European Radiology

, Volume 17, Issue 3, pp 684–692 | Cite as

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

  • Dongil Choi
  • Hyo K. Lim
  • Hyunchul Rhim
  • Young-sun Kim
  • Won Jae Lee
  • Seung Woon Paik
  • Kwang Cheol Koh
  • Joon Hyoek Lee
  • Moon Seok Choi
  • Byung Chul Yoo


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.


Hepatocellular 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.


  1. 1.
    Okuda K (1992) Hepatocellular carcinoma: recent progress. Hepatology 15(5):948–963PubMedGoogle Scholar
  2. 2.
    Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362(9399):1907–1917PubMedCrossRefGoogle Scholar
  3. 3.
    Song TJ, Ip EW, Fong Y (2004) Hepatocellular carcinoma: current surgical management. Gastroenterology 127(5 Suppl 1):248–260CrossRefGoogle Scholar
  4. 4.
    Llovet JM, Fuster J, Bruix J (1999) Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 30(6):1434–1440PubMedCrossRefGoogle Scholar
  5. 5.
    Jansen MC, van Hillegersberg R, Chamuleau RA, van Delden OM, Gouma DJ, van Gulik TM (2005) Outcome of regional and local ablative therapies for hepatocellular carcinoma: a collective review. Eur J Surg Oncol 31(4):331–347PubMedCrossRefGoogle Scholar
  6. 6.
    Shibata T, Iimuro Y, Yamamoto Y, Maetani Y, Ametani F, Itoh K, Konishi J (2002) Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy. Radiology 223(2):331–337PubMedGoogle Scholar
  7. 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
  8. 8.
    Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC (2004) Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or =4 cm. Gastroenterology 127(6):1714–1723PubMedCrossRefGoogle Scholar
  9. 9.
    Shiina S, Teratani T, Obi S, Sato S, Tateishi R, Fujishima T, Ishikawa T, Koike Y, Yoshida H, Kawabe T, Omata M (2005) A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology 129(1):122–130PubMedCrossRefGoogle Scholar
  10. 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
  11. 11.
    Buscarini L, Buscarini E, Di Stasi M, Vallisa D, Quaretti P, Rocca A (2001) Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long term results. Eur Radiol 11(6):914–921PubMedCrossRefGoogle Scholar
  12. 12.
    Lencioni R, Cioni D, Crocetti L, Franchini C, Pina CD, Lera J, Bartolozzi C (2005) Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 234(3):961–967PubMedGoogle Scholar
  13. 13.
    Tateishi R, Shiina S, Teratani T, Obi S, Sato S, Koike Y, Fujishima T, Yoshida H, Kawabe T, Omata M (2005) Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer 103(6):1201–1209PubMedCrossRefGoogle Scholar
  14. 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. 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. 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
  17. 17.
    Choi D, Lim HK, Lee WJ, Kim SH, Kim MJ, Kim SK, Jang KM, Lee JY, Lim JH (2004) Radiofrequency ablation of liver cancer: early evaluation of therapeutic response with contrast-enhanced ultrasonography. Korean J Radiol 5(3):185–198PubMedCrossRefGoogle Scholar
  18. 18.
    Lim HK, Choi D, Lee WJ, Kim SH, Lee SJ, Jang HJ, Lee JH, Lim JH, Choo IW (2001) Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: evaluation with follow-up multiphase helical CT. Radiology 221(2):447–454PubMedGoogle Scholar
  19. 19.
    Livraghi T, Festi D, Monti F, Salmi A, Vettori C (1986) US-guided percutaneous alcohol injection of small hepatic and abdominal tumors. Radiology 161(2):309–312PubMedGoogle Scholar
  20. 20.
    Khan KN, Yatsuhashi H, Yamasaki K, Yamasaki M, Inoue O, Koga M, Yano M (2000) Prospective analysis of risk factors for early intrahepatic recurrence of hepatocellular carcinoma following ethanol injection. J Hepatol 32(2):269–278PubMedCrossRefGoogle Scholar
  21. 21.
    Choti MA (2002) Surgical management of hepatocellular carcinoma: resection and ablation. J Vasc Interv Radiol 13(9 Pt 2):S197–S203PubMedGoogle Scholar
  22. 22.
    Buscarini E, Savoia A, Brambilla G, Menozzi F, Reduzzi L, Strobel D, Hansler J, Buscarini L, Gaiti L, Zambelli A (2005) Radiofrequency thermal ablation of liver tumors. Eur Radiol 15(5):884–894PubMedCrossRefGoogle Scholar
  23. 23.
    Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN (2003) Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 226(2):441–451PubMedGoogle Scholar
  24. 24.
    Rhim H, Yoon KH, Lee JM, Cho Y, Cho JS, Kim SH, Lee WJ, Lim HK, Nam GJ, Han SS, Kim YH, Park CM, Kim PN, Byun JY (2003) Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiographics 23(1):123–134PubMedGoogle Scholar
  25. 25.
    Shibata T, Shibata T, Maetani Y, Isoda H, Hiraoka M (2006) Radiofrequency ablation for small hepatocellular carcinoma: prospective comparison of internally cooled electrode and expandable electrode. Radiology 238(1):346–353PubMedGoogle Scholar
  26. 26.
    Lee JM, Han JK, Kim SH, Sohn KL, Choi SH, Choi BI (2005) Bipolar radiofrequency ablation in ex vivo bovine liver with the open-perfused system versus the cooled-wet system. Eur Radiol 15(4):759–764PubMedCrossRefGoogle Scholar
  27. 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. 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

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Dongil Choi
    • 1
  • Hyo K. Lim
    • 1
  • Hyunchul Rhim
    • 1
  • Young-sun Kim
    • 1
  • Won Jae Lee
    • 1
  • Seung Woon Paik
    • 2
  • Kwang Cheol Koh
    • 2
  • Joon Hyoek Lee
    • 2
  • Moon Seok Choi
    • 2
  • Byung Chul Yoo
    • 2
  1. 1.Department of Radiology and Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
  2. 2.Department of Internal Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea

Personalised recommendations