RADIOFREQUENCY CURRENT ABLATION TREATMENT IN 56 PATIENTS WITH INTRACTABLE SUPRAVENTRICULAR TACHYCARDIA

Fifty six patients with intractable supraventricular tachycardiainduced by 57 accessory pathways were treated by radiofrequencycurrent catheter ablatio(RFCA)from October,1993 to January,1998.34 sales and 22 females,aged from 16-63 years.They had no organiccardia disease and treated with antiarrhythemia agents in all casesbut failed before RFCA therapy,the electrophysiological examinaionwas done for dsterming the location of acceesory pathway andevaluating the results before and after the treatment,34 dominantpathways and 23 latent pathways,and 42 on the left side and 15 onthe right side were found in examination.We used 12±11 time ofmean pulses,29±2.6 watts of radiofrequency energy,8105±6059J ofcumulative electro-energy and 1.1±0.5 hours in each patient,allpatient had no arrhythemia even antiarrhythemia agents was withdrewafter the therapy and during 2-62 months follow-up.They had no arerecurrence.Tne results suggested as follows:1.The accurate location of the accessory pathway was a importantfactor in the successful ablation therapy and the standardlocation of ablation target was the shortest A-V or V-A interval;the accessory pathway potential wasn’t a marker in the location inour study.2.The procedure time and consumption of ablation energy on theright side was wore and higher than that on the left(1h and 1.3h.5418J and 12864J respectlvely)which was due to the cathetercouldn’t touch wih endocardia closely so result to the accessorypathway wasn’t blocked properly.

Radiofrequency ablation combined with transcatheter arterial chemoembolization for recurrent liver cancer

BACKGROUND The recurrence rate of liver cancer after surgery is high.Radiofrequency ablation(RFA)combined with transcatheter arterial chemoembolization(TACE)is an effective treatment for liver cancer;however,its efficacy in recurrent liver cancer remains unclear.AIM To investigate the clinical effect of TACE combined with RFA in the treatment of recurrent liver cancer.METHODS Ninety patients with recurrent liver cancer were divided into 2 groups according to treatment plan:Control(RFA alone);and experimental[TACE combined with RFA(TACE+RFA)].The incidence of increased alanine aminotransferase levels,complications,and other indices were compared between the two groups before and after the procedures.RESULTS One month after the procedures,the short-term efficacy rate and Karnofsky Performance Status scores of the experimental group were significantly higher than those of the control group(P<0.05).Alpha-fetoprotein(AFP)and total bilirubin levels were lower than those in the control group(P<0.05);The overall response rate was 82.22%and 66.67%in the experimental and control groups,respectively;The disease control rate was 93.33%and 82.22%in the experimental and control groups,respectively,the differences are statistically significant(P<0.05).And there were no statistical differences in complications between the two groups(P>0.05).CONCLUSION TACE+RFA was effective for the treatment of recurrent liver cancer and significantly reduced AFP levels and improved various indices of liver function.

Efficacy and safety of percutaneous transhepatic biliary radiofrequency ablation in patients with malignant obstructive jaundice

BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice,yet the safety and effect of endobiliary radiofrequency ablation(EB-RFA)combined PTCD is rarely reported,in this article,we report our experience of EB-RFA combined PTCD in such patients.AIM To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice.METHODS Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected,the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases.The general conditions of all patients,preoperative tumour markers,total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),alkaline phosphatase(ALP),and glutamyl transferase(GGT)before and on the 7th day after the procedure,as well as perioperative complications,stent patency time and patient survival were recorded.RESULTS All patients successfully completed the operation,TBIL and DBIL decreased significantly in all patients at the 7th postoperative day(P=0.009 and 0.006,respectively);the values of ALB,ALP and GGT also decreased compared with the preoperative period,but the difference was not statistically significant.Perioperative biliary bleeding occurred in 2 patients,which was improved after transfusion of blood and other conservative treatments,pancreatitis appeared in 1 patient after the operation,no serious complication and death happened after operation.Except for 3 patients with loss of visits,the stent patency rate of the remaining 14 patients was 100%71%and 29%at the 1^(st),3^(rd),and 6^(th)postoperative months respectively,with a median survival of 4 months.CONCLUSION EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety,which is worthy of further clinical practice.

