Percutaneous Irreversible Electroporation: Long-term survival analysis of 71 patients with inoperable malignant hepatic tumors

C Niessen, S Thumann, L Beyer, B Pregler, J Kramer, S Lang, A Teufel, E M Jung, C Stroszczynski, P Wiggermann, C Niessen, S Thumann, L Beyer, B Pregler, J Kramer, S Lang, A Teufel, E M Jung, C Stroszczynski, P Wiggermann

Abstract

Aim of this retrospective analysis was to evaluate the survival times after percutaneous irreversible electroporation (IRE) in inoperable liver tumors not amenable to thermal ablation. 71 patients (14 females, 57 males, median age 63.5 ± 10.8 years) with 103 liver tumors were treated in 83 interventions using IRE (NanoKnife® system). The median tumor short-axis diameter was 1.9 cm (minimum 0.4 cm, maximum 4.5 cm). 35 patients had primary liver tumors and 36 patients had liver metastases. The Kaplan-Meier method was employed to calculate the survival rates, and the different groups were compared using multivariate log-rank and Wilcoxon tests. The overall median survival time was 26.3 months; the median survival of patients with primary land secondary liver cancer did not significantly differ (26.8 vs. 19.9 months; p = 0.41). Patients with a tumor diameter >3 cm (p < 0.001) or more than 2 lesions (p < 0.005) died significantly earlier than patients with smaller or fewer tumors. Patients with hepatocellular carcinoma and Child-Pugh class B or C cirrhosis died significantly earlier than patients with Child-Pugh class A (p < 0.05). Patients with very early stage HCC survived significantly longer than patients with early stage HCC with a median survival of 22.3 vs. 13.7 months (p < 0.05).

Conflict of interest statement

The authors declare no competing financial interests.

Figures

Figure 1. 52-year-old patient with hepatocellular carcinoma.
Figure 1. 52-year-old patient with hepatocellular carcinoma.
Pre-interventional computed tomography for intervention planning: arterial hypervascularized mass on the transition to liver segment I posterior to the main stem of the portal vein.
Figure 2
Figure 2
Same patient as in Fig. 1: pre-interventional MRI with liver-specific contrast agent (Gd-EOB-DTPA): (a) Hyperintense visualization of the HCC (arrow) in native fat-saturated T2-weighted sequence posterior to the main stem of the portal vein at the transition to liver segment I. (b) Dynamic T1-weighted fat-saturated sequence after contrast in arterial phase shows sluggish arterial hypervascularization of the HCC (arrow).(c) Dynamic T1-weighted fat-saturated sequence after contrast in portal venous phase shows the directly adjacent main stem of the portal vein (tip of arrow). (d) T1-weighted fat-saturated sequence in hepatobiliary phase with wash-out (arrow).
Figure 3. Same patient as in Figs…
Figure 3. Same patient as in Figs 1 and 2 with HCC.
Control CT during irreversible electroporation of HCC mass posterior to the main stem of the portal vein. The intervention required the patient to be placed in prone position in order to insert the 3 electrodes (tips of arrows).
Figure 4. Same patient as in Figs…
Figure 4. Same patient as in Figs 1, 2 and 3 with HCC.
The post-interventional control CT the day after the intervention shows hypodense demarcation of the ablation defect (arrow), and the adjacent portal vein (tips of arrows) is thoroughly contrasted. No post-interventional complications.
Figure 5
Figure 5
Same patient as in Figs 1, 2, 3 and 4: Follow-up 2 years post-intervention: (a) Native, fat-saturated T2 sequence: cicatricial changes after IRE ablation with distinct shrinkage of the ablation defect. (b) Dynamic, fat-saturated T2 sequence after contrast: in arterial phase no indication of arterial hypervascularization (arrow), no indication of recurrence. (c) Dynamic fat-saturated T1 sequence after contrast: in portal venous phase continued full contrast of portal vein (tip of arrow). (d) Follow-up CT in the portal venous phase with full contrast of portal vein (tip of arrow) and distinct shrinkage of the hypodense ablation defect 2 years post-IRE (arrow).
Figure 6
Figure 6
Kaplan-Meier curves: (A) The solid line shows the survival time for patients with primary liver tumors (hepatocellular and cholangiocellular carcinoma); the dashed line illustrates the survival time of patients with liver metastases. The survival time of both groups did not exhibit a significant difference. (B) The Kaplan-Meier survival curves show significantly better survival for patients with fewer than 3 tumors (solid line) when compared with patients with 3 or more tumors (dotted line). (C) Compared to patients with a tumor diameter greater than 3 cm (dashed line), the Kaplan-Meier survival curves show significantly better survival for patients with a short axis diameter less than 3 cm (solid line).
Figure 7
Figure 7
The Kaplan-Meier survival curves for patients with hepatocellular carcinoma: (A) significantly better survival of patients with Child-Pugh class A cirrhosis of the liver (solid line) compared to those with Child-Pugh class B (dashed line) and C (dotted line). (B) Significantly longer survival of patients with very early stage HCC (dashed line) according to the BCLC classification compared to patients with early stage HCC (solid line).

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