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Whole tumor ablation of locally recurred hepatocellular carcinoma including retained iodized oil after transarterial chemoembolization improves progression-free survival

  • Dong Ho Lee
  • Jeong Min LeeEmail author
  • Pyo Nyun Kim
  • Yun-Jin Jang
  • Tae Wook Kang
  • Hyunchul Rhim
  • Jung Wook Seo
  • Young Joon Lee
Hepatobiliary-Pancreas
  • 103 Downloads

Abstract

Objectives

To evaluate and compare clinical outcomes of two different radiofrequency ablation (RFA) methods for locally recurred hepatocellular carcinoma (LrHCC) after locoregional treatment.

Methods

Our institutional review board approved this study with a waiver of informed consent. A total of 313 patients previously treated with transarterial chemoembolization (TACE) (n = 167) and RFA (n = 146) with a single LrHCC ≤ 3 cm was included from five tertiary referral hospitals. RFA was done for LrHCCs using either viable tumor alone ablation (VTA) method (VTA: n = 61 in the TACE group and n = 127 in the RFA group) or whole tumor ablation (WTA) method which includes both viable tumor and retained iodized oil or previously ablated zone (WTA: n = 106 in the TACE group and n = 19 in the RFA group). Local tumor progression (LTP)-free survival as well as progression-free survival (PFS) were estimated using the Kaplan-Meier method, and prognostic factors were evaluated using the Cox proportional hazards regression model.

Results

In 167 patients with LrHCC who underwent TACE, the 5-year LTP-free survival after RFA was significantly higher with the VTA method than with the WTA method (26.9% vs. 87.8%; p < 0.001; hazard ratio (HR) = 8.53 [4.16–17.5]). The estimated 5-year PFS after RFA for LrHCC after TACE using the VTA method was 5.7%, which was significantly lower than that with the WTA method (26.4%) (p = 0.014; HR = 1.62 [1.10–2.38]). However, in 146 patients with LrHCC after initial RFA, there were no significant differences in cumulative incidence of LTP (p = 0.514) or PFS (p = 0.905) after RFA between the two ablation methods.

Conclusions

For RFA of LrHCC after TACE, the WTA method including both viable tumor and retained iodized oil could significantly lower LTP and improve PFS than VTA.

Key Points

Whole tumor ablation (WTA) could provide significantly better local tumor control for locally recurred HCC (LrHCC) after TACE than viable tumor alone ablation (VTA).

WTA for LrHCC after TACE could also provide significantly better progression-free survival than VTA.

Regarding LrHCC after RFA, VTA would provide a comparable clinical outcome to WTA.

Keywords

Hepatocellular carcinoma Ablation techniques Progression-free survival Chemoembolization Therapeutic 

Abbreviations

AFP

Alpha-fetoprotein

CI

Confidence interval

CT

Computed tomography

EM

Extrahepatic metastasis

HCC

Hepatocellular carcinoma

HR

Hazard ratio

IDR

Intrahepatic distant recurrence

LrHCC

Locally recurred hepatocellular carcinoma

LTP

Local tumor progression

MR

Magnetic resonance

PFS

Progression-free survival

RFA

Radiofrequency ablation

TACE

Transarterial chemoembolization

US

Ultrasound

Notes

Funding

The authors state that this study was supported by a grant from the Korean Society of Imaging-guided Tumor Ablation (KSITA) (grant number KSITA-201701).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Jeong Min Lee.

Conflict of interest

The authors declare that they have no competing interests.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional review board.

Ethical approval

Institutional review board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at five institutes

Supplementary material

330_2018_5993_MOESM1_ESM.docx (28 kb)
ESM 1 (DOCX 27 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Dong Ho Lee
  • Jeong Min Lee
    • 1
    • 2
    Email author
  • Pyo Nyun Kim
    • 3
  • Yun-Jin Jang
    • 3
  • Tae Wook Kang
    • 4
  • Hyunchul Rhim
    • 4
  • Jung Wook Seo
    • 5
  • Young Joon Lee
    • 6
  1. 1.Department of RadiologySeoul National University HospitalSeoulSouth Korea
  2. 2.Institute of Radiation Medicine, College of MedicineSeoul National UniversitySeoulSouth Korea
  3. 3.Department of Radiology and Research Institute of RadiologyUniversity of Ulsan, Asan Medical CenterSeoulSouth Korea
  4. 4.Department of Radiology, Samsung Medical Center, School of MedicineSungkyunkwan UniversitySeoulSouth Korea
  5. 5.Department of RadiologyInje University Ilsan Paik HospitalGoyangSouth Korea
  6. 6.Department of Radiology, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulSouth Korea

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