Wei Yang

Peking University Cancer Hospital, Peping, Beijing, China

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Publications (59)59.62 Total impact

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    ABSTRACT: To investigate the treatment strategies and long-term outcomes of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in difficult locations and to compare the results with non-difficult HCC. From 2004 to 2012, a total of 470 HCC patients underwent ultrasound-guided percutaneous RFA. Among these HCC patients, 382 with tumors located ≤ 5 mm from a major vessel/bile duct (n = 87), from peripheral important structures (n = 232) or from the liver capsule (n = 63) were regarded as difficult cases. There were 331 male patients and 51 female patients, with an average age of 55.3 ± 10.1 years old. A total of 235 and 147 patients had Child-Pugh class A and class B liver function, respectively. The average tumor size was 3.4 ± 1.2 cm. Individual treatment strategies were developed to treat these difficult cases. During the same period, 88 HCC patients with tumors that were not in difficult locations served as the control group. In the control group, 74 patients were male, and 14 patients were female, with an average age of 57.4 ± 11.8 years old. Of these, 62 patients and 26 patients had Child-Pugh class A and class B liver function, respectively. Regular follow-up after RFA was performed to assess treatment efficacy. Survival results were generated from Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model. Early tumor necrosis rate in the difficult group was similar to that in the control group (97.6% vs 94.3%, P = 0.080). The complication rate in the difficult group was significantly higher than that in the control group (4.9% vs 0.8%, P = 0.041). The follow-up period ranged from 6 to 116 mo, with an average of 28 ± 22.4 mo. Local progression rate in the difficult group was significantly higher than that in the control group (12.7% vs 7.1%, P = 0.046). However, the 1-, 3-, 5-, and 7-year overall survival rates in the difficult group were not significantly different from those in the control group (84.3%, 54.4%, 41.2%, and 29.9% vs 92.5%, 60.3%, 43.2%, and 32.8%, respectively, P = 0.371). Additionally, a multivariate analysis revealed that tumor location was not a significant risk factor for survival. There was no significant difference in long-term overall survival between the two groups even though the local progression rate was higher in the difficult group.
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    ABSTRACT: To compare the enhancement features of dysplastic nodules with a focus of hepatocellular carcinoma (DN-HCC) versus HCC and regenerative nodules (RN) in cirrhotic patients. One hundred and ninety-three cirrhotic patients were enrolled in this study; they had 215 focal liver lesions, 1.0-3.5 cm in size, which were examined using contrast-enhanced ultrasound (CEUS) with SonoVue(®) and diagnosed as HCC, RN or DN-HCC by biopsy. Samples were obtained using 18-gauge needles in the different enhanced areas. The enhancement features of DN-HCC, HCC and RN were evaluated. There were 86 HCC lesions, 102 RN lesions, and 27 DN-HCC lesions diagnosed by biopsy. Of 86 HCC lesions, 87.2% (75/86) showed complete enhancement during the arterial phase, and 12.8% (11/86) had inhomogeneous enhancement, with no enhancement in the central area during the arterial phase; 100% (86/86) exhibited washout during the late phase. Of 102 RN lesions, 95.1% (97/102) had delayed or simultaneous enhancement during the arterial phase, and 4.9% (5/102) displayed slight enhancement during the arterial phase; 26.5% (27/102) exhibited washout and 73.5% (75/102) exhibited no washout during the late phase. In 27 DN-HCC lesions, only part of the lesions enhanced during the arterial phase and washed out during the late phase; the other areas had delayed or simultaneous enhancement during the arterial phase, and 29.6% (8/27) exhibited slight washout in the late phase. In 86 HCCs, the pathological feature was HCC in the enhanced area of 75 lesions, hepatocellular fatty degeneration in the slightly enhanced area of 7 lesions, and hepatocellular necrosis in the unenhanced area and HCC in the enhanced area of 4 lesions. In 102 RNs, the pathological diagnosis was hepatocyte proliferation with or without fatty degeneration. In 27 DN-HCCs, the pathological feature was HCC in the enhanced area and hepatocyte regeneration in the unenhanced area. CEUS is useful for the diagnosis of focal liver lesions in cirrhotic patients. CEUS can help determine the progression from RN to DN-HCC to HCC by analyzing the hemodynamics. CEUS can promote the diagnostic accuracy of a biopsy by providing more accurate information on the site of the biopsy.
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    ABSTRACT: Objective. To investigate the value of contrast-enhanced ultrasound (CEUS) in transthoracic biopsy of peripheral lung and mediastinal lesions. Methods. Of 142 patients, 82 patients received CEUS before biopsy and were defined as CEUS group. The remaining 60 patients only underwent conventional ultrasound (US) before biopsy and were served as US group. The information of CEUS was used for selecting indication and instructing biopsy. The imaging features, number of punctures, diagnostic successful rate, and complication rate between the two groups were compared. Results. Necrosis was demonstrated in 43.9% of the lesions in CEUS group and in 6.7% of US group (). Detection rate of lesion hidden in pulmonary atelectasis in CEUS group was 13.4%, which was statistically higher than 1.7% of US group (). The diagnostic success rate was 96.3% for CEUS group and 80% for US group, respectively (). The average number of punctures was and , respectively. There was no significant difference in complications between CEUS group and US group. Conclusions. CEUS could play an important role in selecting proper indication and improving diagnostic accuracy rate of lung biopsy.
