Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long-term results and prognostic factors in a large single-institution series
The purpose of this study was to evaluate the long-term survival results and complications of percutaneous radiofrequency ablation (RFA) in patients with early-stage hepatocellular carcinoma (HCC). Between April 1999 and May 2005, 570 patients with 674 early-stage HCCs underwent percutaneous RFA as a first-line treatment option in a single institution. We evaluated the effectiveness rates, local tumor progression rates, survival rates, and complications. We also assessed the prognostic values of survival rates by using Cox proportional hazard models. The primary technique effectiveness rate was 96.7% (652 of 674). The cumulative rates of local tumor progression at 1, 2, and 3 years were 8.1%, 10.9%, and 11.8%, respectively. The cumulative survival rates at 1, 2, 3, 4, and 5 years were 95.2%, 82.9%, 69.5%, 60.8%, and 58.0%, respectively. Patients with Child-Pugh class A cirrhosis, of younger age (≤58 years), or having lower AFP level (≤100 μg/L) demonstrated better survival results (P < 0.05). A total of 11 major complications (1.9% per treatment) were found during the follow-up period. There was no procedure-related death. Percutaneous RFA can be used successfully as a first-line treatment modality for early-stage HCCs. Child-Pugh class, age, and AFP level before RFA were significant prognostic predictors of long-term survival.
KeywordsHepatocellular carcinoma Radiofrequency ablation Ultrasonography Survival Prognosis Complications
This study was supported by a Samsung Medical Center Clinical Research Development Program grant. We thank Sang Hee Han and Kyong Hee Lee at the Samsung Biomedical Research Institute for data collection.
- 7.Lencioni RA, Allgaier HP, Cioni D, Olschewski M, Deibert P, Crocetti L, Frings H, Laubenberger J, Zuber I, Blum HE, Bartolozzi C (2003) Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology 228(1):235–240PubMedGoogle Scholar
- 10.Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC (2005) Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut 54(8):1151–1156PubMedCrossRefGoogle Scholar
- 14.Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, Pagliaro L, Colombo M, Rodes J; EASL Panel of Experts on HCC (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35(3):421–430PubMedCrossRefGoogle Scholar
- 15.Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD 3rd, Dupuy DE, Gervais D, Gillams AR, Kane RA, Lee FT Jr, Livraghi T, McGahan J, Phillips DA, Rhim H, Silverman SG; Society of Interventional Radiology Technology Assessment Committee (2005) Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 235(3):728–739PubMedGoogle Scholar
- 16.Choi D, Lim HK, Kim SH, Lee WJ, Jang HJ, Lee JY, Paik SW, Koh KC, Lee JH (2000) Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: usefulness of power Doppler US with a microbubble contrast agent in evaluating therapeutic response-preliminary results. Radiology 217(2):558–563PubMedGoogle Scholar
- 27.Burdio F, Navarro A, Sousa R, Burdio JM, Guemes A, Gonzalez A, Cruz I, Castiella T, Lozano R, Berjano E, Figueras J, de Gregorio MA (2006) Evolving technology in bipolar perfused radiofrequency ablation: assessment of efficacy, predictability and safety in a pig liver model. Eur Radiol 16(8):1826–1834PubMedCrossRefGoogle Scholar
- 28.Vilana R, Bianchi L, Varela M, Nicolau C, Sanchez M, Ayuso C, Garcia M, Sala M, Llovet JM, Bruix J, Bru C; BCLC Group (2006) Is microbubble-enhanced ultrasonography sufficient for assessment of response to percutaneous treatment in patients with early hepatocellular carcinoma? Eur Radiol DOI 10.1007/s00330-006-0264-8