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Chao An,1,&ast; Hongcai Yang,1,2,&ast; Xiaoling Yu,1 Zhi-Yu Han,1 Zhigang Cheng,1 Fangyi Liu,1 Jianping Dou,1 Bing Li,3 Yansheng Li,4 Yichao Li,4 Jie Yu,1 Ping Liang1 1Department of Ultrasound, PLA Medical College & 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China; 2School of Medicine, Nankai University, Tianjin, People’s Republic of China; 3National Laboratory of Pattern Recognition (NLPR), Institute of Automation, Chinese Academy of Sciences, Beijing, People’s Republic of China; 4DHC Mediway Technology CO, Ltd, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ping Liang; Jie Yu, Department of Ultrasound, PLA Medical College & 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China, Tel +86-10-66939530, Fax +86-10-68161218, Email liangping301@126.com; yu-jie301@hotmail.comBackground and Aim: Early recurrence (ER) presents a challenge for the survival prognosis of patients with hepatocellular carcinoma (HCC). The aim of this study was to investigate machine learning (ML) models using clinical data for predicting ER after microwave ablation (MWA).Methods: Between August 2005 and December 2019, 1574 patients with early-stage HCC underwent MWA at four hospitals were reviewed. Then, 36 clinical data points per patient were collected, and the patients were assigned to the training, internal, and external validation set. Apart from traditional logistic regression (LR), three ML models—random forest, support vector machine, and eXtreme Gradient Boosting (XGBoost)—were built and validated for their predictive ability with the area under ROC curve (AUC). Algorithms such as SHapley Additive exPlanations (SHAP) and local interpretable model-agnostic explanations (LIME) were used to realize their interpretability.Results: The three ML models all outperformed LR (P < 0.001 for all) in predictive ability. When nine variables (tumor number, platelet, α-fetoprotein, comorbidity score, white blood cell, cholinesterase, prothrombin time, neutrophils, and etiology) were extracted simultaneously using recursive feature elimination with cross-validation, the XGBoost model achieved the best discrimination among all models, with an AUC value 0.75 (95% CI [confidence interval]: 0.72– 0.78) in the training set, 0.74 (95% CI: 0.69– 0.80) in the internal validation set, and 0.76 (95% CI: 0.70– 0.82) in the external validation set, and it was interpreted depending on the visualization of risk factors by the SHAP and LIME algorithms. The predictive system of post-ablation recurrence risk stratification was provided on online (http://114.251.235.51:8001/) based on XGboost analysis.Conclusion: The XGBoost model based on clinical data can effectively predict ER risk after MWA, which can contribute to surveillance, prevention, and treatment strategies for HCC.Keywords: microwave ablation, hepatocellular carcinoma, recurrence, machine learning, risk stratification

Minimal extrathyroid extension (mETE) was removed from the TNM staging system. This study was designed prospectively to compare the safety and efficacy of microwave ablation (MWA) versus surgery for treating T1N0M0 papillary thyroid carcinomas (PTC) with sonographically detected mETE.From December 2019 to April 2021, 198 patients with T1N0M0 mETE-PTCs evaluated by preoperative ultrasound from 10 hospitals were included. Ninety-two patients elected MWA, and 106 patients elected surgery for treatment. MWA was performed using extensive ablation with hydrodissection. Surgery consisted of lobectomy with ipsilateral central lymph node dissection (CLD), lobe and isthmus excision with ipsilateral CLD and total thyroidectomy with ipsilateral CLD. The rates of technical success, cost, oncologic outcomes, complications and quality of life of the two groups were assessed.The follow-up times for the MWA and surgery groups were 12.7 ± 4.1 and 12.6 ± 5.0 months, respectively. The technical success rate was 100% for both groups. Oncological outcomes of the two groups were similar during the follow-up (all p0.05). The MWA group had a shorter operation time, less blood loss and lower costs (all p0.001). Three complications (3.3%) were reported in the MWA group and 4 (3.8%) in the surgery group (p = 0.846). The surgery group had higher scores for scar problems and anxiety (p0.001 and p = 0.003, respectively).Microwave ablation was comparable in the short term to surgery in terms of treatment safety and efficacy in selected patients with T1N0M0 mETE-PTC detected by ultrasound.• Microwave ablation is comparable to surgery in the safety and short-term efficacy for PTCs with sonographically detected mETE. • Thermal ablation is technically feasible for mETE-PTC treatment. • Patients with mETE-PTC have similar quality of life in the two groups, except for worse scar problems and anxiety in the surgery group.

