Radiofrequency ablation for intrahepatic recurrent hepatocellular carcinoma: long-term results and prognostic factors in 168 patients with cirrhosis

Dong Ho Lee, Jeong Min Lee, Jae Young Lee, Se Hyung Kim, Joon Koo Han, Byung Ihn Choi
Cardiovascular and Interventional Radiology 2014, 37 (3): 705-15

PURPOSE: To analyze the clinical outcome of radiofrequency ablation (RFA) for recurrent intrahepatic hepatocellular carcinoma (HCC) after variable first-line treatment.

MATERIALS AND METHODS: From January 2006 to December 2007, 168 consecutive patients (133 male, 35 female; mean age 66.7 ± 10.1 years) with cirrhosis (Child-Pugh class A/B [146/22]) who underwent RFA for treatment for recurrent intrahepatic HCC ≤5 cm, and in up to three nodules (214 HCCs; mean diameter 20.8 ± 7.5 mm; 38 multinodular forms), were included. Univariate and multivariate analyses for potential clinical, tumor-related, and radiologic factors affecting overall and recurrence-free patient survival were performed using the Cox proportional hazard model.

RESULTS: Major complications occurred in 5 patients (5 of 168, 3.0 %), although there were no procedure-related deaths. Complete ablation was achieved in 161 patients (161 of 168, 95.8 %). After a mean follow-up period of 4 ± 21 months, local tumor progression, distant intrahepatic recurrence, and extrahepatic metastasis occurred in 22, 132, and 41 patients, respectively. Overall 5-year survival and recurrence-free survival were 48.0 and 11.9 %, respectively. Significant predicting factors for overall patient survival were Child-Pugh class B (relative risk [RR] = 4.52, 95 % confidence interval [CI] 1.97-10.34; P < 0.001), serum alpha-fetoprotein (AFP) level (RR = 1.01, 95 % CI 1.01-1.01; P < 0.001), number of HCC nodules (RR = 1.70, 95 % CI 1.04-2.76; P = 0.033), tumor size (RR = 1.40, 95 % CI 1.07-1.83; P = 0.014), and presence of portosystemic collaterals (RR = 1.78, 95 % CI 1.09-2.92; P = 0.022).

CONCLUSION: RFA is a safe and effective treatment modality for recurrent intrahepatic HCC and has a 5-year survival rate of 48.0 %. Serum AFP level, Child-Pugh class, tumor number and size, and presence of portosystemic collaterals significantly affect overall patient survival.

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