients compared to MWA and radio-frequency-ablation (RFA) 10 , 11 , 12 . Whether CRA or MWA combined with immunotherapy can improve therapeutic efficacy for HCC treatments still needs to be further studied.…”

Percutaneous Ablation of Hepatic Tumors at the Hepatocaval Confluence Using Irreversible Electroporation: A Preliminary Study

“…Heat-based ablation sometimes faces limitations when the tumors are near large blood vessels, bile duct, stomach, or the intestines. Although artificial pneumoperitoneum or ascites can be created to push the stomach or intestines away, the heat-sink effect of large vessels can seriously affect the treatment outcome [ 16 ].…”

Non-Surgical Locoregional Therapies Alone or in Combination with Systemic Therapy in Patients with Hepatocellular Carcinoma

“…This method relies on cyclical freeze–thaw mechanisms, which involve the use of cryoprobes that are cooled using argon gas and then heated with helium gas [ 19 ]. As a result, tumor necrosis is induced through the formation of intracellular ice crystals, which cause damage to the integrity of the cell membranes and lead to the release of their contents into the extracellular space, thereby setting off the body’s immune defenses [ 20 ]. Among the advantages of cryoablation over RFA are its creation of greater ablation zones, the occurrence of less procedural pain and the development of ice balls generated by cryoprobes during the procedure, which allows intraprocedural monitoring [ 18 , 21 ].…”