Ten-year survival of hepatocellular carcinoma patients undergoing radiofrequency ablation as a first-line treatment

AIM: To investigate the long-term survival and prognostic factors in hepatocellular carcinoma (HCC) patients undergoing radiofrequency ablation (RFA) as a first-line treatment.METHODS: From 2000 to 2013, 316 consecutive patients with 404 HCC (1.0-5.0 cm; mean: 3.2 ± 1.1 cm) underwent ultrasonography-guided percutaneous RFA as a first-line treatment. There were 250 males and 66 females with an average age of 60.1 ± 10.8 years (24-87 years). Patients were followed for 1 year to > 10 years after RFA (234, 181, 136, and 71 for 3, 5, 7, and 10 years, respectively). Overall local response rates and long-term survival rates were assessed. Survival results were generated using Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model.RESULTS: In total, 548 RFA sessions were performed and major complications occurred in 10 sessions (1.8%). Local tumor progression and/or new tumor development were observed in 43.3% (132/305) of the patients during the follow-up period. Overall 5- and 10-year survival rates were 49.7% and 28.4%, respectively. Based on multivariate analysis, three factors were identified as independent prognostic factors for overall survival: Child-Pugh classification (HR = 4.054, P < 0.001), portal vein hypertension (HR = 2.743, P = 0.002), and tumor number (HR = 2.693, P = 0.003). The local progression-free 5- and 10-year survival rates were 42.7% and 19.5%. In addition to the Child-Pugh classification and the number of tumors, the number of RFA sessions (HR = 1.550, P = 0.002) was associated with local progression-free survival.CONCLUSION: RFA can achieve acceptable outcomes for HCC patients as a first-line treatment, especially for patients with Child-Pugh class A, patients with a single tumor and patients without portal vein hypertension.

Hemobilia due to hepatic artery aneurysm as the presenting sign of fibro-muscular dysplasia

Fibro-muscular dysplasia(FMD)is a rare but well documented disease with multiple arterial aneurysms. The patients,usually women,present with various clinical manifestations according to the specific arteries that are affected.Typical findings are aneurysmatic dilatations of medium-sized arteries.The renal and the internal carotid arteries are most frequently affected, but other anatomical sites might be affected too.The typical angiographic picture is that of a"string of beads". Common histological features are additionally described. Here we present a case of a 47-year-old woman,who was hospitalized due to intractable abdominal pain.A routine work-up revealed a liver mass near the portal vein.Before a definite diagnosis was reached,the patient developed massive upper gastrointestinal bleeding.In order to control the hemorrhage,celiac angiography was performed revealing features of FMD in several arteries, including large aneurysms of the hepatic artery.Active bleeding from one of these aneurysms into the biliary tree indicated selective embolization of the hepatic artery.The immediate results were satisfactory,and the 5 years follow-up revealed absence of any clinical symptoms.

肝脏局灶性病灶的超声引导穿刺活检:基于细胞学和组织病理学结果的经验教训

目的 在有细胞学和组织病理学结果的前提下，回顾性分析成功进行超声引导下肝脏局灶性病灶穿刺活检的影响因素。方法 机构审查委员会豁免此项符合HIPAA法案的回顾性研究。收集2000年1月—2006年2月间在同一结构进行经皮超声引导下肝脏局灶性病灶穿刺活检并有细胞学和组织病理学结果的病例。

Accessory spleen-like masses in oncology patients:Are they always benign?

AIM:To assess retrospectively the significance of accessory spleen-like mass(ASLM) in oncology patients undergoing positron emission tomography/computed tomography(PET/CT).METHODS:The results of PET/CT of 913 patients(278 lymphoma;635 solid tumors) were reviewed.The number,size,location and attenuation of all ASLMs,and spleen attenuation,were recorded.ASLM fluorodeoxyglucose uptake was graded as normal(less than or equal to that in the liver) or representative of malignancy(more than in the liver).Follow-up PET/CT in patients with ASLM was reviewed when available.ASLM size and attenuation for spleen and ASLM were compared by unpaired Student's t test.The χ2 and Fisher's exact tests were used to compare ASLM frequency and uptake for lymphomatous and solid tumors,respectively.RESULTS:ASLM frequency was 14.8,with 152 ASLMs found in 135 patients.Mean attenuation was lower in ASLM compared with spleen by enhanced and nonenhanced CT(80.7 ± 20.4 HU vs 92.0 ± 14.4 HU,P < 0.0011 and 42.3 ± 9.0 HU vs 51.5 ± 6.3 HU,P < 0.0001,respectively).ASLM incidence was higher in lymphoma patients(56/278,20.1) than in those with solid tumors(56/278,20.1 vs 79/635,12.4,P = 0.0036).Pathological uptake was found in four(7.1) lymphoma patients but not in any patients with a solid tumor(P = 0.028) and it upstaged one patient with lymphoma.Follow-up PET/CT within 3-16 mo was available in 54 of patients with ASLM.Lesion regression was noted in all four pathological ASLMs on follow-up PET/CT after chemotherapy.CONCLUSION:In patients with lymphoma,ASLM can represent malignancy,and thus further characterization with PET/CT might be warranted.Patients with neoplasia other than ASLM can be confidently diagnosed with accessory spleen.