Rationale and Objectives
To retrospectively evaluate effectiveness and safety of radiofrequency (RF) ablation with retroperitoneal metastatic lymph nodes from hepatocellular carcinoma (HCC).
Materials and Methods
Thirty-two patients with retroperitoneal metastatic lymph node recurrence from HCC were enrolled in our study and the patients stratified into two groups based on the treatment. Nineteen patients in Group A were percutaneously treated and each metastatic lymph node was ablated with computed tomographic (CT) guidance. Thirteen patients in Group B only underwent RF ablation for hematogenous metastases, but did not undergo RF ablation or any other treatment for metastatic lymph nodes. Follow-up contrast material–enhanced CT or positron emission tomographic scans were reviewed and Kaplan-Meier survival estimates were analyzed.
Results
There were no significant differences between characteristics of the two groups. Kaplan-Meier analysis indicated the patients of Group A had an overall survival of 26.3% at 1 year compared with 7.7% for those of Group B. Mantel-Cox log rank test showed the 1-year survival rate of Group A was significantly higher than that of Group B ( P = .029). In Group A, the local control rate of 3, 6, 10, and 15 months was 78.9%, 73.3%, 41.7%, and 25.0%, respectively. Sixteen, 12, 6, and 2 patients showed no evidence of local progression for 3, 6, 10, and 15 months, respectively. There was no thermal injury of gastrointestinal tract or bile duct during RF ablation in all the 19 patients of Group A.
Conclusion
RF ablation is effective and may be safely applied to retroperitoneal metastatic lymph nodes from HCC.
Introduction
Hepatocellular carcinoma (HCC) is the fifth most common solid tumor in the world and accounts for about 500,000 deaths each year . The highest incidence of HCC is seen in China ,and the survival rate remains low . Lymph node recurrence in the retroperitoneum is an important cause of death for patients who undergo surgery or interventional therapy for HCC and is thus considered a major prognostic factor. If metastatic lymph node is treated effectively, relatively long survival may be possible for selected patients , especially when the primary foci in liver is removed and the lymph node was the only evidence of recurrence. However, treatment of recurrent HCC is usually challenging because the previous therapies (including surgery, radiation, chemoembolization, and various combinations of these treatments) limit the options available for subsequent treatment. Radiofrequency (RF) ablation has been accepted as a useful minimally invasive therapy for tumors in a variety of organs . Thus, RF ablation might be a useful alternative as therapy for lymph node metastasis from HCC, although to our knowledge it had not yet been investigated in the retroperitoneal metastatic lymph nodes from HCC. Potential advantages include favorable local tumor control, the freedom to perform the procedure regardless of any previous therapies, and the potential for repetition as needed .
Materials and methods
Ethics
This work has been carried out in accordance with the Declaration of Helsinki (2000) of the World Medical Association. This study was approved ethically by Sun Yat-sen University Cancer Center. All patients provided informed written consent.
Patients
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Table 1
Characteristics of 32 Patients with Retroperitoneal Lymph Node Metastases from HCC
Variables Group A Group B_P_ Value Sex M (15) F (4) M (10) F (3) .892 Cases of virus-related liver disease HBV (17) HCV (0) HBV (12) HCV (0) .171 Performance status 0 (2) 1 (15) 2 (2) 0 (2) 1 (10) 2 (1) 1.000 Child grade A (12) B (7) A (9) B (4) .770 Okuda stage I (11) II (8) I (8) II (5) .912 Treatment of primary cancer ∗ A (10) B (6) C (3) A (8) B (3) C (2) .673 Age (year) 57.3 ± 2.3 52.1 ± 2.9 .166 AFP level (ng/mL) 352 ± 98 347 ± 123 .977 Vascular invasion 0 0 – Largest diameter of metastatic lymph node (cm) 2.2 ± 0.1 2.1 ± 0.2 .885 Hematogenous metastasis 4 3 – Time to diagnosis of metastatic lymph node (months) † 9.7 ± 0.5 10.4 ± 0.6 .363
AFP, α-fetoprotein; F, female; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; M, male.
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Methods
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Follow-up
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Statistical Analysis
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Results
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Table 2
Clinical Efficacy of RF Ablation on Retroperitoneal Metastatic Lymph Node
Follow-up Time (Months) No. of Patients Local Control Efficacy Local Control Rate (%) (CR + PR)/Total % CR PR NC PD 3 19 8 7 1 3 78.9 6 15 5 6 1 4 73.3 10 12 3 2 1 6 41.7 15 8 2 0 0 6 25.0
CR, complete response; NC, no change; PD, progression of disease; PR, partial response; RF, radiofrequency.
Months are counted from the time of ablation session. Three patients who were alive without evidence of recurrence at 8, 9, and 9 months, respectively, at the time of writing were excluded at 10 and 15 months of follow-up time.
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Side Effects
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Discussion
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Acknowledgments
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