Importance of Percutaneous Radiofrequency Ablation for Recurrent Hepatocellular Carcinoma

Objective: To study the importance of percutaneous radiofrequency ablation (PRFA) guided by ultrasound for inoperable recurrent hepatocellular carcinoma.Methods: Forty-seven patients with inoperable recurrent hepatocellular carcinoma underwent percutaneous radiofrequency ablation (PRFA) under ultrasond between October 1999 and July 2001. Twenty-four patients had single recurrent tumor and 23 patients had multiple lesions. Twelve patients had single lesion with less than 3.5 cm in diameter. All patients were followed up to examine the value of AFP, MRI or CT after PRFA. Kaplan-Meier estimation was used to analyze the survival rate.Results: The 1-, 2- and 3-year survival rate in single lesion group was 65.2%, 37.5% and 37.5% respectively. The survival rate of 1 and 2 years was 41.7% and 19.5% in the multiple lesions group. The 1-, 2-and 3-year survival rate in single lesion groups with less than 3.5 cm in diameter was 83.3%, 51.4% and 51.4% respectively.Conclusion: PRFA is one of the important comprehensive methods for recurrent hepatocellular carcinoma. According to the size, number and recurrent time, PRFA can be performed separately or combined with transcatheter arterial chemoembolization for inoperable recurrent hepatocellular carcinoma. This method can control the recurrence and increase the survival rate effectively. Key words recurrence - hepatocellular cacinoma - radiofrequency ablation

Benefits and drawbacks of radiofrequency ablation via percutaneous or minimally invasive surgery for treating hepatocellular carcinoma

The management of early stage hepatocellular carcinoma(HCC)presents significant challenges.While radiofrequency ablation(RFA)has shown safety and effectiveness in treating HCC,with lower mortality rates and shorter hospital stays,its high recurrence rate remains a significant impediment.Consequently,achieving improved survival solely through RFA is challenging,particularly in retrospective studies with inherent biases.Ultrasound is commonly used for guiding percutaneous RFA,but its low contrast can lead to missed tumors and the risk of HCC recurrence.To enhance the efficiency of ultrasound-guided percutaneous RFA,various techniques such as artificial ascites and contrast-enhanced ultrasound have been developed to facilitate complete tumor ablation.Minimally invasive surgery(MIS)offers advantages over open surgery and has gained traction in various surgical fields.Recent studies suggest that laparoscopic intraoperative RFA(IORFA)may be more effective than percutaneous RFA in terms of survival for HCC patients unsuitable for surgery,highlighting its significance.Therefore,combining MIS-IORFA with these enhanced percutaneous RFA techniques may hold greater significance for HCC treatment using the MIS-IORFA approach.This article reviews liver resection and RFA in HCC treatment,comparing their merits and proposing a trajectory involving their combination in future therapy.

Nomogram predicting the prognosis of primary liver cancer after radiofrequency ablation combined with transcatheter arterial chemoembolization

BACKGROUND The incidence and mortality rates of primary hepatocellular carcinoma(HCC)are high,and the conventional treatment is radiofrequency ablation(RFA)with transcatheter arterial chemoembolization(TACE);however,the 3-year survival rate is still low.Further,there are no visual methods to effectively predict their prognosis.AIM To explore the factors influencing the prognosis of HCC after RFA and TACE and develop a nomogram prediction model.METHODS Clinical and follow-up information of 150 patients with HCC treated using RFA and TACE in the Hangzhou Linping Hospital of Traditional Chinese Medicine from May 2020 to December 2022 was retrospectively collected and recorded.We examined their prognostic factors using multivariate logistic regression and created a nomogram prognosis prediction model using the R software(version 4.1.2).Internal verification was performed using the bootstrapping technique.The prognostic efficacy of the nomogram prediction model was evaluated using the concordance index(CI),calibration curve,and receiver operating characteristic RESULTS Of the 150 patients treated with RFA and TACE,92(61.33%)developed recurrence and metastasis.Logistic regression analysis identified six variables,and a predictive model was created.The internal validation results of the model showed a CI of 0.882.The correction curve trend of the prognosis prediction model was always near the diagonal,and the mean absolute error before and after internal validation was 0.021.The area under the curve of the prediction model after internal verification was 0.882[95%confidence interval(95%CI):0.820-0.945],with a specificity of 0.828 and sensitivity of 0.656.According to the Hosmer-Lemeshow test,χ^(2)=3.552 and P=0.895.The predictive model demonstrated a satisfactory calibration,and the decision curve analysis demonstrated its clinical applicability.CONCLUSION The prognosis of patients with HCC after RFA and TACE is affected by several factors.The developed prediction model based on the influencing parameters shows a good prognosis predictive efficacy.

