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Radiofrequency ablation of subcapsular versus nonsubcapsular hepatocellular carcinomas ≤ 3 cm: analysis of long-term outcomes from two large-volume liver centers

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare the safety and efficacy of RFA for single HCCs ≤ 3 cm in subcapsular versus nonsubcapsular locations using a propensity score matched analysis.

Materials and methods

This retrospective study included patients with solitary HCCs ≤ 3 cm in size who underwent percutaneous RFA from 2005 to 2015 as initial treatment at two large-volume liver centers. Patients were divided into two groups, consisting of those with subcapsular and nonsubcapsular tumor locations. Complications, local tumor progression (LTP), and overall survival (OS) were compared in these two groups before and after propensity score matching (PSM).

Results

The study population consisted of 964 patients (712 men [74%]) of mean age 58.3 years. Of these 964 patients, 561 (58%) had nonsubcapsular and 403 (42%) had subcapsular HCCs. PSM generated 402 pairs of patients. Major complication rate was low, but significantly higher in the subcapscular group (p = 0.047). Rates of technical effectiveness in these two groups were 99% and 98%, respectively (p = 0.315). However, during follow-up, cumulative 1-, 3-, 5-, and 10-year LTP and OS rates did significantly differ in both entire and PSM cohorts, resulting in the latter 8%, 15%, 20%, and 26% in the nonsubcapsular group vs. 13%, 24%, 30%, and 31% in the subcapsular group (p = 0.015), and 99%, 91%, 80%, and 59% vs. 98%, 85%, 73%, and 50% in the two groups (p = 0.004), respectively.

Conclusion

Rates of major complications, LTP, and OS differed significantly following first-line RFA treatment of single HCCs ≤ 3 cm in favor of the nonsubcapsular locations.

Clinical relevance statement

This large-scale study provides evidence that radiofrequency ablation for small (≤ 3 cm) hepatocellular carcinomas is safer and more effective in nonsubcapsular location than in subcapsular location.

Key Points

• There exist conflicting outcomes on the effectiveness of RFA for early HCC depending on tumor location.

• Rate of local tumor progression was significantly higher in the subcapsular hepatocellular carcinomas.

• Overall survival rate was significantly poorer in the subcapsular hepatocellular carcinomas.

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Abbreviations

AFP:

Alpha-feto protein

CI:

Confidence interval

ECOG PS:

Eastern Cooperative Oncology Group performance status

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HR:

Hazard ratio

IQR:

Interquartile range

LTP:

Local tumor progression

OS:

Overall survival

PSM:

Propensity score matching

RFA:

Radiofrequency ablation

SMD:

Standardized mean difference

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea

    Kichang Han, Sungmo Moon, Joon Ho Kwon & Gyoung Min Kim

  2. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea

    Jin Hyoung Kim, Gun Ha Kim, Ji Hoon Kim, So Yeon Kim, Seong Ho Park, So Jung Lee, Hyung Jin Won & Yong Moon Shin

Authors
  1. Kichang Han
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Corresponding author

Correspondence to Jin Hyoung Kim.

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Guarantor

The scientific guarantor of this publication is Jin Hyoung Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Two of the authors (Gun Ha Kim, Seong Ho Park) have significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

This study protocol was reviewed and approved by the Institutional Review Boards of Asan Medical Center (IRB No.2022-1094) and Severance Hospital (IRB No.2022-3387-001).

Study subjects or cohorts overlap

There is no patient overlap in this study.

Methodology

• retrospective

• observational

• multicenter study

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Han, K., Kim, J.H., Kim, G.H. et al. Radiofrequency ablation of subcapsular versus nonsubcapsular hepatocellular carcinomas ≤ 3 cm: analysis of long-term outcomes from two large-volume liver centers. Eur Radiol 34, 1578–1586 (2024). https://doi.org/10.1007/s00330-023-10165-6

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  • DOI: https://doi.org/10.1007/s00330-023-10165-6

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