    01/2015; 2015:1-8. DOI:10.1155/2015/231782
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    ABSTRACT: This study compared the imaging features of conventional gray scale ultrasound (US) before and after contrast-enhanced ultrasound (CEUS) for focal liver lesions and 22 evaluated the role of US post-CEUS in characterizing liver lesions. 126 patients with 158 focal liver lesions underwent CEUS and US post-CEUS examination and entered this study. There were 74 hepatocellular carcinomas (HCC), 43 hepatic metastases, and 41 hemangiomas. Imaging features of US pre-CEUS and US post-CEUS were analyzed offsite by two blinded experienced radiologists to evaluate size, boundary, echogenicity, internal texture, posterior acoustic enhancement, spatial resolution, and contrast resolution. In the end with pathological and clinical evidence, the diagnostic accuracy rate of US pre-CEUS was 53.8% (85/158 lesions), lower than that of CEUS (88.0%, 139/158 lesions); with the complementation of US post-CEUS the rate rose to 93.0% (147/158 lesions). US post-CEUS could improve the visibility of typical structures of focal liver lesions and might provide important complementary information for CEUS diagnosis. It also increases the visibility of small liver lesions compared with US pre-CEUS and helps to guide local interventional procedure.
    01/2015; 2015:1-11. DOI:10.1155/2015/193178
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    ABSTRACT: Ultrasonography is non-invasive and can give useful clues in the diagnosis of cervical lymphadenopathy, However, differential diagnosis is difficult in some situations even combined with color Doppler imaging. The present study was conducted to evaluate the clinical value of real time elastography in patients with unexplained cervical lymphadenopathy using a quantitative method. From May 2011 to February 2012, 39 enlarged lymph nodes from 39 patients with unexplained cervical lymphadenopathy were assessed. All the patients were examined by both B-mode ultrasound, color Doppler flow imaging and elastography. The method of analyzing elasto-graphic data was the calculation of the 10 parametres ("mean", "sd", "area%", "com", "kur", "ske", "con", "ent", "idm", "asm") offered by the software integrated into the Hitachi system. The findings were then correlated with the definitive tissue diagnosis obtained by lymph node dissection or biopsy. Final histology revealed 10 cases of metastatic lymph nodes, 11 cases of lymphoma, 12 cases of tuberculosis and 6 cases of nonspecific lymphadenitis. The significant distinguishing features for conventional ultrasound were the maximum short diameter (p=0.007) and absent of echogenic hilum (p=0.0293). The diagnostic accuracy was 43.6% (17/39 cases) and there were 17 patients with equivocal diagnosis. For elastography, "mean" (p=0.003), "area%" (p=0.009), "kurt" (p=0.0291), "skew" (p=0.014) and "cont" (p=0.012) demonstrated significant differences between groups. With 9 of the 17 patients with previous equivocal diagnoses (52.9%) definite and correct diagnoses could be obtained. The diagnostic accuracy for conventional ultrasound combined elastography was 69.2% (27/39 cases). There were differences in the diagnostic sensitivity of the two methods (p=0.0224). Ultrasound combined with elastography demonstrated higher rates of conclusive and accurate diagnoses in patients with unexplained cervical lymphadenopathy than conventional ultrasound. The quantitative program showed good correlation with the pathology of different lymph node diseases.
    Asian Pacific journal of cancer prevention: APJCP 07/2014; 15(13):5487-92. DOI:10.7314/APJCP.2014.15.13.5487 · 2.51 Impact Factor
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    ABSTRACT: PURPOSE To our knowledge, the long-term (>5 years) survival results for radiofrequency ablation (RFA) in HCC is few. Our study aimed to investigate the efficacy of RFA for 318 patients with hepatocellular carcinoma (HCC) as first line treatment, and the prognostic factors for post-RFA survival rate. METHOD AND MATERIALS From 2000 to 2012, 730 patients with HCCs underwent ultrasound guided percutaneous RFA treatment in our department. Among them, 318 consecutive patients received RFA as first treatment and enrolled in this study. They were 251 males and 67 females, average age 60.3±11.3 years (24-87 years). The HCC were 1.0-6.7 cm in diameters (average 3.3±1.2 cm). Univariate and multivariate analysis with 15 potential variables were examined to identify prognostic factors for post-RFA survival rate. RESULTS The overall post-RFA survival rates at 1, 3, 5, 7, 10 year were 90.2%, 67.3%, 53.6%, 41.2% and 29.1%, respectively. In the 209 patients with stage I of HCC (AJCC staging), the 1, 3, 5, 7, 10 year survival rates were 94.2%, 72.9%, 63.6%, 57.6%, 41.5% , respectively. In the 239 patients with liver function class A (Child-Pugh classification), the 1, 3, 5, 7, 10 year survival rates were 94.4%, 75.8%, 64.3%, 52.3%, 