Radiofrequency ablation of hepatocellular carcinoma:Current status

Ablation therapy is one of the best curative treatment options for malignant liver tumors,and can be an alternative to resection.Radiofrequency ablation(RFA) of primary and secondary liver cancers can be performed safely using percutaneous,laparoscopic,or open surgical techniques,and RFA has markedly changed the treatment strategy for small hepatocellular carcinoma(HCC).Percutaneous RFA can achieve the same overall and disease-free survival as surgical resection for patients with small HCC.The use of a laparoscopic or open approach allows repeated placements of RFA electrodes at multiple sites to ablate larger tumors.RFA combined with transcatheter arterial chemoembolization will make the treatment of larger tumors a clinically viable treatment alternative.However,an accurate evaluation of treatment response is very important to secure successful RFA therapy.Since a sufficient safety margin(at least 0.5 cm) can prevent local tumor recurrences,an accurate evaluation of treatment response is very important to secure successful RFA therapy.To minimize complications of RFA,clinicians should be familiar with the imaging features of each type of complication.Appropriate management of complications is essential for successful RFA treatment.

Current oncologic applications of radiofrequency ablation therapies

Radiofrequency ablation (RFA) uses high frequency alternating current to heat a volume of tissue around a needle electrode to induce focal coagulative necrosis with minimal injury to surrounding tissues. RFA can be performed via an open, laparoscopic, or image guided percutaneous approach and be performed under general or local anesthesia. Advances in delivery mechanisms, electrode designs, and higher power generators have increased the maximum volume that can be ablated, while maximizing oncological outcomes. In general, RFA is used to control local tumor growth, prevent recurrence, palliate symptoms, and improve survival in a subset of patients that are not candidates for surgical resection. It's equivalence to surgical resection has yet to be proven in large randomized control trials. Currently, the use of RFA has been well described as a primary or adjuvant treatment modality of limited but unresectable hepatocellular carcinoma, liver metastasis, especially colorectal cancer metastases, primary lung tumors, renal cell carcinoma, boney metastasis and osteoid osteomas. The role of RFA in the primary treatment of early stage breast cancer is still evolving. This review will discuss the general features of RFA and outline its role in commonly encountered solid tumors.

Current status of radiofrequency ablation of hepatocellular carcinoma

Loco-regional treatments for hepatocellular carcinoma(HCC) are important alternatives to curative transplantation or resection.Among them,radiofrequency ablation(RFA) is accepted as the most popular technique showing excellent local tumor control and acceptable morbidity.The current role of RFA is well documented in the evidence-based practice guidelines of European Association of Study of Liver,American Association of Study of the Liver Disease and Japanese academic societies.Several randomized controlled trials have confirmed that RFA is superior to percutaneous ethanol injections in terms of local tumor control and survival.The overall survival after RFA is comparable to after surgical resection in a selected group of patients with smaller(< 3 cm) tumors.Currently,the clinical benefits of combined RFA with transarterial chemoembolization for intermediate stage HCC are increasingly being explored.Here we review the ongoing technical advancements of RFA and future potential.

Concurrent and subsequent radiofrequency ablation combined with hepatectomy for hepatocellular carcinomas

Partial hepatectomy has long been the standard treatment modality for patients with hepatocellular carcinoma(HCC),although the majority of patients with HCCs are not candidates for curative resection.Radiofrequency ablation(RFA) has been widely used as the preferred locoregional therapy.RFA and hepatectomy can be complementary to each other for the treatment of multifocal HCCs.Combining hepatectomy with RFA permits the removal of larger tumors while simultaneously ablating any smaller residual tumors.By using this combination treatment,more patients might become candidates for curative resection.For treating recurrent tumors involving the liver after hepatectomy,RFA has been performed recently instead of transcatheter arterial chemoembolization or ethanol ablation.Many retrospective studies on the combination of RFA and hepatectomy demonstrate favorable results of effectiveness and safety.However,further investigation of prospective design will be needed to confirm these encouraging results.