Local tumour progression (LTP) is believed to be a negative consequence of imperfect thermal ablation, but we wondered if all LTP is truly due to imperfect ablation.This study included 185 LTPs occurring within 1 cm of the ablation zone (AZ) after clinical curative thermal ablation for ≤ 5 cm hepatocellular carcinoma between 2010 and 2019. The AZ was divided into 8 quadrants by coronal, sagittal, and horizontal planes. Two methods, visual assessment through pre- and post-MRI (VA) and tumour mapping for 3D visualisation pre- and post-MRI fusion (MF), were used to assess which AZ quadrant included the shortest ablation margin (AM) by three doctors. LTP subclassification was based on whether LTP contacted the AZ margin (contacted LTP and dissociated-type LTP) and occurrence at different time points (12, 18, and 24 months).Fleiss's Kappa of VA and MF was 0.769 and 0.886, respectively. Cohen's Kappa coefficient between VA and MF was 0.830. For all LTPs, 98/185 (53.0%) occurred in the shortest AM quadrant, which showed a significant central tendency (p0.001). However, only 8/51 (15.7%) dissociated - type LTPs and 6/39 (15.4%) LTPs after 24 months occurred in the shortest AM quadrant, which showed no evenly distributed difference (p = 0.360 and 0.303).MF is an accurate and convenient method to assess the shortest AM quadrant. LTP is a central tendency in the shortest AM quadrant, but dissociated-type and LTPs after 24 months are not, and these LTP types could be considered nonablation-related LTPs.• LTPs are not evenly distributed around the AZ. More than half of LTPs occur in the shortest AM quadrant. • Subgroup analysis showed that the occurrence of contacted-type LTPs (tumour margin has direct contact with the AZ) within 24 months after ablation indeed had a high proportion in the shortest AM quadrant, and they could be called ablation-related LTPs. • However, the dissociated-type LTPs (tumour margin adjacent to but not in contact with the AZ) or LTPs occurring beyond 24 months after ablation were evenly distributed around the AZ, and they could be called nonablation-related LTPs.

Background The influence of risk factors on hepatocellular carcinoma (HCC) intrahepatic recurrence may be alterable over time. Objective To explore the evolution of risk factors and its correlation with recurrence pattern over time. Methods The information and treatment method of patients underwent laparoscopic hepatectomy (LH) or microwave ablation (MWA) with single 3-5cm HCC were collected to identify risk factors by Cox proportional hazard model. Then, Landmark test was used to analyze the evolution of factor influences from 6th to 36th months. Intrahepatic recurrence was classified into three types: local tumor progression + surgical margin recurrence (LTP + SMR), proximal intrahepatic recurrence (PIR), and distal intrahepatic recurrence (DIR) and recorded. Results From January 2010 to October 2019, 1207 patients from 12 hospitals were included with 38.7-month median follow-up. Multivariate analysis showed: male, cirrhosis, elevated alpha-fetoprotein (AFP) and MWA were risk factors for recurrence. Landmark test and recurrence pattern record show that: the influence of AFP manifested in the first 12 months after treatment (p

Objectives: To compare the prognosis, complication and cosmetic results of ultrasound-guided percutaneous microwave ablation (MWA) with those of breast-conserving surgery (BCS) for 2-5cm BC patients. Methods: This retrospective study was conducted in two academic centers, which enrolled 224 invasive BC patients treated with MWA (n=39) or BCS (n=185) from November 2015 to February 2022. Propensity score matching (PSM) was performed at 1:2 and the baseline characteristics were well balanced between MWA (n=32) and BCS (n=56) group thereafter. Prognosis was analyzed by the Kaplan-Meier curves. Association between treatment modality and disease-free survival (DFS) was assessed using seven different Cox proportional hazards models. Results: After PSM, during a median follow-up of 33 months (interquartile range: 21.25, 51.00 months), between MWA and BCS group, there was no statistic difference in 3-year DFS (95.03% vs 98.26%, P=0.171) and 3-year local tumor progression (LTP, 3.39% vs 1.20%, P =0.438). Statistically comparable DFS and LTP were also achieved for the 2-3 cm and 3-5 cm BC subgroups. Consistent results were validated by seven survival models in DFS (all, P>0.05). Compared to BCS, patients in MWA group reported better cosmetic results (P =0.004), spent shorter operative time (56.96 min vs 86.30 min, P=0.002), while with higher costs (24,063.85 RMB vs 15,399.32 RMB, PConclusion: With survival models validation, this pilot study suggests that MWA may be a potential alternative local therapy for selected 2-5cm BC patients, especially those not indicated for surgery. Complete ablation is the key to achieving no statistical difference between MWA and BCS.

The study objective was to compare the effectiveness of microwave ablation (MWA) and laparoscopic liver resection (LLR) on solitary 3-5-cm HCC over time.From 2008 to 2019, 1289 patients from 12 hospitals were enrolled in this retrospective study. Diagnosis of all lesions were based on histopathology. Propensity score matching was used to balance all baseline variables between the two groups in 2008-2019 (n = 335 in each group) and 2014-2019 (n = 257 in each group) cohorts, respectively. For cohort 2008-2019, during a median follow-up of 35.8 months, there were no differences in overall survival (OS) between MWA and LLR (HR: 0.88, 95% CI 0.65-1.19, p = 0.420), and MWA was inferior to LLR regarding disease-free survival (DFS) (HR 1.36, 95% CI 1.05-1.75, p = 0.017). For cohort 2014-2019, there was comparable OS (HR 0.85, 95% CI 0.56-1.30, p = 0.460) and approached statistical significance for DFS (HR 1.33, 95% CI 0.98-1.82, p = 0.071) between MWA and LLR. Subgroup analyses showed comparable OS in 3.1-4.0-cm HCCs (HR 0.88, 95% CI 0.53-1.47, p = 0.630) and 4.1-5.0-cm HCCs (HR 0.77, 95% CI 0.37-1.60, p = 0.483) between two modalities. For both cohorts, MWA shared comparable major complications (both p 0.05), shorter hospitalization, and lower cost to LLR (all p 0.001).MWA might be a first-line alternative to LLR for solitary 3-5-cm HCC in selected patients with technical advances, especially for patients unsuitable for LLR.

