Elsevier

Surgical Oncology

Volume 17, Issue 1, July 2008, Pages 23-31
Surgical Oncology

REVIEW
Risk factors of survival after percutaneous radiofrequency ablation of hepatocellular carcinoma

https://doi.org/10.1016/j.suronc.2007.08.002Get rights and content

Summary

Aims

This study aimed to determine the risk factors of survival in patients with hepatocellular carcinoma (HCC) undergoing percutaneous radiofrequency ablation (PRFA).

Patients and methods

Between August 1999 and May 2005, 281 patients (250 males and 31 females) who were 33–80 years old (mean 65.3 years) received PRFA only or PRFA in combination with percutaneous ethanol injection (PEI) in our center. Patients were treated with PRFA or PEI by a percutaneous approach with ultrasound (US) guidance and were evaluated at regular intervals to determine disease recurrence and survival. The survival curves were constructed by the Kaplan–Meier method and compared by the log-rank test. The relative significance of the variables in the risk factors of overall survival was assessed by multivariate Cox proportional hazards regression analysis.

Results

At the end of the study, 189 patients were alive, and 92 were dead. Median survival was 48.7 months. The overall 1-, 3-, and 5-year survival rates were 89%, 54%, and 43%, respectively. The overall 1-, 3-, and 5-year survival rates for small tumor (size ⩽3 cm) were 97.8%, 65.7%, 58.6%, respectively, for medium tumor (size 3.1–5 cm) 94.1%, 57.1%, 37.1%, respectively, and for large tumor (size >5 cm) 62.8%, 40.3%, 0%, respectively. Survival of patients treated with PRFA was dependent on tumor size (p<0.001; risk ratio [RR] 9.6, 95% CI 5.2–17.8), number of tumors (p=0.003; RR 1.6, 95% CI 1.2–2.0), combination with PEI (p=0.01; RR 0.6, 95% CI 0.4–0.9), Child-Pugh class (p=0.002; RR 2.0, 95% CI 1.3–3.0) and safety margin (p=0.0026; RR 0.6, 95% CI 0.4–0.9).

Conclusions

PRFA is an effective treatment for HCC. This study showed after PRFA, tumor size, number of tumors, combination with PEI, safety margin, and Child-Pugh class were independent risk factors of survival.

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.

Section snippets

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

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  • Cited by (0)

    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.

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