The current role of radiofrequency ablation in the treatment of hepatocellular carcinoma

Local ablative therapy is used in treating liver tumors by either injection of cytotoxic agents（chemicals,radioactive isotopes,hyperthermic agents or chemotherapeutic agents）or application of an energy source to achieve thermal ablation,cryoablation or conformal external beam radiation（Table 1）.

Radiofrequency ablation of recurrent cholangiocarcinoma after orthotopic liver transplantation—a case report

AIM: To report the use of radiofrequency ablation in the treatment of recurrenct cholangiocarcinoma in the transplanted liver.METHODS: A lady who underwent orthotopic liver transplantation (OLT) for intrahepatic cholangiocarcinoma recurrence of tumour 13 mo after tralsplantation inspite of adjuvant chemotherapy. Her recurrent tumour was treated with radiofrequency ablation.RESULTS: She survived for 18 mo following the recurrence of her tumour.CONCLUSION: Radiofrequency ablation can be used safely in the transplanted liver to treat recurrent tumour.

Efficacy of radiofrequency ablation combined with sorafenib for treating liver cancer complicated with portal hypertension and prognostic factors

BACKGROUND Patients with liver cancer complicated by portal hypertension present complex challenges in treatment.AIM To evaluate the efficacy of radiofrequency ablation in combination with sorafenib for improving liver function and its impact on the prognosis of patients with this condition.METHODS Data from 100 patients with liver cancer complicated with portal hypertension from May 2014 to March 2019 were analyzed and divided into a study group(n=50)and a control group(n=50)according to the treatment regimen.The research group received radiofrequency ablation(RFA)in combination with sorafenib,and the control group only received RFA.The short-term efficacy of both the research and control groups was observed.Liver function and portal hypertension were compared before and after treatment.Alpha-fetoprotein(AFP),glypican-3(GPC-3),and AFP-L3 levels were compared between the two groups prior to and after treatment.The occurrence of adverse reactions in both groups was observed.The 3-year survival rate was compared between the two groups.Basic data were compared between the survival and non-surviving groups.To identify the independent risk factors for poor prognosis in patients with liver cancer complicated by portal hypertension,multivariate logistic regression analysis was employed.RESULTS When comparing the two groups,the research group's total effective rate(82.00%)was significantly greater than that of the control group(56.00%;P<0.05).Following treatment,alanine aminotransferase and aspartate aminotransferase levels increased,and portal vein pressure decreased in both groups.The degree of improvement for every index was substantially greater in the research group than in the control group(P<0.05).Following treatment,the AFP,GPC-3,and AFP-L3 levels in both groups decreased,with the research group having significantly lower levels than the control group(P<0.05).The incidence of diarrhea,rash,nausea and vomiting,and fatigue in the research group was significantly greater than that in the control group(P<0.05).The 1-,2-,and 3-year survival rates of the research group(94.00%,84.00%,and 72.00%,respectively)were significantly greater than those of the control group(80.00%,64.00%,and 40.00%,respectively;P<0.05).Significant differences were observed between the survival group and the non-surviving group in terms of Child-Pugh grade,history of hepatitis,number of tumors,tumor size,use of sorafenib,stage of liver cancer,histological differentiation,history of splenectomy and other basic data(P<0.05).Logistic regression analysis demonstrated that high Child-Pugh grade,tumor size(6–10 cm),history of hepatitis,no use of sorafenib,liver cancer stage IIIC,and previous splenectomy were independent risk factors for poor prognosis in patients with liver cancer complicated with portal hypertension(P<0.05).CONCLUSION Patients suffering from liver cancer complicated by portal hypertension benefit from the combination of RFA and sorafenib therapy because it effectively restores liver function and increases survival rates.The prognosis of patients suffering from liver cancer complicated by portal hypertension is strongly associated with factors such as high Child-Pugh grade,tumor size(6-10 cm),history of hepatitis,lack of sorafenib use,liver cancer at stage IIIC,and prior splenectomy.