Background Very early recurrence (VER) significantly affects the survival of patients with treated primary hepatocellular carcinoma. Purpose To compare the survival of patients with VER after laparoscopic resection and thermal ablation treatment. To establish a model predicting very early recurrence after laparoscopic resection. Methods 956 primary HCC patients treated with thermal ablation or laparoscopic resection from 12 centers were included in our study. The overall survival (OS) and cancer specific survival (CSS) rate of all patients and patients with VER in two groups were compared. Propensity score matching (PSM) was done to keep baseline balance. Risk factors that may lead to VER occurrence were presented. Different machine learning methods were used to build prediction models of VER occurrence after laparoscopic resection. Results VER significantly affects the OS and CSS of patients in both groups(p

To develop and validate a deep learning (DL) model based on quantitative analysis of contrast-enhanced ultrasound (CEUS) images that predicts early recurrence (ER) after thermal ablation (TA) of colorectal cancer liver metastasis (CRLM).Between January 2010 and May 2019, a total of 207 consecutive patients with CRLM with 13,248 slice images at three dynamic phases who received CEUS within 2 weeks before TA were retrospectively enrolled in two centres (153 for the training cohort (TC), 32 for the internal test cohort (ITC), and 22 for the external test cohort (ETC)). Clinical and CEUS data were used to develop and validate the clinical model, DL model, and DL combining with clinical (DL-C) model to predict ER after TA. The performance of these models was compared by the receiver operating characteristic curve (ROC) with the DeLong test.After a median follow-up of 56 months, 49% (99/207) of patients experienced ER. Three key clinical features (preoperative chemotherapy (PC), lymph node metastasis of the primary colorectal cancer (LMPCC), and T stage) were used to develop the clinical model. The DL model yielded better performance than the clinical model in the ETC (AUC: 0.67 for the clinical model, 0.76 for the DL model). The DL-C model significantly outperformed the clinical model and DL model (AUC: 0.78 for the DL-C model in the ETC; both, p0.001).The model based on CEUS can achieve satisfactory prediction and assist physicians during the therapeutic decision-making process in clinical practice.• This is an exploratory study in which ablation-related contrast-enhanced ultrasound (CEUS) data from consecutive patients with colorectal cancer liver metastasis (CRLM) were collected simultaneously at multiple institutions. • The deep learning combining with clinical (DL-C) model provided desirable performance for the prediction of early recurrence (ER) after thermal ablation (TA). • The DL-C model based on CEUS provides guidance for TA indication selection and making therapeutic decisions.

Objectives To prospectively compare the effectiveness and safety of percutaneous microwave ablation (PMWA) and ultrasound-guided radiofrequency ablation (USgRFA) for treating symptomatic uterine adenomyosis. Methods One hundred and thirty-three women with symptomatic uterine adenomyosis who met the inclusion criteria were enrolled in our study from October 2015 to October 2017. Sixty-eight patients underwent PMWA, and sixty-five patients underwent USgRFA. All patients were followed up for 12 months. Assessment endpoints included treatment time, percentage ablation, percentage uterine regression, symptom severity scores (SSSs), dysmenorrhea scores and adverse events. Results The mean age of the patients in our study was 39.4 ± 4.2 years (range, 35–50 years), and the median volume of uterine adenomyosis was 124.3 cm3 (range, 28.7–374.5 cm3). The mean ablation time was 16.3 ± 4.9 min (range, 5–23 min) in the MWA group, which was demonstrably superior to that of the RFA group, which was 37.5 ± 6.2 min (range, 5–39 min). The mean percentages of ablation of uterine adenomyosis were 79.7 ± 15.1% and 79.2 ± 14.2% in the MWA group and the RFA group, respectively, and showed no significant difference between the groups. The percentages of regression of uterine volume also showed no marked difference between the two groups. Changes in the dysmenorrhea scores and the SSSs after ablation were similar in the MWA group and in the RFA group, and no significant difference was found between the groups. Finally, the percentage occurrence of adverse events was the same in the two groups. Conclusions The safety and effectiveness of PMWA and USgRFA in the treatment of uterine adenomyosis were similar; however, the mean ablation time of PMWA was shorter than that of USgRFA.