32.4%, respectively. Ten potential factors were found with significant effects on survival rate, and they were AJCC staging, tumor pathological grading, number of tumors, pre-RFA liver function enzymes, pre-RFA AFP level, Child-Pugh classification, portal vein hypertension, using contrast ultrasound in RFA procedure, RFA electrode type and tumor necrosis one month after RFA. After multivariate analysis, 4 factors were identified as independent prognostic factors for survival rate, and they were Child-Pugh classification, number of tumors, pre-RFA AFP level, and portal vein hypertension. Totally, 548 RFA sessions were performed and major complications occurred in 12 sessions (2.1%). CONCLUSION This long-term follow-up study on a large group of HCC patients confirmed that RFA could achieve favorable outcome on HCC patients as first line treatment, especially for patients with child-Pugh class A, single tumor, low AFP level pre-RFA and without portal vein hypertension. CLINICAL RELEVANCE/APPLICATION This study provided evidence that RFA for early HCC was effective and safe as a first-line treatment even for patients usually considered good candidates for surgery.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: OBJECTIVE: To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) by comparison with conventional ultrasound (US) and contrast-enhanced CT (CECT) in solid pancreatic lesions. METHOD: Ninety patients with solid pancreatic focal lesions were enrolled, including 36 cases of pancreatic carcinoma, 28 cases of pancreatitis, 6 cases of pancreatic neuroendocrine tumor, 12 cases of solid pseudopapillary tumor of the pancreas, 6 cases of pancreatic metastases, 1 case of cavernous hemolymphangioma and 1 case of lymphoma. US and CEUS were applied respectively for the diagnosis of a total of 90 cases of solid pancreatic lesions. The diagnostic results were scored on a 5-point scale. Results of CEUS were compared with CECT. RESULTS: (1) 3-score cases (undetermined) diagnosed by CEUS were obviously fewer than that of US, while the number of 1-score (definitely benign) and 5-score (definitely malignant) cases diagnosed by CEUS was significantly more than that of US. There was a significant difference in the distribution of final scores using the two methods (p<0.001). The overall diagnostic accuracies of the 90 cases for CEUS and US were 83.33% and 44.44%, respectively, which indicated an obvious advantage for CEUS (p<0.001). (2) The diagnostic consistency among three ultrasound doctors: the kappa values calculated for US were 0.537, 0.444 and 0.525, compared with 0.748, 0.645 and 0.795 for CEUS. The interobserver agreement for CEUS was higher than that for US. (3) The sensitivity, specificity and accuracy of the diagnosis of pancreatic carcinoma with CEUS and CECT were 91.7% and 97.2%, 87.0% and 88.9%, and 88.9% and 92.2%, respectively, while for the diagnosis of pancreatitis, the corresponding indices were 82.1% and 67.9%, 91.9% and 100%, and 88.9% and 90%, respectively, showing no significant differences (p>0.05). CONCLUSION: CEUS has obvious superiority over conventional US in the general diagnostic accuracy of solid pancreatic lesions and in the diagnostic consistency among doctors. The performances of CEUS are similar to that of CECT in the diagnosis of pancreatic carcinoma and focal pancreatitis.
    European journal of radiology 05/2013; 82(9). DOI:10.1016/j.ejrad.2013.04.016 · 2.16 Impact Factor
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    ABSTRACT: To retrospectively investigate the role of contrast-enhanced ultrasonography (CEUS) in percutaneous radiofrequency ablation (RFA) in patients with liver metastases and evaluate the therapeutic efficacy of RFA assisted by CEUS. From May 2004 to September 2010, 136 patients with 219 liver metastatic lesions received CEUS examination 1 h before RFA (CEUS group), and other 126 patients with 216 lesions without CEUS examination in the earlier period were served as a historical control group. The mean tumor size was 3.2 cm and the mean tumor number was 1.6 in the CEUS group, while 3.4 cm and 1.7 in the control group, respectively (P>0.05). The clinical characteristics, recurrence results and survival outcomes were compared between two groups. In the CEUS group, two isoechoic tumors were not demonstrated on unenhanced ultrasonography (US), and 63 (47%) of 134 tumors examined with CEUS were 0.3 cm larger than with unenhanced US. Furthermore, in 18.4% of 136 patients, additional 1-3 tumors were detected on CEUS. The CEUS group showed higher early tumor necrosis and lower intrahepatic recurrence than the control group. The 3-year overall survival (OS) rate and the 3-year local recurrence-free survival (LRFS) rate in the CEUS group were 50.1% and 38.3%, in contrast to 25.3% and 19.3% in the control group, respectively (P=0.002 and P<0.001). CEUS provides important information for RFA treatment in patients with liver metastases and better therapeutic effect could be attained.
