Supplementary Material for: C-Arm Cone Beam Computed Tomography Guidance for Radiofrequency Ablation in Hepatocellular Carcinoma

<b><i>Objective:</i></b> To assess the usefulness of C-arm cone beam computed tomography (CBCT) combined with ultrasound for the treatment of hepatocellular carcinoma (HCC) by radiofrequency ablation (RFA). <b><i>Methods:</i></b> Patients underwent RFA following transcatheter arterial chemoembolization (TACE) or RFA alone under ultrasound or CBCT guidance combined with ultrasound-based techniques. They were divided into 2 groups based on the use (C group) and nonuse (NC group) of CBCT guidance. The technical success of RFA and local tumor progression after the first RFA session were evaluated by dynamic contrast-enhanced imaging methods. Between-group differences were assessed retrospectively. <b><i>Results:</i></b> We enrolled 198 patients with 260 HCC nodules. The complete ablation rates were 63.0 and 89.4% in the NC and C groups, respectively. In log-rank testing, local tumor progression occurred significantly more often in the NC group when RFA was used without TACE, in males when des-gamma-carboxy prothrombin was ≥29 mAU/mL, and when the diameter of a nodule was ≥18 mm. On Cox proportional-hazards regression analysis, the NC group, RFA alone without TACE, and male gender were significant independent variables. <b><i>Conclusion:</i></b> TACE followed by RFA under CBCT and ultrasound guidance improves the reliability of ablation of target HCC nodules, reduces the need for additional treatment sessions, and prevents local tumor progression.<b><i>研究目的：</i></b> 评估C臂锥形束计算机断层扫描（C-arm cone beam computed tomography, CBCT）联合超声用于肝细胞癌（hepatocellular carcinoma, HCC）射频消融术（radiofrequency ablation, RFA）治疗的临床价值。<b><i>方法：</i></b> 受试者分别接受经导管动脉化疗栓塞术（transcatheter arterial chemoembolization, TACE）联合射频消融术，或单纯射频消融术，术中采用超声引导，或CBCT联合超声引导技术。根据是否使用CBCT引导将受试者分为CBCT组（C组）与非CBCT组（NC组）。采用动态增强成像方法评估首次射频消融术后的技术成功率与局部肿瘤进展情况。本研究为回顾性分析，比较两组间的差异。<b><i>结果：</i></b> 本研究共纳入198例患者，共计260个HCC结节。非CBCT组与CBCT组的完全消融率分别为63.0%与89.4%。对数秩检验（log-rank testing）显示，在未联合TACE的单纯射频消融场景下、男性且脱γ-羧基凝血酶原（des-gamma-carboxy prothrombin）水平≥29 mAU/mL时，以及结节直径≥18 mm时，非CBCT组的局部肿瘤进展发生率显著更高。经Cox比例风险回归分析（Cox proportional-hazards regression analysis）显示，非CBCT组、未联合TACE的单纯射频消融术以及男性性别为独立危险因素。<b><i>结论：</i></b> 采用CBCT联合超声引导行经导管动脉化疗栓塞术后射频消融术，可提升目标HCC结节的消融可靠性，减少额外治疗次数，并预防局部肿瘤进展。