Background and aim: Most patients with pancreatic cancer (PC) suffer from an unresectable tumor at the time of diagnosis with limited treatment effectiveness. The aim of this study is to investigate the feasibility and safety of percutaneous laser ablation (LA) for locally advanced and metastatic PC. Methods Between September 2016 and November 2019, ten patients (mean age, 64.2 ± 6.7 years; range, 62–68 years) with histologically proved PC were prospectively included to undergo ultrasound-guided percutaneous LA. Treatment effect including safety, pain perception and survival were evaluated. Results Three patients were with locally advanced PC (stage III) and seven with metastases (stage IV). All patients underwent LA in one session. The mean largest diameter of tumor was 5.5 ± 0.9 cm (range, 4.2–9.4 cm). Ablation power of all patients was 5 W and the mean ablation energy was 8.1 ± 2.6 KJ (range, 4.4–12KJ). Mean ablation volume was 16.1 ± 3.8 ml (range, 13.0 – 22.1 ml), which reached 89.1 ± 7.4% (range, 80.2 – 98.0 %) of tumor volume. After a median follow-up period of 10.4 months (range, 6.2–18.4 months), the median survival from diagnosis was 11.5 months. Four stage IV patients died during 6.5–12.5 months after LA because of one hepatic encephalopathy and three tumor progression. No major complications occurred. Pain symptom achieved significant remission (P < 0.001) and patients experienced ameliorative physical function after LA. Conclusions Percutaneous LA for unresectable PC is generally well tolerated. Preliminary results are encouraging with tumor size reducing and physical function significant improvement. The technique provides a new minimally invasive therapy modality for PC.

The survival of children with recurrent hepatoblastoma (RHB) is still unsatisfactory and the treatment for relapsed patients is challenging.To compare short-term results between open liver resection (OLR) and percutaneous thermal ablation (TA) in the treatment of RHB and provide evidence to support the treatment options for such patients.A retrospective data of 21 patients with RHB in two Chinese centers were analyzed from January 2013 to May 2019. The baseline indicators and clinical effect of the two groups of children were compared.There was no statistical difference in baseline indicators between the two groups of children, and complete remission (CR) was achieved after comprehensive treatment. The median follow-up time was 30 months (IQR 38.5 months) in the TA group, and 23 months (IQR 21.7 months) in OLR group (Ultrasound-guided percutaneous TA for RHB is a safe and effect treatment option for children. It has comparable effect with surgery within 2 years after treatment. Particularly, due to its minimally invasive advantage, it needs shorter operation and hospitalization time. Percutaneous ablation may be an alternative minimally invasive treatment for RHB children.

Introduction: Although microwave ablation (MWA) is a promising technique for hepatocellular carcinoma (HCC) treatment, its 10-year efficacy is unknown. Objective: The objective of the study was to assess whether the advances in MWA for HCC translated into a real-world survival benefit. Methods: This retrospective study included 2,354 patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 to B from 5 hospitals, with at least 2 years of follow-up for all the patients. Recurrence and survival were analyzed using the Kaplan-Meier method with time-period stratification. Results: A total of 5,326 HCCs (mean diameter, 2.9 cm ± 1.2) underwent 4,051 sessions of MWA with a median follow-up of 61.3 (0.6–169.5 range) months during 3 periods (2007–2010, 2011–2014, and 2015–2018). Technical success was achieved in 5,194 (97.5%) tumors with significant improvement over time, especially for >3.0-cm HCC (p < 0.001). Local tumor progression (LTP) showed no period-dependent advance, with >3.0-cm HCC and perivascular location being the risk factors for LTP. The median intrahepatic metastasis time was 27.6 (95% confidence interval [CI]: 25.2–28.8) months, with 5- and 10-year occurrence rates of 68.8% and 79.4%, respectively. The 5- and 10-year overall survivals were 63.9% and 41.1%, respectively, and BCLC stage 0, A, and all B patients showed an observable survival improvement over time (p < 0.001). The median disease-free survival time increased from 19.4 (95% CI: 16.5–22.6) months in 2007–2010 to 28.1 (95% CI: 25.9–32.3) months in 2015–2018. The improved survival for early recurrent (≤2 years) patients was period-dependent, as verified by Cox regression analyses. The major complications rate per procedure was 3.0% (122/4,051). Conclusions: These real-world data show that MWA provided an upward trend in survival for HCC patients with BCLC stage 0–B over a 12-year follow-up period. An encouraging clear survival benefit in early recurrent patients was also observed.

We updated the experience on percutaneous microwave ablation for renal cell carcinoma with five-center data and long-term follow-up.This retrospective study reviewed the T1N0M0 renal cell carcinoma patients who underwent microwave ablation between April 2006 and December 2019. Clinicopathological and procedural data were collected. Technical effectiveness and complications were assessed, and the Kaplan-Meier method was used for cancer-specific survival, disease-free survival, overall survival, and local neoplastic process analyses.A total of 323 consecutive patients (mean age, 62.9 years ± 14.0) with 371 biopsy-proved tumors (mean diameter, 2.9 cm ± 1.2) were enrolled, and 42.6% of the tumors were located adjacent to collecting system/bowel and technical effectiveness was achieved in 360 (97.0%) tumors. For 275 cT1a patients, during median follow-up time of 66.0 months (IQR, 58.4-73.6), 10-year local neoplastic processes, cancer-specific survival, disease-free survival, and overall survival rates were 1.9%, 87.4%, 71.8, and 67.5%, respectively. For 48 cT1b patients, during the median follow-up time of 30.4 months (IQR, 17.7-44.8), 5-year local tumor progression, cancer-specific survival, disease-free survival, and overall survival rates were 11.3%, 91.4%, 69.1, and 89.2%, respectively. Major complications showed no differences between cT1a (3.5%) and cT1b (6.9%) patients (p = 0.28). A clinical risk stratification system was developed based on multivariable model to predict DFS and CSS with c-indexes of 0.78 (95% CI: 0.71-0.85) and 0.77 (95% CI: 0.65-0.90), respectively.With matured follow-up at five institutions, ultrasound-guided percutaneous microwave ablation is a reliable treatment option for cT1a renal cell carcinoma even in dangerous location and appears to be promising for cT1b tumors.• To our knowledge, this is the first multicenter cohort of long-term oncologic outcomes with percutaneous MWA of cT1 RCC. • The predicting model we developed is accurate to predict the long-term DFS and CSS, which can help to provide a better MWA prognostication over routinely available clinical information. • The available evidence shows that microwave ablation of clinical stage T1 RCC is safe and reliable with promising long-term oncologic outcomes, especially for cT1a RCC with excellent 10-year results.