    Chinese Journal of Cancer Research 04/2013; 25(2):143-154. DOI:10.3978/j.issn.1000-9604.2013.01.02 · 0.93 Impact Factor
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    ABSTRACT: PURPOSE To investigate the role of enhancement patterns and time intensity curve (TIC) of contrast enhanced ultrasound (CEUS) in differential diagnosis of atypical hepatic inflammatory lesions and hepatocellular carcinoma (HCC). METHOD AND MATERIALS 37 consecutive cases of inflammatory liver lesions were suspected as malignancy by conventional US and underwent CEUS examination in our department. Of them, 23 cases with atypical perfusion pattern (enhancement in arterial phase) which mimic HCC feature were included in the study (inflammatory group). At the same period, 385 patients with HCC were also underwent CEUS. HCC group is comparatively large, thus 46 HCC patients were randomly selected to be the control group (HCC group). Each lesion was scanned with low-MI CEUS with SonoVue as the contrast agent. CEUS enhancement features and TIC parameters of the liver lesions were evaluated and compared. A stepwise logistic regression model was carried out using the CEUS findings as independent variables to determine the significant factors for differentiate inflammatory lesion from HCC. RESULTS Logistic regression analysis showed three significant factors in differential diagnosis for inflammatory lesions and HCC, including feeding vessel (P= 0.003), lesion margin at enhancing peak (P=0.005) and shape of internal necrotic area (P=0.015). Combined these three factors, the diagnosis sensitivity, specificity and accuracy were 91.3%, 93.5% and 92.7%, respectively. Quantitative analysis of TIC showed statistic significance between HCC and inflammatory lesions in lesion/parenchymal peak intensity/time difference, lesion accelerate time, curve ascending slope and area under curve, suggesting inflammatory lesions showed less-intense enhancement with took longer time to reach enhancing peak CONCLUSION Analysis of CEUS pattern and TIC provides important information for differentiating atypical inflammatory liver lesions and HCC, and is helpful for improves diagnostic accuracy and decrease unnecessary invasive diagnostic method. CLINICAL RELEVANCE/APPLICATION the diagnosis sensitivity, specificity and accuracy for atypical inflammatory liver lesions with CEUS were 91.3%, 93.5% and 92.7%.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: Hepatocellular carcinoma (HCC) often occurs in association with liver cirrhosis. A stepwise carcinogenesis for HCC has been proposed. The purpose of this study was to observe the enhancement pattern of hepatocellular nodules in cirrhotic patients using contrast-enhanced ultrasound (CEUS) and to correlate patterns of enhancement at CEUS with the diagnosis of hepatocellular nodules using pathologic correlation as the gold standard. Ninety-three cirrhotic patients with indeterminate hepatocellular nodules at ultrasound, underwent biopsy of each indeterminate nodule. Patients with nodules found to have pathologic diagnoses of regenerative nodules (RNs), dysplastic nodules (DNs), or DNs with focus of HCC (DN-HCC), were enrolled in this study. Enhancement patterns of all nodules were examined throughout the various vascular phases of CEUS and classified into five enhancement patterns: type I, isoenhancement to hepatic parenchyma at all phases; type II, hypoenhancement in the arterial phase, and isoenhancement in the portal venous phase and late phase; type III, iso-to-hypoenhancement in arterial and portal venous phase, and hypoenhancement in the late phase (washout); type IV, slight hyperenhancement in the arterial and portal venous phase and hypoenhancement in the late phase (washout); and type V, partial hyperenhancement in the arterial phase and hypoenhancement in the late phase; and another partial iso-to-hypoenhancement in the arterial and portal venous phase and hypoenhancement in the late phase (washout). The correlation between the contrast enhancement patterns and the pathological diagnoses was analyzed by the chi-squared test. Totally 132 lesions were examined with CEUS in 93 patients. Pathologic diagnoses included 45 DN, 68 RN, and 19 DN-HCC. The enhancement patterns observed were as follows: type I, 49 (37.1%); type II, 27 (20.5%); type III, 28 (21.2%); type IV, 9 (6.8%); type V, 19 (14.4%). Nodules with type I enhancement showed dysplasia in 5 (10.2%) cases; nodules with type II were dysplastic in 11 (40.7%) of cases; nodules with type III enhancement pattern were dysplastic in 22 (78.6%), and those with type IV enhancement contained dysplasia in 7 (77.8%) of cases. Type V enhancement corresponded to DN-HCC in 19 (100%) of cases. CEUS enhancement pattern was correlated with likelihood of dysplasia at pathologic analysis (Trend chi-square test, P < 0.001). Pathological diagnosis was HCC in the enhanced area and hepatocyte dysplasia in the un-enhanced area in the 19 DN-HCC. Pattern of enhancement at CEUS correlates with the pathologic diagnosis of hepatocellular nodules in liver cirrhosis, and may be helpful in predicting the progress from RN to HCC nodules.
    Chinese medical journal 09/2012; 125(17):3104-9. · 1.02 Impact Factor
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    ABSTRACT: To evaluate the efficacy of radiofrequency (RF) ablation for treatment of unresectable intrahepatic cholangiocarcinoma (ICC) and to explore the impact of prognostic variables on outcomes. From 2000-2010, 17 patients with 26 ICCs underwent RF ablation at a single institution. None of the patients were surgery candidates. Seven patients had 15 primary ICCs, and 10 patients had 11 recurrent ICCs. The median largest diameter was 4.4 cm (range 2.1-6.8 cm). A percutaneous approach was used in 15 patients, and an open approach was used in 2 patients. Early tumor necrosis, recurrence-free survival, and overall survival were analyzed. Univariate analysis was performed to evaluate 12 clinicopathologic and treatment-related variables associated with recurrence-free survival and overall survival. Early tumor necrosis was 96.2% (25 of 26 tumors). The median follow-up period after RF ablation was 29 months. The median recurrence-free survival and overall survival were 17 months and 33 months. The 1-year, 3-year, and 5-year survival rates were 84.6%, 43.3%, and 28.9%, with an overall complication rate of 3.6% (1 of 28 sessions). Three variables were found to be closely associated with recurrence-free survival: lymph node metastases (P = .023), tumor differentiation (P = .034), and tumor number (P = .035). The only variable significantly associated with overall survival was tumor differentiation (P = .033). Preliminary results showed that RF ablation may be an effective treatment for ICC because it achieved an acceptable survival rate in a small population. Prognostic factors might allow better patient selection and outcomes.