Retrospective Analysis of Radiofrequency Ablation in Patients with Small Solitary Hepatocellular Carcinoma:Survival Outcomes and Development of a Machine Learning Prognostic Model

Background and Objective The effectiveness of radiofrequency ablation(RFA)in improving long-term survival outcomes for patients with a solitary hepatocellular carcinoma(HCC)measuring 5 cm or less remains uncertain.This study was designed to elucidate the impact of RFA therapy on the survival outcomes of these patients and to construct a prognostic model for patients following RFA.Methods This study was performed using the Surveillance,Epidemiology,and End Results(SEER)database from 2004 to 2017,focusing on patients diagnosed with a solitary HCC lesion≤5 cm in size.We compared the overall survival(OS)and cancer-specific survival(CSS)rates of these patients with those of patients who received hepatectomy,radiotherapy,or chemotherapy or who were part of a blank control group.To enhance the reliability of our findings,we employed stabilized inverse probability treatment weighting(sIPTW)and stratified analyses.Additionally,we conducted a Cox regression analysis to identify prognostic factors.XGBoost models were developed to predict 1-,3-,and 5-year CSS.The XGBoost models were evaluated via receiver operating characteristic(ROC)curves,calibration plots,decision curve analysis(DCA)curves and so on.Results Regardless of whether the data were unadjusted or adjusted for the use of sIPTWs,the 5-year OS(46.7%)and CSS(58.9%)rates were greater in the RFA group than in the radiotherapy(27.1%/35.8%),chemotherapy(32.9%/43.7%),and blank control(18.6%/30.7%)groups,but these rates were lower than those in the hepatectomy group(69.4%/78.9%).Stratified analysis based on age and cirrhosis status revealed that RFA and hepatectomy yielded similar OS and CSS outcomes for patients with cirrhosis aged over 65 years.Age,race,marital status,grade,cirrhosis status,tumor size,and AFP level were selected to construct the XGBoost models based on the training cohort.The areas under the curve(AUCs)for 1,3,and 5 years in the validation cohort were 0.88,0.81,and 0.79,respectively.Calibration plots further demonstrated the consistency between the predicted and actual values in both the training and validation cohorts.Conclusion RFA can improve the survival of patients diagnosed with a solitary HCC lesion≤5 cm.In certain clinical scenarios,RFA achieves survival outcomes comparable to those of hepatectomy.The XGBoost models developed in this study performed admirably in predicting the CSS of patients with solitary HCC tumors smaller than 5 cm following RFA.

Drug-eluting beads transarterial chemoembolization sequentially combined with radiofrequency ablation in the treatment of untreated and recurrent hepatocellular carcinoma

BACKGROUND Drug-eluting beads transarterial chemoem-bolization(DEB-TACE)has the advantages of slow and steady release,high local concentration,and low incidence of adverse drug reactions compared to the traditional TACE.DEBTACE combined with sequentially ultrasound-guided radiofrequency ablation(RFA)therapy has strong anti-cancer effects and little side effects,but there are fewer related long-term studies until now.AIM To explore the outcome of DEB-TACE sequentially combined with RFA for patients with primary hepatocellular carcinoma(HCC).METHODS Seventy-six patients with primary HCC who underwent DEB-TACE sequentially combined with RFA were recruited.Forty patients with untreated HCC were included in Group A,and 36 patients with recurrent HCC were included in Group B.In addition,40 patients with untreated HCC who were treated with hepatectomy were included in Group C.The serological examination,preoperative magnetic resonance imaging examination,and post-treatment computed tomography enhanced examination were performed for all patients.The efficacy was graded as complete remission(CR),partial remission(PR),stable disease and progressive disease at the 3rd,6th,and 9th.All patients were followed up for 3 years and their overall survival(OS),disease-free survival(DFS)were assessed.RESULTS The efficacy of Group A and Group C was similar(P>0.05),but the alanine aminotransferase,aspartate aminotransferase and total bilirubin of Group A were lower than those of Group C(all P<0.05).The proportions of CR(32.5%),PR(37.5%)were slightly higher than Group A(CR:27.5%,PR:35%),but the difference was not statistically significant(χ2=0.701,P=0.873).No operationalrelated deaths occurred in Group A and Group C.The OS(97.5%,84.7%,and 66.1%)and the DFS(75.0%,51.7%,and 35.4%)of Group A at the 1st,2nd,and 3rd year after treatment were similar with those of Group C(OS:90.0%,79.7%,and 63.8%;DFS:80.0%,59.7%,and 48.6%;P>0.05).The OS rates in Group A and Group B(90%,82.3%,and 66.4%)were similar(P>0.05).The DFS rates in Group B(50%,31.6%,and 17.2%)were lower than that of Group A(P=0.013).CONCLUSION The efficacy of DEA-TACE combined with RFA for untreated HCC is similar with hepatectomy.Patients with recurrent HCC could get a longer survival time through the combined treatment.