To analyze the influence of tumor location, including tumor adjacency and located segments on long-term survival outcomes for patients with solitary hepatocellular carcinoma (HCC) after microwave ablation (MWA).This retrospective study evaluated 850 patients. The hepatic segments where the tumor is located, tumor adjacency (important tissues adjacent to tumor) and other clinical characteristics were collected. Overall survival (OS), local tumor progression (LTP) and disease-free survival (DFS) were compared and analyzed. Influence of tumor location was evaluated by multi-models and the effect of adjacency for OS, LTP, and DFS in different segments was analyzed by stratification analysis.The OS, LTP, and DFS rates were similar in different hepatic segments, so were in high risk and safe locations. In multi-models, HCC in segment 8 showed lower death rate of 43% than that in segment 2 (HR 0.57; P = 0.01) and tumors in segment 6 seemed to have lower LTP rate. Tumors in high-risk locations were risk factors for OS, LTP, and DFS compared with tumors in safe locations, but all differences were not significant in different models. The effects of tumor adjacency on survival outcomes among subgroups of segments were limited.The tumor adjacency was not a prognostic factor of survival outcomes for patients with solitary tumors after MWA, but tumors in segment 8 seemed to better OS rate than tumors in other segments.

Background Percutaneous microwave ablation (MWA) and laparoscopic partial nephrectomy (LPN) are two modalities indicated for early-stage renal cell carcinoma (RCC) with low extent of invasion. Purpose To compare the long-term results of percutaneous MWA and LPN in the treatment of cT1a RCC. Materials and Methods This retrospective study included 1955 patients with cT1a RCC treated with percutaneous MWA or LPN between April 2006 and November 2017. Propensity score matching was used. Oncologic outcomes were analyzed by using the Fine-and-Gray competing risk models. Results A total of 185 patients underwent percutaneous MWA (mean age, 63.2 years ± 15.2 [standard deviation]) and 1770 underwent LPN (mean age, 50.9 years ± 13.2). During the follow-up (median, 40.6 months), after propensity score matching, no difference was observed between local tumor progression (3.2% vs 0.5%, P = .10), cancer-specific survival (2.2% vs 3.8%, P = .24), and distant metastases (4.3% vs 4.3%, P = .76). Patients who underwent percutaneous MWA had worse overall survival (hazard ratio, 2.4; 95% confidence interval: 1.0, 5.7; P = .049 vs LPN) and disease-free survival (82.9% vs 91.4%, P = .003). Percutaneous MWA led to smaller drop in estimated glomerular filtration rate at discharge (6.2% vs 16.4%, P < .001), smaller estimated blood loss (4.5 mL ± 1.3 vs 54.2 mL ± 69.2), lower cost ($3150 ± 2970 vs $6045 ± 1860 U.S. dollars), shorter operative time (0.5 minute ± 0.1 vs 1.8 minutes ± 0.6), and shorter postoperative hospitalization time (5.1 days ± 2.6 vs 6.9 days ± 2.8) (all P < .001 vs LPN). There were fewer cases of fever in the percutaneous MWA group (16.2% vs 73.0%, P < .001). Conclusion There were no significant differences regarding oncologic outcomes and complications between percutaneous microwave ablation and laparoscopic partial nephrectomy for patients with cT1a renal cell carcinoma. Percutaneous microwave ablation led to smaller renal function change and lower blood loss. For patients who cannot be subjected to the risks of more invasive laparoscopic partial nephrectomy, percutaneous microwave ablation could be an alternative less invasive treatment option. © RSNA, 2020 Online supplemental material is available for this article.