    Journal of vascular and interventional radiology: JVIR 05/2012; 23(5):642-9. DOI:10.1016/j.jvir.2012.01.081 · 2.15 Impact Factor
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    ABSTRACT: To retrospectively investigate the feasibility of radiofrequency ablation (RFA) in treating advanced hepatocellular carcinoma (HCC) using standard ultrasound-guided percutaneous RFA. A total of 655 patients with unresectable advanced HCC underwent ultrasound-guided percutaneous RFA therapy at our institution between July 2000 to September 2001. Ninety-two of those patients, representing 136 tumors, were selected for analysis based on the following criteria: presence of UICC/AJCC-TNM (6th edition) stage III and IV advanced HCC, (III: n=82 patients, with 126 tumors; IV: n=10 patients, with 10 tumors); extensive portal vein or inferior vena cava tumor thrombus; extrahepatic metastasis after surgical resection; and complete follow-up data. Follow-up consisted of enhanced computed tomography (CT) performed at one month post-RFA treatment, then every three months. Contrast-enhanced ultrasound (CEUS) was performed in 51 (55.4%) patients before RFA. The standard treatment using optimal strategies were applied in (72.8%) 67 patients. The established strategies included: (1) select RFA indications based on CEUS results; (2) design radical protocols based on invasive range showed by CEUS; (3) multiple overlapping ablations based on mathematical protocols; (4) two or three bipolar RFA electrodes with three-dimensional localization; (5) color ultrasound-guided percutaneous ablation of tumor feeding artery (PAA)/transcatheter arterial chemoembolization (TACE) + RFA for HCC with rich supply. The other 25 patients (27.2 %) were treated with conventional RFA protocols. The ablation procedure was considered a success if no abnormal enhancement or wash-out was detected in the treated area on the CT scan at one month. All patients had received liver protection treatments following RFA. Chi-squared test or Fisher's exact test were used to compare the early complete tumor necrosis rates and the local recurrence rates. Survival was estimated by Kaplan-Meier analysis and log-rank test. P less than 0.05 was considered statistically significant. The RFA-treated tumors ranged in size from 1.5 to 7.0 cm (average: 4.5 cm). Fifty-nine patients had solitary tumor, and the remaining 33 had multiple tumors (2 to 4 tumors). Patients were classified by Child-Pugh score as A (n=58), B (n=32) and C (n=2). Early complete tumor necrosis rate after initial RFA was 90.4% (123/136 tumors). Serious complications developed in two patients (2.2%). No treatment-related death occurred. Follow-up ranged from 3-134 months. Local recurrence rate was 16.9% (23/136 tumors). The 1-, 3- and 5-year overall survival rates were 83.3%, 48.3% and 21.9%, respectively, and the median survival time was 35 months. Stratification analysis indicated the early complete tumor necrosis rate was higher in groups of patients with Child-Pugh A score (98.3%) , CEUS administration (98.0%), and standard treatment (97.0%). The local recurrence rate was lower in groups of patients with tumors less than or equal to 3.0 cm (5.9%), CEUS administration (11.8%), and standard treatment (16.4%). The 5-year survival was significantly higher in patients with Child-Pugh A, tumors less than or equal to 3.0 cm, CEUS administration, and standard treatment (all, P less than 0.05). RFA treatment of patients with advanced HCC, tumors less than 7.0 cm, and without thrombosis in the main vessels was efficacious. The RFA treatment strategy and subsequent liver protection therapy in RFA may improve survival.
    Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 04/2012; 20(4):256-60.
