REVIEWRisk factors of survival after percutaneous radiofrequency ablation of hepatocellular carcinoma☆
Introduction
Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world [1]. Although the majority of cases are still found in Asia and Africa, recent evidence has shown that the incidence and mortality rate of HCC are rising in North America and Europe [2], [3]. The 2005 guidelines of the American Association for the Study of Liver Disease (AASLD) for HCC [4] state that surgical resection can be offered to patients with a solitary lesion if they are non-cirrhotic, or have cirrhosis but still have well-preserved liver function. Liver transplantation is an effective option for patients with a solitary lesion ⩽5 cm or up to three lesions, each <3 cm in diameter. Local ablation is a safe and effective therapy for patients who cannot undergo resection, or as a bridge to transplantation. However, surgical resection is the treatment of choice for only ∼5% of western patients and ∼40% of Asian patients [5], [6], and liver transplantation is limited due to donor shortage and long waiting lists [4], [7].
In the past two decades, percutaneous radiofrequency ablation (PRFA) has emerged as a new treatment modality and has attracted great interest because of its effectiveness and safety for small HCC (⩽5.0 cm) [8], with a 3-year survival rate of 62–68%, a low treatment complication rate of 8–9%, and a low treatment mortality of 0–0.5% [9], [10], [11]. Studies describing the impact of this technique on the long-term outcome of patients, especially studies focusing on the major risk factors of survival, are rare [12], [13]. In these studies: TNM cancer stage, the operative approach method employed for radiofrequency ablation (RFA), Child-Pugh class and alpha-fetoprotein (AFP) level were the risk factors of survival. The purpose of our analysis was to define these risk factors, thereby identifying the subgroup of individuals that may benefit most from therapy.
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Materials and methods
This study was approved by the Ethical Committee of the Cancer Center of the Sun Yat-sen University. Written informed consent was obtained before entrance into the study.
Results
The demographic, clinical, and surgical characteristics of the patients are given in Table 1. No major complications occurred during any of the PRFA sessions, although there were minor transient side effects (fever, local abdominal pain, nausea, and emesis). We performed a total of 352 PRFA sessions (range, 1–3; mean 1.3). Overall, 257 of 281 (91.5%) patients achieved primary technique effectiveness. Twenty-four patients in whom PRFA failed underwent TACE. All responses observed by CT scan at 4
Discussion
PRFA was introduced in Italy for treatment of HCC in the late 1980s by Rossi [21], and the first clinical study was reported in 1995. They used PRFA for small HCC (less than 3 cm), and a long follow-up result was reported in 1996 [22]. In the past two decades, PRFA has emerged as a new treatment modality and has attracted great interest. An intent-to-treat study of 187 patients who were excluded from liver resection and were treated with radiofrequency ablation (RFA) as primary treatment for HCC
References (41)
- et al.
Increase in primary liver cancer in the UK 1979–94
Lancet
(1997) - et al.
Hepatocellular carcinoma
Lancet
(2003) Liver transplantation for hepatocellular carcinoma
Gastroenterology
(2004)- et al.
Clinical management of hepatocellular carcinoma: conclusions of the Barcelona 2000 EASL conference. European Association for the Study of the Liver
J Hepatol
(2001) - et al.
Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors
J Vasc Interv Radiol
(2003) - et al.
Percutaneous radiofrequency thermal ablation of hepatocellular carcinoma: a safe and effective bridge to liver transplantation
Liver Transpl
(2002) The evolution of pathologic features of hepatocellular carcinoma
- et al.
Factors affecting long term outcome after hepatic resection for hepatocellular carcinoma
Am J Surg
(1995) - et al.
Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinoma
Surgery
(2000) - et al.
Percutaneous ethanol injection for small hepatocellular carcinoma: therapeutic efficacy based on 20-year observation
J Hepatol
(2005)
Epidemiology of primary liver cancer
Semin Liver Dis
Rising incidence of hepatocellular carcinoma in the United States
N Engl J Med
Management of hepatocellular carcinoma
Hepatology
Hepatic resection for hepatocellular carcinoma. An audit of 343 patients
Ann Surg
Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future
Ann Surg
Radiofrequency ablation of malignant liver tumors
Oncologist
Complications of radiofrequency coagulation of liver tumours
Br J Surg
A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma
Ann Surg
Long-term follow-up outcome of patients undergoing radiofrequency ablation for unresectable hepatocellular carcinoma
World J Surg
Predictors of survival after laparoscopic radiofrequency thermal ablation of hepatocellular cancer: a prospective study
Surg Endosc
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Financial Support: This study is supported by the grant of Sciences and Technology Committee of Guangdong Province, 2002 China and Sciences and Technology Committee of Guangzhou City, 2002 China.