Radiofrequency Ablation for Hepatocellular Carcinoma: 10-Year Outcome and Prognostic Factors

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
The American Journal of Gastroenterology (Impact Factor: 10.76). 12/2011; 107(4):569-77; quiz 578. DOI: 10.1038/ajg.2011.425
Source: PubMed


Radiofrequency ablation (RFA) is widely performed for hepatocellular carcinoma (HCC). However, there has been no report on 10-year outcome of RFA. The objective of this study was to report a 10-year consecutive case series at a tertiary referral center.
We performed 2,982 RFA treatments on 1,170 primary HCC patients and analyzed a collected database.
Final computed tomography images showed complete tumor ablation in 2,964 (99.4%) of 2,982 treatments performed for the 1,170 primary HCC patients. With a median follow-up of 38.2 months, 5- and 10-year survival rates were 60.2% (95% confidence interval (CI): 56.7-63.9%) and 27.3% (95% CI: 21.5-34.7%), respectively. Multivariate analysis demonstrated that age, antibody to hepatitis C virus (anti-HCV), Child-Pugh class, tumor size, tumor number, serum des-γ-carboxy-prothrombin (DCP) level, and serum lectin-reactive α-fetoprotein level (AFP-L3) were significantly related to survival. Five- and 10-year local tumor progression rates were both 3.2% (95% CI: 2.1-4.3%). Serum DCP level alone was significantly related to local tumor progression. Five- and 10-year distant recurrence rates were 74.8% (95% CI: 71.8-77.8%) and 80.8% (95% CI: 77.4-84.3%), respectively. Anti-HCV, Child-Pugh class, platelet count, tumor size, tumor number, serum AFP level, and serum DCP level were significantly related to distant recurrence. There were 67 complications (2.2%) and 1 death (0.03%).
RFA could be locally curative for HCC, resulting in survival for as long as 10 years, and was a safe procedure. RFA might be a first-line treatment for selected patients with early-stage HCC.

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Available from: Ryosuke Tateishi, Mar 28, 2014
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    • "Our findings showed that the independent predictive factors for overall survival were Child-Pugh class, the pattern of recurrent HCC after TACE (residual or newly developed), and the level of serum AFP in patients with RFA for recurred HCC after TACE. Several studies regarding RFA as the first-line treatment revealed that age, antibody to hepatitis C virus, Child-Pugh class, prothrombin time, tumor size, tumor number, tumor location, and serum tumor marker are related to overall survival.5,6,17 Meanwhile serum AFP, ablated and resected tumor size, serum albumin, and the duration between initial hepatectomy and tumor recurrence were associated with overall survival in the patients with RFA for recurred HCC after surgical resection.8,16 "
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    ABSTRACT: Background/Aims The role of radiofrequency ablation (RFA) remains uncertain in patients with viable hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE). Methods A total of 101 patients (April 2007 to August 2010) underwent RFA for residual or recurrent HCC after TACE. We analyzed their long-term outcomes and predictive factors. Results The overall survival rates after RFA were 93.1%, 65.4%, and 61.0% at 1, 3, and 5 years, respectively. Predictive factors for favorable overall survival were Child-Pugh class A (hazard ratio [HR], 3.45; p=0.001), serum α-fetoprotein (AFP) level <20 ng/mL (HR, 2.90; p=0.02), and recurrent tumors after the last TACE (HR, 3.14; p=0.007). The cumulative recurrence-free survival rate after RFA at 6 months was 50.1%. Predictive factors for early recurrence (within 6 months) were serum AFP level 20 ng/mL (HR, 3.02; p<0.001), tumor size 30 mm at RFA (HR, 2.90; p=0.005), and nonresponse to the last TACE (HR, 2.13; p=0.013). Conclusions Patients with recurrent or residual HCC who undergo prior TACE show a favorable overall survival, although their tumors seem to recur early and frequently. While good liver function, a low serum AFP level, and recurrent tumors were independent predictive factors for a favorable overall survival, poor response to TACE, a high serum AFP level, and large tumors are associated with early recurrence.
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    • "Shiina et al. conducted a large single-center retrospective study involving 1170 HCC patients [269 (23.0%) >75 years old] who underwent RFA 76. In their multivariate analysis, increasing age was significantly associated with OS [HR, 1.03; 95% confidence interval (CI), 1.02-1.04; "
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    • "Practice guideline on “Management of hepatocellular carcinoma (HCC)” [15] and its update are the widely recognized guideline for the diagnosis and treatment for HCC [16–18]. To achieve the best outcomes requires the careful selection of candidates for each treatment option [6]. "
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