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    ABSTRACT: To evaluate the effect of ultrasound-guided percutaneous radiofrequency ablation (RFA) in treating advanced hepatocellular carcinoma (HCC) and to analyze the prognostic factors. A total of 90 patients with unresectablely advanced HCC underwent percuatenous RFA therapy between July 2000 and June 2011 were enrolled into the study. According to the 6th UICC/AJCC-TNM system, 80 and 10 patients were in stage III and IV, respectively.78 patients were men and 12 patients were women. Ages ranged from 24 to 87 years old (mean ± SD, 59 ± 12 years). The tumor size ranged from 1.5 to 8.0 cm (mean ± SD, 4.5 ± 1.4 cm). The maximum tumor of 73 patients (81.1%) was larger than 3.0 cm. 31 patients (34.4%) had 2-4 tumors. The Child-Pugh classification of B and C were 32 patients (35.6%) altogether. By regular follow-up, enhanced CT combined with AFP was used to evaluate the effect after RFA. Kaplan-Meier model and Log-rank test were used in univariate analysis and Cox regression model was used in multivariate analysis to identify prognostic factors for survival. P < 0.05 was considered statistically significant difference. Complete tumor necrosis rate after initial RFA was 90.9% (120/132 tumors). Serious complications were developed in two patients (2.2%) and no treatment-related death occurred. 3 - 129 months were followed up. Local recurrence rate was 15.2% (20/132 tumors). The 1-, 3-, 5-year overall survival rates were 83.3%, 48.3%, 21.9%, respectively, and the median survival time was 35 months. The univariate analyses showed that patients with Child-Pugh classification of A, tumor less than 3.0 cm, applying CEUS, using standard treatment protocols, achieving complete tumor necrosis and without tumor recurrence survived longer (P < 0.05). Child-Pugh classification and the standard treatment protocols were identified as independent prognostic factors for survival by multivariate model (P = 0.001, P < 0.001). Paying attention to the following factors of CEUS, standard treatment protocols, initially complete tumor necrosis and liver protection therapy for patients with advanced HCC is helpful to improve the patients' survival.
    Zhonghua yi xue za zhi 03/2012; 92(11):735-8.
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    ABSTRACT: To investigate the application of contrast enhanced ultrasound (CEUS) in planning and guiding for radiofrequency ablation (RFA) for metastatic liver carcinoma (MLC). One hundred and thirty-five patients with clinically and pathologically diagnosed MLC (from gastrointestinal tumors) were included in the present study, and 104 of them had received CEUS prior to RFA to assess the number, size, shape, infiltration, location and enhancing features of the lesions. Among the 104 patients, 21 (20.1%) were excluded from RFA treatment due to too many lesions or large infiltrative range based on CEUS. The remaining 83 patients with 147 lesions underwent RFA (group A). During the same period, other 31 patients with 102 lesions serving as control group were treated based on findings of conventional ultrasound without contrast (group B). The patients underwent follow-up enhanced CT at the 1st month, and then every 3-6 months after RFA. The tumor was considered as early necrosis if no contrast enhancement was detected in the treated area on the CT scan at the 1st month. In group A, 72 of 147 MLC lesions (48.9%) showed increased sizes on CEUS. Among them, 48 lesions (66.6%) appeared enlarged in arterial phase, and 24 (33.3%) showed enlarged hypoechoic area in parenchymal phase. CEUS showed total 61 additional lesions in 35 patients (42.1%) (ranged from 8 to 15 mm) compared with conventional ultrasound (US), and 42 (68.8%) of them were visualized in parenchymal phase only. There were total 208 lesions in group A underwent RFA with CEUS planning, and the tumor necrosis rate was 94.2% (196/208). In this group, local recurrence was found in 16 lesions (7.7%) during 3-42 months' following up, and new metastases were seen in 30 cases (36.1%). For group B, the tumor necrosis rate was 86.3% (88/102), local recurrence in 17 lesions (16.7%), and new metastases in 13 cases (41.9%). Tumor early necrosis and recurrence rates were significantly different between the two groups (P=0.018, P=0.016, respectively). CEUS played an important role in RFA for liver metastases by candidate selecting and therapy planning, which helped to improve the outcome of the treatment.
    Chinese Journal of Cancer Research 03/2012; 24(1):44-51. DOI:10.1007/s11670-012-0044-8 · 0.93 Impact Factor
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    ABSTRACT: Most recurrent intrahepatic cholangiocarcinoma (RICC) lost the opportunity of radical resection while most nonsurgical management failed to prolong patients' survival. The efficacy and safety of radiofrequency ablation (RFA) as a local treatment for recurrent hepatocellular carcinoma have been confirmed by many clinical studies. The purpose of this study was to evaluate the efficacy, long-term survival and complications of RFA for RICC. A total of 12 patients with 19 RICCs after radical resection were included in this study. The tumors were 1.9-6.8 cm at the maximum diameter (median, 3.2±1.6 cm). All patients were treated with ultrasound guided RFA. There were two RFA approaches including percutaneous and open. A total of 18 RFA treatment sessions were performed. Ablation was successful (evaluated by 1-month CT after the initial RFA procedure) in 18 (94.7%) of 19 tumors. By a median follow-up period of 29.9 months after RFA, 5 patients received repeated RFA because of intrahepatic lesion recurrence. The median local recurrence-free survival period and median event-free survival period after RFA were 21.0 months and 13.0 months, respectively. The median overall survival was 30 months, and the 1- and 3-year survival rates were 87.5% and 37.5%, respectively. The complication rate was 5.6% (1/18 sessions). The only one major complication was pleural effusion requiring thoracentesis. This study showed RFA may effectively and safely manage RICC with 3-year survival of 37.5%. It provides a treatment option for these RICC patients who lost chance for surgery.
