Study On The Safety And Effectiveness Of Percutaneous Cryoablation For Subdiaphragmatic Hepatocellular Carcinoma

Objective: We aimed to evaluate the efficacy and safety of US/CT-CT guided percutaneous argon-helium cryoablation(CA)for hepatocellular carcinoma(HCC)abutting the diaphragm.Methods: We retrospectively enrolled 61 patients(50 men,11 women;mean age,56.3±12.1 years;range,32–83 years)with 74 HCC tumor lesions(mean size,3.3±1.7 cm;range,0.8–7 cm)who were treated with percutaneous argon-helium CA.All the adverse events experienced by the patients were evaluated by Common Terminology Criteria of Adverse Events,v.5.0(CTCAE v5.0).Major and minor complications were assessed.Change of blood tests,such as blood routine,liver function,and blood coagulationwere analyzed using t-test.Treatment response was classified as complete response(CR),partial response(PR),stable disease(SD),and progressive disease(PD)in accordance with the modified response evaluation criteria in solid tumors(mRECIST).Local tumor progression(LTP)and overall survival(OS)were analyzed using Kaplan–Meier and log-rank tests.The risk factors associated with OS and LTP were evaluated using univariable and multivariable Cox regression analysis.Results: No periprocedural(30-day)deaths wasobserved.Major complications were noted in 5 patients,of these,pleural effusion required catheter drainagewas observed in 4patients and pneumothorax requiring catheter placement was noted in 1 patient.According to CTCAE v5.0,the 61 patients exhibited a total of 198 complications,of these,29 cases of thoracic disorder,including cough,pneumothorax,pneumonitis,and pleural effusion,were noted in 24(39.3%)patients.Pleural effusion after CA was the most common thoracic disorder,and was observed in 16(26.2%)patients.At 1 month after CA,54(73%)lesions achieved CR,14(18.9%)lesions achieved PR and 3(4.1%)lesions were considered PD according to mRECIST.The median LTP from CA was 22.5 months.The median OS from CA and diagnosis was 27.3 months and 40.9 months,respectively.Tumor location and number ofintrahepatic tumors were independent prognostic factors of OS,while age and origin of liver disease were independent prognostic factors of LTP.Conclusion: Percutaneous argon-helium CA is safe for the treatment of HCC abutting the diaphragm,with an acceptable LTP and OS.CA of tumor lesions located in left lobe was more complicated and challenging to and related with a shorter OS.