Percutaneous transhepatic cholangiography:An effective option for endo-biliary radiofrequency ablation before stent insertion in unresectable biliary cancer?

Biliary cancer is a highly aggressive disease that is typically diagnosed at advanced stages when surgical removal is no longer an option.In these cases,palliative care and mechanical widening of the blocked biliary system are preferred.The insertion of a stent is often necessary to prevent the recurrence of blockages caused by cancer progression.Prior to stent placement,endo-biliary radiofrequency ablation(EB-RFA)appears to result in longer-lasting stent effectiveness without increasing the risk of severe complications.However,its impact on overall survival is not yet clear.Additionally,while endoscopic retrograde cholangiopancreatography is the most common method for performing EB-RFA,percutaneous transhepatic cholangiodrainage seems to be a safe and potentially more efficient alternative,particularly for long,angulated,or significantly narrowed bile ducts.

Severe hypoxemia after radiofrequency ablation for atrial fibrillation in palliatively repaired tetralogy of Fallot: A case report

BACKGROUND Patients with tetralogy of Fallot(TOF)often have arrhythmias,commonly being atrial fibrillation(AF).Radiofrequency ablation is an effective treatment for AF and does not usually cause severe postoperative hypoxemia,but the risk of complications may increase in patients with conditions such as TOF.CASE SUMMARY We report a young male patient with a history of TOF repair who developed severe hypoxemia after radiofrequency ablation for AF and was ultimately confirmed to have a new right-to-left shunt.The patient subsequently underwent atrial septal occlusion and eventually recovered.CONCLUSION Radiofrequency ablation may cause iatrogenic atrial septal injury;thus possible complications should be predicted in order to ensure successful treatment and patient safety.

Analysis of alkaline phosphatase and γ-glutamyltransferase after radiofrequency ablation of primary liver cancer: A retrospective study

BACKGROUND Changes in alkaline phosphatase(ALP)andγ-glutamyltransferase(GGT)levels in patients with primary liver cancer(PLC)after radiofrequency ablation(RFA).Hepatocellular carcinoma is a malignant tumor with high incidence worldwide.As a common local treatment,RFA has attracted much attention for its efficacy and influence on liver function.AIM To investigate the effect of serum ALP and GGT levels on the prognosis of patients with PLC treated by RFA.METHODS The preoperative clinical data of 165 patients who were pathologically or clinically diagnosed with PLC and who received RFA in our hospital between October 2018 and June 2023 were collected.The chi-square test was used to compare the data between groups.The Kaplan-Meier method and Cox regression were used to analyze the associ-ations between serum ALP and GGT levels and overall survival,progression-free survival(PFS)and clinical characteristics of patients before treatment.RESULTS The 1-year survival rates of patients with normal(≤135 U/L)and abnormal(>135 U/L)serum ALP before treatment were 91%and 79%,respectively;the 2-year survival rates were 90%and 68%,respectively;and the 5-year survival rates were 35%and 18%,respectively.The difference between the two groups was statistically significant(P=0.01).Before treatment,the 1-year survival rates of patients with normal serum GGT levels(≤45 U/L)and abnormal serum GGT levels(>45 U/L)were 95%and 87%,the 2-year survival rates were 85%and 71%,and the 5-year survival rates were 37%and 21%,respectively.The difference between the two groups was statist-ically significant(P<0.001).Serum ALP[hazard ratio(HR)=1.766,95%confidence interval(95%CI):1.068-2.921,P=0.027]and GGT(HR=2.312,95%CI:1.367-3.912,P=0.002)is closely related to the overall survival of PLC patients after RF ablation and is an independent prognostic factor.The 1-year PFS rates were 72%and 50%,the 2-year PFS rates were 52%and 21%,and the 5-year PFS rates were 14%and 3%,respectively.The difference between the two groups was statistically significant(P<0001).The 1-year PFS rates were 81%and 56%in patients with normal and abnormal serum GGT levels before treatment,respectively;the 2-year PFS rates were 62%and 35%,respectively;and the 5-year PFS rates were 18%and 7%,respectively,with statistical significance between the two groups(P<0.001).The serum ALP concentration(HR=1.653,95%CI:1.001-2.729,P=0.049)and GGT(HR=1.949,95%CI:1.296-2.930,P=0.001)was closely associated with PFS after RFA in patients with PLC.The proportion of male patients with abnormal ALP levels is high,the Child-Pugh grade of liver function is poor,and the incidence of ascites is high.Among GGT-abnormal patients,the Child-Pugh grade of liver function was poor,the tumor stage was late,the proportion of patients with tumors≥5 cm was high,and the incidence of hepatic encephalopathy was high.CONCLUSION Serum ALP and GGT levels before treatment can be used to predict the prognosis of patients with PLC after RFA,and they have certain guiding significance for the long-term survival of patients with PLC after radiofrequency therapy.

