Pretreatment microbubble-induced enhancement in hepatocellular carcinoma predicts intrahepatic distant recurrence after radiofrequency ablation.
ABSTRACT The purpose of this study is to examine whether pretreatment findings in hepatocellular carcinoma (HCC) using contrast-enhanced ultrasound can predict local or distant recurrence after radiofrequency ablation (RFA).
Subjects of the prospective study were 54 patients with HCC lesions treated by RFA. Intensity differences between lesion and liver parenchyma at early arterial (4 seconds) and peak enhancement times and washout at late phase were provided on contrast-enhanced sonograms with perflubutane microbubble agent. The pretreatment findings were examined with respect to intrahepatic local and distant recurrence.
Univariate analysis showed that intensity differences at the early arterial time (hazard ratio [HR], 2.2; 95% CI, 1.0-4.6; p = 0.042) and lesion frequency (HR, 2.3; 95% CI, 1.0-5.0; p = 0.044) were risk factors for distant recurrence. Multivariate analysis showed that intensity differences at the early arterial time (HR, 2.7; 95% CI, 1.2-5.8; p = 0.014) and lesion frequency (HR, 2.9; 95% CI, 1.3-6.5; p = 0.015) were risk factors for distant recurrence. The cumulative distant recurrence rate for patients with intensity differences at the early arterial time was greater at less than 10 dB than at 10 dB or higher (33.3% and 91.3% vs 23.9% and 65.1% at 1 and 2 years, respectively; p = 0.035). The cumulative distant recurrence rate was 16.5% and 61.1% at 1 and 2 years, respectively, in patients with solitary lesions and 54.7% and 77.4% at 1 and 2 years, respectively, in patients with multiple lesions (p = 0.0296). No pretreatment findings were predictive for local recurrence.
HCC lesions with gradual enhancement in the early arterial time displayed potential distant recurrence risk after RFA, requiring careful posttreatment surveillance.
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ABSTRACT: The recurrence of hepatocellular carcinoma, the sixth most common neoplasm and the third leading cause of cancer-related mortality worldwide, represents an important clinical problem, since it may occur after both surgical and medical treatment. The recurrence rate involves 2 phases: an early phase and a late phase. The early phase usually occurs within 2 years after resection; it is mainly related to local invasion and intrahepatic metastases and, therefore, to the intrinsic biology of the tumor. On the other hand, the late phase occurs more than 2 years after surgery and is mainly related to de novo tumor formation as a consequence of the carcinogenic cirrhotic environment. Since recent studies have reported that early and late recurrences may have different risk factors, it is clinically important to recognize these factors in the individual patient as soon as possible. The aim of this review was, therefore, to identify predicting factors for the recurrence of hepatocellular carcinoma, by means of invasive and non-invasive methods, according to the different therapeutic strategies available. In particular the role of emerging techniques (e.g., transient elastography) and biological features of hepatocellular carcinoma in predicting recurrence have been discussed. In particular, invasive methods were differentiated from non-invasive ones for research purposes, taking into consideration the emerging role of the genetic signature of hepatocellular carcinoma in order to better allocate treatment strategies and surveillance follow-up in patients with this type of tumor.