This study aimed to investigate the outcomes of hepatocellular carcinoma (HCC) patients after curative microwave ablation (MWA) with and without diabetes mellitus (DM).A total of 308 patients with HCC were retrospectively studied from 2005 to 2012 over an 8-year period. They were all successfully treated by MWA. Progression-free survival (PFS) and overall survival (OS) were analyzed according to the status of DM. The presence of other comorbidities and tumor status were studied using multivariate analysis.Significant differences were observed both for 1-, 3-, 5- year's PFS rates (DM: 63.8, 23.0 and 15.8 vs non-DM: 72.7, 43.6 and 30.8%; p=0.013) and OS rates (DM: 87.3, 75.1 and 49.5% vs non-DM: 97.9, 82.9 and 70.5%; p=0.045) between patients with and without DM. Cox multivariate analysis identified the following factors significantly associated with PFS: (hazard ration (HR): 1.191, 95% CI: 1.051-1,349, p=0.006), AFP (HR:1.000, 95% CI: 1.000-1.000, p=0.022), alcohol abuse (100g/d vs ≤100g/d, HR:1.579, 95% CI:1.128- 2.212, p=0.008), mean fasting plasma glucose level after initial therapy for HCC(7.0 / ≤7.0, HR:2.728, 95%CI:1.414- 5.265, p=0.003); and the followings associated with OS:Child-Pugh classification A against B, C (risk 1.692, 95%CI 1.065-2.689, P=0.026), tumor diameter (risk 1.251. 95% CI 1.021-1.534, P=0.031), and AFP (risk 1.000. 95% CI 1.000- 1.000, P=0.000).DM may affect the HCC progression and overall survival in patients undergoing curative MWA. A good control of the glucose levels after ablation may be important for improving the prognosis of HCC.

The aim of the present study was to investigate the therapeutic efficacy of immunotherapy after microwave ablation (MWA), which was used to improve liver function, reduce the recurrence rate and enhance survival period in patients with hepatocellular carcinoma (HCC). Between February 2009 and December 2010, 14 patients received immunotherapy after MWA (immunotherapy group) and 15 patients received MWA alone with no post-ablated adjuvant therapy (control group). Immune and liver parameters, recurrence rate and survival time were recorded. The absolute lymphocyte count in the immunotherapy group exceeded that in the control group after 3 courses of immunotherapy (P0.05); however, certain cytotoxic subsets (CD3+/CD8+, CD8+CD28+ and CD3+CD16+CD56+ T cells) were over-represented and negative regulatory or helper subsets (CD4+CD8+, CD4+, CD4+CD25+) were under-represented in the immunotherapy group between 1 and 12 months after immunotherapy (P0.05). In conclusion, the results of the present study indicate that immunotherapy improves the immune status and liver function of patients with HCC.

Background Microwave ablation (MWA) has been developed as one of the most commonly used local oncologic treatments. However, there is still a dearth of studies concerning MWA in the treatment of renal angiomyolipomas (AML). Purpose To evaluate the efficacy and safety of ultrasound (US)-guided percutaneous MWA when treating AML. Material and Methods Nineteen lesions with pathologically confirmed AML in 14 patients (5 men, 9 women; mean age, 49.2 ± 14 years) were treated with US-guided percutaneous MWA with one or two cooled-shaft needle antennae. A power output of 45 W or 50 W for 300–1140 s was emitted to achieve complete tumor necrosis. Contrast-enhanced ultrasound (CEUS) was performed to observe the treatment efficacy 3 days later. Patients were followed up with CEUS, computed tomography (CT), and/or magnetic resonance imaging (MRI) after 1, 3, and 6 months, and long-term ablation efficacy was evaluated every 6 months thereafter. Results Among the 19 renal lesions, 17 achieved complete ablation as monitored by US after one session of MWA, and two patients required a second session of MWA. Postoperative evaluation with CEUS showed that complete ablation was obtained in 15 lesions; however, in four lesions, complete ablation could not be attained. During the follow-up period of 6–36 months (median, 10 months), a fistula to the descending colon was found in one patient and local infection around the ablation zone was found in another. Neither injury to the renal pelvis nor damage to renal function was observed. None of the patients exhibited hematuria or abnormalities in routine urine tests during the hospitalization period or during follow-up. Minor complications, such as subcapsular bleeding, mild to moderate pain, and fever were eliminated after appropriate treatment. Conclusion MWA is an effective and minimally invasive technique for the management of AML that can preserve renal function with acceptable complication rates.

To review intermediate-term clinical outcomes of microwave ablation (MWA) compared with open radial nephrectomy (ORN) in small renal cell carcinoma (RCC) patients and to identify prognostic factors associated with two techniques.This retrospective study was institutional review board-approved. A total of 163 patients (127 men and 36 women) with small RCC (≤4 cm) were included from April 2006 to March 2012. Sixty-five patients underwent MWA and 98 patients underwent ORN. Survival, recurrence, and renal function changes were compared between the two groups. Effect of changes in key parameters (ie, overall survival, RCC-related survival, and metastasis-free survival) was statistically analyzed with the log-rank test.Although overall survival after MWA was lower than that after ORN (P = .002), RCC-related survival was comparable to ORN (P = .78). Estimated 5-year overall survival rates were 67.3% after MWA and 97.8% after ORN; for RCC-related survival, estimated 5-year rates were 97.1% after MWA and 97.8% after ORN. There was one local tumor recurrence 32 months after MWA and none after ORN. Major complication rates were comparable (P = .81) between the two techniques (MWA, 2.5% vs ORN, 3.1%). The MWA group had less surgical time (P.001), estimated blood loss (P.001), and postoperative hospitalization (P.001). Multivariate analysis showed age (P = .014), tumor type (P = .003), postoperative urea nitrogen (P = .042), comorbid disease (P = .005), and treatment modality (P.001) may become survival rate predictors.In intermediate term, ultrasonographically guided percutaneous MWA and ORN provide comparable results in oncologic outcomes. MWA appears to be a safe and effective technique for management of small RCC in patients with little loss of renal function.

