Percutaneous Cryoablation Treat Hepatocellular Carcinoma:A Clinical Study

Objective: Argon-helium cryoablation for the treatment of liver cancer has been developed rapidly in recent years.But there is still no systematic comparison between Argon-helium cryoablation and traditional surgical resection in the regard of clinical treatment effect.There is also no in-depth study of its combination use in clinical application,such as in combination with transarterial chemoembolization(TACE).The aim of this study is to evaluate the clinical therapeutic effect of argon-helium cryoablation therapy and its combination on hepatocellular carcinoma(HCC)by two clinical trials,therefor provide scientific basis for the future treatment of liver cancer.Methods: First,in order to evaluate and compare the effect of argon-helium cryotherapy and traditional surgical resection on HCC,One-hundred and twenty patients with 1-3 HCC tumors <5 cm in diameter from Zhangjiagang Hospital Affiliated to Soochow University and The First Affiliated Hospital of Soochow University were enrolled into this study.Among them,49 patients were treated by cryoablation and 71 were treated by hepatectomy.Follow-up examinations were performed for the first four weeks after treatment,then every three months for the first 24 months and every six months thereafter.Second,in order to evaluate the effect of argon-helium cryotherapy and TACE combination on HCC.77 cases of advanced liver cancer were randomly divided into two groups,including a group of 37 cases,treated with TACE combined with argon-helium cryotherapy;a group of 40 patients,treated with TACE alone.The serum AFP level and the half year and one year survival rate were used as the evaluation indexes.Results: in the comparative study of argon-helium cryoablation and conventional surgical resection for HCC.One-,two-and three-year overall survival rates were 97.1%,87.3% and 61.5% for hepatectomy,respectively,and 89.8%,77.5% and 51.0% for cryoablation,respectively(P=0.194).One-,two-and three-year disease-free survival rates were 93.2%,60.9% and 23.3% after hepatectomy,respectively,and 85.7%,51.0% and 18.3% after cryoablation,respectively(P=0.205).Subgroup analyses indicate that patients with tumors ≤3 cm had significantly better survival rates compared with patients with tumors >3 cm(P=0.005).Neither patients with ≤3 cm tumors nor patients with >3 cm tumors exhibited survival differences when treated with either resection or cryoablation(P=0.103 and P=0.254,respectively).Patients with single tumors exhibited significantly better survival rates than patients with multiple tumors(P<0.001).No significant differences were observed in the survival rates of either single or multiple tumor patients treated with resection or cryoablation(P=0.973 and P=0.805,respectively).Tumor diameter,number and Child-Pugh scores were significant prognostic factors for overall survival.In the evaluation of the combined effect of argon-helium cryoablation and TACE on HCC,the AFP level in TACE combined with argon-helium cryoablation group was significantly lower than that of TACE alone group(p < 0.05).The one year mean overall survival rate of TACE combined with argon-helium cryotherapy group was also higher than that of TACE alone group(p <0.05).Conclusion: Percutaneous cryoablation and hepatectomy were equally effective HCC treatments.Compared with TACE,the effect of TACE combined with argon cryoablation in the treatment of HCC is superior to TACE alone,which indicates that this combination could be an effective method for the treatment of advanced liver cancer.