    Chinese Journal of Cancer Research 12/2011; 23(4):295-300. DOI:10.1007/s11670-011-0295-9 · 0.93 Impact Factor
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    ABSTRACT: Biliary injury after radiofrequency ablation can cause serious consequences including death. However, there are limited data regarding bile duct changes with or without complications associated with radiofrequency ablation of hepatic malignancies. This study aimed to assess the incidence, prognosis and risk factors of intrahepatic biliary injury associated with radiofrequency ablation. Between June 2001 and January 2009, 638 patients with hepatic malignancies (405 with hepatocellular carcinoma, and 233 with liver metastasis) who had 955 treatment sessions were enrolled in this study. Imaging and laboratory data, the course of treatment, and patient outcomes were reviewed retrospectively. The risk factors of biliary injury and the impact on overall survival of patients were analyzed. The chi-square test, Fisher's exact test, Kaplan-Meier curves and stepwise Logistic regression model were used for statistical analysis where appropriate. Biliary injury was observed in 17 patients after 17 ablation sessions based on imaging findings. The overall incidence of biliary injury was 1.8% (17/955) with an average onset time of 12 weeks (2-36 weeks). Mild, moderate and severe complications of biliary injury were identified in 9, 6 and 2 cases, respectively. The median survival time after detection of biliary injury was 40 months. There seemed no notable difference in overall survival between patients with and those without biliary injuries. By multivariate analysis, vessel infiltration (P = 0.034) and treatment session ≥ 4 times (P = 0.025) were independent risk factors for biliary injury of hepatocellular carcinoma; while tumor located centrally was the only independent risk factor in the metastasis group (P = 0.043). The incidence of biliary injury was not frequent (1.8%). Through appropriate treatment, intrahepatic bile duct injuries seemed not affect the patients' long-term survival. Additionally, risk factors may be helpful for selecting radiofrequency ablation candidates and predicting biliary complications.
    Chinese medical journal 07/2011; 124(13):1957-63. · 1.02 Impact Factor
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    ABSTRACT: To investigate the efficacy of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) according to standardized treatment strategy and individualized protocol. A total of 468 patients of HCC underwent ultrasound/Contrast-enhanced ultrasound guided RF ablation in our department according to individualized protocol for large tumors, hypervascular tumors and tumors located adjacent to important structures in our study, of which 22 HCCs having undergone palliative RF ablation were excluded because of huge size, diffusive multiple tumors or adjacent structures invasion. The remaining 446 HCCs (680 sessions) were included and followed-up regularly to assess treatment efficiency. Of the 446 patients, 367 were male and 79 were female. 828 lesions underwent RFA. The mean size of tumors was (3.6±1.4)cm. Regular follow-up was conducted for 3-119 months. In this study, long-term outcome of various refractory tumors were also investigated. The overall ablation success rate was 97%(803/828) 1 month after RFA. The recurrent rate was 7.2% (60/828). Base on Kaplan-Meier method, the 1-, 3- and 5-year overall survival rates after RF ablation were 85.3%, 61.3% and 47.0%, respectively. The ablation success rate of tumors larger than 3.5 cm was 90.8% (275/303). The 5-year survival rates of patients who had HCC for 3.1-5 cm and >5 cm were 45.1% and 35.9%, respectively. In this study, there were 40.3% (334/828) tumors located adjacent to important structures. The ablation success rates of these tumors located adjacent to gallbladder, diaphragm, bowel and major vessels were 93.5% (58/62), 92.5% (123/133), 92.4% (61/66) and 93.2% (68/73), respectively. The incidence of major complications was 3.1% (21/680), which included 5 intraperitoneal hemorrhages, 4 biliary injuries, 2 hemopleural effusions, 3 bowel perforations and 7 needle tract seedings. Treatment-related death occurred in 1 case of bowel perforation. In RF ablation of refractory HCC, application of standardized treatment strategy and individualized protocol plays important roles in improving ablation success rate and minimizing potential complications. It could extend the indications of RF ablation for HCC in China.
    Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 12/2010; 42(6):716-21.