To evaluate the long-term efficacy of microwave ablation in the treatment of small renal cell carcinoma (RCC).We retrospectively analyzed 140 cases of small cell renal carcinoma (151 lesions with a mean diameter of 2.8±0.8 cm) treated between April, 2006 and October, 2015 with ultrasound-guided microwave ablation with cooled-shaft needle antenna. One microwave ablation antenna was used for tumors less than 2 cm in diameter and 2 antennas were used for larger tumors. The patients received enhanced ultrasound and CT/MRI examinations at 1, 3, and 6 months after the operation and every 6 months thereafter. The overall survival, disease-free survival, and local tumor progression rate of the patients were evaluated.The response rate of treatment (complete ablation at one month on enhanced images) was 100% in these patients. The local tumor progression rates at 1, 3, and 5 years were 0.9%, 2.0%, and 7.1%, respectively, and the 1-, 3-, and 5-year distant metastasis rates were 1.6%, 2.5%, and 7.9%, respectively. The overall survival rates of the patients at 1, 3, and 5 years were 98.4%, 94.8%, 89.5%, respectively, with disease-free survival rates of 98.4%, 93.0%, and 83.1%, respectively. No major complications occurred in these cases, and multivariate analysis showed that the tumor number (P=0.015) and tumor growth patterns (P=0.049) were independent risk factors that adversely affected the long-term outcome after surgery.Our data show that microwave ablation is a safe and effective modality for treatment of renal cell carcinoma.

The effects of butanol-diesel blending ratio, injecting timing and pilot injection quantity on combustion and emissions were experimentally investigated for a passenger car diesel engine. The results showed that under the typical operating condition of 2000r/min engine speed and 0.2MPa BMEP engine load, the engine’s combustion phase retarded, the peak combustion pressure and maximum in-cylinder mean temperature decreasing with the delay of the main injection timing using both the neat diesel and diesel-butanol blends. And the engine smoke level increased, while the NOx and CO emissions decreased. However, at the same main injection timing, with the increase of the butanol in the blends, the ignition delay of the combustion prolonged, the burn rate and brake specific fuel consumption increased, NOx and soot emissions decreased, and HC and CO emissions increased, while the peak in-cylinder pressure was slightly influenced. The results of this study indicate that the selection of the butanol-diesel blend ratio and injection timing should consider the engineering balances among the engine’s fuel economy and emissions.

Tissue perfusion and vascular-mediated cooling have less impact on microwave ablation when compared with radiofrequency ablation. Microwave ablation could create larger and more lethal ablation zones with shorter treatment times. The minimally invasive microwave ablation of renal angiomyolipoma could directly reduce the lesion size, which could reduce the risk of hemorrhage, avoid a surgical procedure, and alleviate symptoms such as pain. The procedures were tolerated well. Microwave ablation may be an alternative minimally invasive technique for the management of angiomyolipoma that can preserve renal function with acceptable complication rates.

We read with interest the article by Wang et al 1 on zinc-finger protein 545 (ZNF545) acting as a tumour suppressor gene (TSG) in gastric cancer by inhibiting rRNA transcription and its methylation as a prognostic factor for early stages of gastric cancer. Inactivation of TSGs through promoter hypermethylation also plays an important role in progression of hepatocellular carcinoma (HCC).2–4 We wish to report the results of the expression profile and epigenetic regulation of ZNF545 in HCC, and its methylation role on early-stage HCC progression after thermal ablation. Our results showed reduced or loss of ZNF545 expression was found in seven human hepatic cancer cell lines, including SMMC7721, PRF/PCL-5, SK-hep1, HepG2, BEL7402, LAM3 and SNU449, by semiquantitative reverse transcription PCR. Expression of ZNF545 was detected in another cell of HBXF344. The methylation status of the ZNF545 promoter was examined by methylation-specific PCR (MSP). Complete methylation of the …

To explore the complications and clinical outcome of liver metastatic cholangiocarcinoma after microwave ablation (MWA) in patients with a history of pancreatoduodenectomy or liver resection with bilioenteric anastomosis.Retrospective study was made on 10 lesions of intra-hepatic metastatic cholangiocarcinoma undergoing MWA (range: 1.5 - 3.6 cm, mean: 3.3 ± 1.3 cm) in 6 patients (5 males and 1 female) from February 2008 to October 2011. All had a history of surgical resection for primary neoplasm and bilioenteric anastomosis. Four cases had intrahepatic biliary dilatation pneumatosis.All lesions were completely ablated according to the results of contrast-enhanced ultrasound (CEUS) or contrast-enhanced computed tomography/magnetic resonance imaging (CT/MRI) at Month 1 post-MWA. Liver abscess and fistula occurred in 5 ablation zones (5/10) of 4 patients. Three cases were satisfactorily cured with antibiotic dosing, catheter drainage and supportive care. One case died 13 days after MWA. The overall 1, 2, 3-year survival rates of were 64.8%, 21.6% and 21.0% respectively (median: 15.7 months).A high technical success rate of MWA is obtained in the treatment of intrahepatic metastatic cholangiocarcinoma with bilioenteric anastomosis. However, the incidence of abscess formation remains high due to a coexistence of multiple risk factors.