Efficacy and safety of B-ultrasound-guided radiofrequency ablation in the treatment of primary liver cancer: Systematic review and metaanalysis

BACKGROUND Primary liver cancer is one of the most lethal malignancies in the world.Tradi-tional treatment methods have limitations in terms of efficacy and safety.Ra-diofrequency ablation(RFA)guided by B-ultrasound,as a minimally invasive treatment,has attracted increasing attention in the treatment of primary liver cancer in recent years.AIM To study the efficacy and safety of RFA were compared with those of traditional surgery(TS)for treating small liver cancer.METHODS At least 2 people were required to search domestic and foreign public databases,including foreign databases such as EMBASE,PubMed and the Cochrane Library,and Chinese databases such as the China National Knowledge Infrastructure database,China Biomedical Literature database,Wanfang database and VIP database.Controlled trials of RFA vs conventional surgery for small liver cancer were retrieved from January 2008 to January 2023.They were screened and eva-luated according to the quality evaluation criteria in the Cochrane Handbook of Systematic Reviews.The meta-analysis was performed using RevMan 5.3 soft-ware.RESULTS A total of 10 studies were included in this study,including 1503 patients in the RFA group and 1657 patients in the surgery group.The results of the meta-ana-lysis showed that there was no significant difference in 1-year overall survival between the two groups(P>0.05),while the 3-year and 5-year overall survival rates and 1-year,3-year and 5-year tumor-free survival rates in the surgery group were greater than those in the RFA group(P<0.05).In terms of complications,the incidence of complications in the RFA group was lower than that in the surgery group(P<0.05).CONCLUSION In terms of long-term survival,TS is better than RFA for small liver cancer patients.However,RFA has fewer complications and is safer.

Hepatocellular Carcinoma: Review of Current Treatment with a Focus on Transarterial Chemoembolization and Radiofrequency Ablation

Hepatocellular carcinoma (HCC) is one of the most deadly tumors and its incidence has been rising worldwide. In its various stages, several modalities of treatment and therapies have been developed. Appropriate HCC treatment needs to consider the tumor stage, underlying liver disease and patient’s performance levels. Liver transplantation is an effective treatment but unreliable due to scarcity of donors, whereas surgical resection possesses the potential to achieve long-term survival. However, most tumors are not resectable due to their size, location, number and the function of the liver being compromised. Thus, resection is the first choice treatment for resectable tumors only. This prompts the rise of transarterial chemoembolization (TACE) for unresectable HCC. Progressively, radiofrequency ablation (RFA) arose though it exhibits high postoperative recurrence and cancer mortality. Notably, identifying the best-suited treatment is critical in enabling maximum long-term survival. Though HCC is an identified chemoresistant tumor, chemotherapies have been developed for advanced HCC. Among them, sorafenib, blocks tumor cell proliferation thus improving patient survival, even though costly. In comparison to RFA, TACE has been identified to have more complications and symptoms. However, it demonstrates improved survival benefits and quality of patient care more than symptomatic supportive care. Furthermore, for unresectable HCC, TACE can replace the costly and modestly effective sorafenib treatment;whereas RFA is potentially curative in treating HCC and an alternative to liver transplantation or surgical resection in the early HCC stages. It treats primary and secondary liver tumor in the very early stage HCC. Its reliance on image guidance is minimally invasive and enhances its efficacy and safety, especially where surgery will not have been possible. However, skin burns, hemorrhage, hepatic abscess and pleural effusion are complications that accompany RFA prompting the need for additional treatment.