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    ABSTRACT: PURPOSE To investigate the efficacy of radiofrequency ablation(RFA) for hepatocellular carcinoma(HCC) according to standardized treatment strategy and individualized protocol. METHOD AND MATERIALS A total of 723 patients(>1600 lesions) with liver malignancies underwent ultrasound/Contrast-enhanced ultrasound guided RFA in our department according to individualized protocol for large tumors, hypervascular tumors and tumors located adjacent to important structures. There were 473 cases of HCC. Among these tumors, 27 HCCs underwent palliative RF ablation were excluded because of huge size, diffusive multiple tumors or adjacent structures invasion. The remaining 446 HCCs(680 sessions) were included and followed-up regularly to assess treatment efficiency. In this study, long-term outcome of various refractory tumors were also investigated. RESULTS 466 HCCs(828 lesions) underwent RFA according to standardized treatment strategy and individualized protocol. Of the 466 patients, 367 were male and 79 were female. The mean size of tumors was 3.6±1.4cm. Regular follow up was conducted for 3-119 months. The overall ablation success rate was 97%(803/828) 1 month after RFA. The recurrent rate was 7.2%(60/828). Base on Kaplan-Meier method, the 1-, 3- and 5-year overall survival rates after RF ablation were 85.3%, 61.3% and 47.0%, respectively. The ablation success rate of tumors larger than 3.5cm was 90.8%(275/303). The 5-year survival rates of patients had HCC for 3.1~5cm and >5cm were 45.1% and 35.9%, respectively. In this study, there were 40.3%(334/828) tumors located adjacent to important structures. The ablation success rates of these tumors located adjacent to gallbladder, diaphragm, bowel and major vessels were 93.5%(58/62), 92.5%(123/133), 92.4%(61/66) and 93.2%(68/73), respectively. The incidence of major complications was 3.1%(21/680), which included of 5 intraperitoneal hemorrhages, 4 bile injuries, 2 hemopleural effusions, 3 bowel perforations and 7 needle tract seedings. Treatment-related death occurred in 1 case of bowel perforation. CONCLUSION In RF ablation of refractory HCC, application of standardized treatment strategy and individualized protocol play important roles in improving ablation success rate and minimizing potential complications. CLINICAL RELEVANCE/APPLICATION The application of standardized treatment strategy and individualized protocol play important roles in RFA of HCC.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting; 11/2010
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    ABSTRACT: Most HCC patients with decompensation of liver function lost the chance of surgical and/or interventional treatment. The aim of this study was to evaluate feasibility and outcome of radiofrequency ablation (RFA) in treating hepatocellular carcinoma (HCC) patients with poor liver function (Child-Pugh class C), who are not suitable for surgery or hepatic artery chemo-embolization. Thirteen HCC patients (the number of tumors was 17) with liver function of Child-Pugh C (scores: 10.2 +/- 0.4) were included in the study. Among the patients, 8 were male and 5 were female with the average age of (61.6 +/- 10.9) years old. The average size of HCC was (3.8 +/- 1.0) cm. Two patients were recurrent HCC and 30.8% of the patients had multiple tumors (2 - 3 tumors). All the patients were treated with RFA. There were 22 RFA sessions (1 - 4 sessions per patient) in all, average ablations per tumor at first session was 3.1. One week after RFA, the liver enzymes elevated in 9 patients (69.2%), in 7 of them, the liver enzyme returned to pre-RFA level in 1 - 3 months. One month after RFA, the Child-Pugh grading was 10.3 +/- 0.8 (Child-Pugh C), while that of pre-RFA was 10.2 +/- 0.4 (Child-Pugh C), with no significant difference. Computer tomography (CT) one month after RFA showed that the tumor necrosis rate was 88.2% (15/17). Five patients had 2 - 4 repeated RFA due to HCC recurrence. During the follow-up of 2- 69 months in this group, survival rate of one year was 53.8%, two years was 30.8%, and three year was 15.4%. The incidence of RFA-related complications was 13.6% (3/22 sessions), including 1 case of GI hemorrhage and 1 sub-capsular hemorrhage of the liver. One patient with HCC over 5 cm who had fever and liver abscess after RFA, and was dead 2 months later due to liver function failure. Minimal invasive RFA provides possible treatment modality for HCC patients with poor liver function, who are not candidates for surgical and/or interventional therapy. For large HCC, due to the required extended treatment region, special attention should be paid to the possibility of acute liver failure.
    Chinese medical journal 08/2010; 123(15):1967-72. · 1.02 Impact Factor
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    ABSTRACT: Limited donor sites of cartilage and dedifferentiation of chondrocytes during expansion, low tissue reconstruction efficiency, and uncontrollable immune reactions to foreign materials are the main obstacles to overcome before cartilage tissue engineering can be widely used in the clinic. In the current study, we developed a novel strategy to fabricate tissue-engineered trachea cartilage grafts using marrow mesenchymal stem cell (MSC) macroaggregates and hydrolyzable scaffold of polylactic acid-polyglycolic acid copolymer (PLGA). Rabbit MSCs were continuously cultured to prepare macroaggregates in sheet form. The macroaggregates were studied for their potential for chondrogenesis. The macroaggregates were wrapped against the PLGA scaffold to make a tubular composite. The composites were incubated in spinner flasks for 4 weeks to fabricate trachea cartilage grafts. Histological observation and polymerase chain reaction array showed that MSC macroaggregates could obtain the optimal chondrogenic capacity under the induction of transforming growth factor-beta. Engineered trachea cartilage consisted of evenly spaced lacunae embedded in a matrix rich in proteoglycans. PLGA scaffold degraded totally during in vitro incubation and the engineered cartilage graft was composed of autologous tissue. Based on this novel, MSC macroaggregate and hydrolyzable scaffold composite strategy, ready-to-implant autologous trachea cartilage grafts could be successfully fabricated. The strategy also had the advantages of high efficiency in cell seeding and tissue regeneration, and could possibly be used in future in vivo experiments.
    Artificial Organs 05/2010; 34(5):426-33. DOI:10.1111/j.1525-1594.2009.00884.x · 1.87 Impact Factor

Publication Stats

524 Citations
59.62 Total Impact Points

Institutions

  • 2011–2015
    • Peking University Cancer Hospital
      Peping, Beijing, China
  • 2004–2014
    • Peking University
      Peping, Beijing, China
  • 2005–2012
    • Beijing Cancer Hospital
      Peping, Beijing, China
  • 2008–2010
    • Northwest University
      Ch’ang-an, Shaanxi, China
    • Northwest University
      China, Maine, United States
  • 2007
    • Beijing University of Technology
      Peping, Beijing, China