Efficacy and safety of CT-guided percutaneous thermal ablation for hepatocellular carcinoma adjacent to the second porta hepatis

Figures & data

Figure 1. Diagram of the patient selection process.

Table 1. Baseline characteristics of patients and tumor.

Characteristics	Value (percentage)
Number of patients	59
Number of intrahepatic tumors	65
1	40 (61.5)
2–3	25 (38.5)
Sex
Male	51 (86.4)
Female	8 (13.6)
Age (years)
Mean ± SD	57.7 ± 11.7
Range	29–85
Hepatic virus infection
HBV	59 (90.8)
HCV	2 (3.1)
No	4 (6.1)
Child-Pugh classification
A	63 (96.9)
B	2 (3.1)
AFP (ng/mL)
<400	55 (84.6)
≥400	10 (15.4)
Position of malignancy
Left of LHV	19 (29.2)
Between LHV and MHV	31 (47.7)
Between RHV and MHV	12 (18.5)
Right of RHV	3 (4.6)
Tumor size (mm)
Mean ± SD	20.5 ± 1.2
Range	5–50
<3	47 (72.3)
≥3	18 (27.7)
Distance from IVC (mm)
0–5	24 (36.9)
6–10	9 (13.8)
11–15	15 (23.1)
16–20	17 (26.2)
Ablation modality
MWA	40 (61.5)
RFA	25 (38.5)
Received TACE before
Yes	20 (30.8)
No	45 (69.2)
Received resection before
Yes	49 (75.4)
No	16 (24.6)

HBV: hepatitis B virus; HCV: hepatitis C virus; LHV: left hepatic vein; RHV: right hepatic vein; MHV: middle hepatic vein; IVC: inferior vena cava; AFP: a-Fetoprotein; RFA: radiofrequency ablation; MWA: microwave ablation; TACE: transarterial chemoembolization

Figure 2. Contrast-enhanced magnetic resonance imaging (MRI) of a 58-year-old male patient diagnosed with a single HCC lesion (3.7 cm × 3.2 cm) adjacent to the second porta hepatis (arrow). The mass showed markedly high signal T2-weighted images (a) and low signal on transverse and coronal MRI in the hepatobiliary phase (b,c). (d) He underwent CT-guided multiple-site MWA in the supine position with the output of 70 W for 20 min in total. A month after the ablation, MRI results (e,f) showed that the lesion was completely necrotic without any enhancement.

Figure 3. (a) The median LPFS was 37.4 months. The 1-, 2-, and 3-year LPFS rates were 86.2%, 66.5%, and 66.5%, respectively. (b) The median PFS was 11.0 months. The 1-, 2-, and 3-year PFS rates were 47.9%, 27.0%, and 20.2%, respectively.

Figure 4. (a) Kaplan–Meier curves of LPFS in patients with tumor smaller than 3 cm (n =47; median LPFS: 42.3 months) or larger than 3 cm (n =18; median LPFS, 18.0 months; P =.007). (b) Kaplan–Meier curves of LPFS in patients with whose distance between tumor and IVC is larger than 5 mm (n =41; median LPFS: 42.3 months) or larger than 5 mm (n =24; median LPFS, 18.4 months; P =.018).

Table 2. Univariate analysis of the risk factors of local progression-free survival.

Factor	Number	Median LPFS	P-value
AFP			0.864
<400 ng/ml	55	42.3 (16.5–68.1)
≥400 ng/ml	10	37.1
Ablation method			0.17
RFA	25	42.2
MWA	40	37.1 (4.0–70.3)
Number of intrahepatic tumor			0.616
1	40	37.4 (15.7–59.2)
2–3	25	N/A
TACE before			0.58
Yes	20	N/A
No	45	37.4 (17.0–57.8)
Tumor size			0.007
<3 cm	47	42.3 (36.4–48.1)
≥3 cm	18	18 (15.9–20.1)
Hepatic virus infection			0.857
HBV/HCV	61	11.8
No	4	37.4 (16.1–58.8)
Distance from IVC			0.018
≤5 mm	24	18.4 (10.2–26.6)
>5 mm	41	42.3 (33.2–51.4)
Number of adjacent hepatic vein			0.404
1	22	37.1 (1.0–73.2)
2	43	37.4 (3.8–71.1)
Child-Pugh classification
A	63	37.4 (32.2–42.7)	0.001
B	2	3.4

* Data in parentheses are 95% confidence intervals.

HBV: hepatitis B virus; HCV: hepatitis C virus; IVC: inferior vena cava; AFP: a-Fetoprotein; RFA: radiofrequency ablation; MWA: microwave ablation; TACE: transarterial chemoembolization

Table 3. Multivariate analysis of the risk factors of local progression-free survival.

Factor	Hazard ratio*	P-value
Tumor size		0.015
<3 cm	1
≥3 cm	3.376 (1.263–9.022)
Distance from cava vena		0.032
>5 mm	1
≤5 mm	2.9 (1.094–7.685)

* Data in parentheses are 95% confidence intervals.

Table 4. Incidence of complications related to ablation.

Complications	All events	Grade A	Grade B	Grade C	Grade D
Tumor seeding	1	–	–	–	1
Hepatorrhagia	7	5	2	–	–
Pulmonary bleeding	4	3	1	–	–
Gallbladder hematocele	1	1	–	–	–
Pneumothorax	5	5	–	–	–
Total	18	14	3	–	1