To analyze the major complications of percutaneous cooled-tip microwave ablation for the treatment of primary liver cancer and the possible risk factors of severe complications in a series of 693 patients.The clinicopathological data of 693 patients with primary liver cancer who underwent ultrasound-guided percutaneous cooled-tip microwave (MW) ablation in our hospital over the past 5 years were retrospectively analyzed, and the risk factors of severe complications were explored.In a total of 693 patients with 898 primary liver tumors were treated and 1111 MW ablation sessions were performed. The mean diameter of tumors was (2.5 ± 1.2) cm and the range was 0.4 - 10.0 cm. Three deaths occurred in the peri-ablation period, including one case died of multiorgan failure, one case died of pulmonary embolism and one case died of hepatorenal syndrome. Major complications occurred in 27 (3.9%) patients, including 12 pleural effusion requiring thoracentesis (1.7%), 10 tumor seeding (1.4%), 3 liver abscess and empyema (0.4%), 1 hemorrhage requiring arterial embolization (0.1%), and 1 bile duct injury (0.1%). The Chi-square test results showed that the diameter of tumors, number of MW ablation sessions and histological type of tumor were significantly associated with the major complications rate (P0.05). The multiple variables 1ogistic regression analysis showed that only type of tumors was associated with the major complication rate (P0.05).Results of this study confirm that cooled-tip MW ablation is a relatively low-risk and effective minimally invasive procedure for the treatment of primary liver cancer. Proper direction for the treatment of cholangiocarcinoma (ICC) patients as well as fewer ablated tumor numbers during one hospital stay may help minimize the major complication rate in patients with primary liver cancer treated by ultrasound-guided percutaneous cooled-tip microwave ablation.

To retrospectively review intermediate-term (median, 20.1 months) clinical outcomes after microwave ablation (MWA) of renal cell carcinoma (RCC).This retrospective study was approved by the institutional review board. The results from 46 patients with 49 RCC nodules (diameter, 0.6-7.7 cm; mean, 3.0 cm ± 1.5 [standard deviation]) treated with ultrasonography (US)-guided percutaneous MWA with cooled-shaft needle antenna from April 2006 to December 2010 were reviewed. One antenna was used for tumors smaller than 2 cm; two, for tumors 2 cm or larger. The patients were followed up with contrast material-enhanced US and computed tomography or magnetic resonance imaging at 1, 3, and 6 months and every 6 months thereafter. The effect of changes in key parameters (including overall survival, disease-free survival, and local tumor progression rate) was statistically analyzed by using the log-rank test.Technical effectiveness (complete ablation at follow-up enhanced imaging 1 month after MWA) was achieved in 48 of 49 (98.0%) tumors, and the metastasis-free rate was 100% (46 of 46). The 1-, 2-, and 3-year local tumor progression rates were 4.6%, 7.7%, and 7.7%, respectively. The cancer-specific survival rate was 100% (46 of 46), and 1-, 2-, and 3-year overall survival rates were 100%, 100%, and 97.8%, respectively. The 1-, 2-, and 3-year disease-free survival rates were 95.4%, 92.3%, and 92.3%, respectively. No major complications occurred. Multivariate analysis showed that tumor number (P = .046), tumor growth patterns (P = .003), and ablation time (P = .04) were independent unfavorable prognostic factors.In the intermediate term, US-guided percutaneous MWA appears to be a safe and effective technique for the management of RCC, especially small RCC, in selected patients.

The purpose of the study was to prospectively evaluate safety and assisted with ethanol injection for hepatocellular carcinoma abutting gastrointestinal tract. 263 patients with 319 hepatic tumors that underwent percutaneous microwave ablation with curative intention were included. 101 lesions located less than 5 mm from gastrointestinal tract were in gastrointestinal group. 218 lesions located more than 5 mm from hepatic surface, gastrointestinal tract and first or second branch of hepatic vessels were in control group. The temperature of marginal ablation tissue proximal to gastrointestinal tract was monitored and controlled to fluctuating between 45 degrees C and 59 degrees C for more than 10 min for tumors in the gastrointestinal group. Ethanol (1-21 ml) was injected into marginal tissue in 62 of 101 lesions of the G1 group. 96 of 101 tumors (95.0%) in the gastrointestinal group and 208 of 218 tumors (95.4%) in the control group achieved complete ablation (P = 0.89). Local tumor progression for all the tumors were in the first year and the 6-,12- month local tumor progression rate in the gastrointestinal group and the control group were 6.9%, 11.9% and 7.3%, 8.3%, respectively (P = 0.21). There were neither immediate nor periprocedural complications in both groups. There was no delayed complication of gastrointestinal and bile ducts injury. Tumor seeding happened in one (1.1%) of the gastrointestinal group and three (1.8%) of the control group (P = 0.92). Under strict temperature monitoring, microwave ablation assisted with ethanol injection is safe and achieves a high complete ablation rate for hepatocellular carcinoma adjacent to gastrointestinal tract.