[Effect and prognostic analysis of radiofrequency ablation in treating advanced hepatocellular carcinoma]

Jie Wu, Min-hua Chen, Kun Yan, Wei Wu, Wei Yang
Zhonghua Yi Xue za Zhi [Chinese medical journal] 2012 March 20, 92 (11): 735-8

OBJECTIVE: To evaluate the effect of ultrasound-guided percutaneous radiofrequency ablation (RFA) in treating advanced hepatocellular carcinoma (HCC) and to analyze the prognostic factors.

METHODS: A total of 90 patients with unresectable advanced HCC underwent percutaneous 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.

RESULTS: 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).

CONCLUSION: 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.

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