Journal of Gastroenterology

, Volume 46, Issue 12, pp 1418–1426 | Cite as

Percutaneous radiofrequency ablation therapy for hepatocellular carcinoma: a proposed new grading system for the ablative margin and prediction of local tumor progression and its validation

  • Hiroki NishikawaEmail author
  • Tadashi Inuzuka
  • Haruhiko Takeda
  • Jun Nakajima
  • Azusa Sakamoto
  • Sinichiro Henmi
  • Fumihiro Matsuda
  • Yuji Eso
  • Tetsuro Ishikawa
  • Sumio Saito
  • Ryuichi Kita
  • Toru Kimura
  • Yukio Osaki
Original Article—Liver, Pancreas, and Biliary Tract



In the present study we classified the radicality of percutaneous radiofrequency thermal ablation (RFA) therapy according to the extent of the ablated margin. We measured the local recurrence rate for each radicality grade to evaluate the significance of the grading system in assessing the therapeutic effectiveness of RFA and predicting local tumor progression.


This retrospective study involved 269 patients with solitary hypervascular hepatocellular carcinoma who had undergone RFA. The mean ± SD observation period after RFA, number of treatment sessions, and tumor diameter were 25.7 ± 19.9 months, 1.2 ± 0.5, and 2.1 ± 0.7 cm, respectively. Patients were evaluated using dynamic computed tomography. We classified the radicality of RFA treatment into four grades (R grades: A, B, C, and D) according to the extent of the ablated tumor margin, calculated the post-RFA cumulative local recurrence rate for each R grade, and analyzed the factors (patient characteristics, biochemical data, contiguous vessels, and tumor marker) contributing to local recurrence.


The cumulative local recurrence rates at 3 years were 6.7, 17.6, 55.8, and 82.2% for Grades A, B, C, and D, respectively. Using univariate analysis, R grade, tumor size (>2 cm), and des-γ-carboxy prothrombin (DCP) (>200 mAU/mL) were shown to be significant factors contributing to local recurrence. However, using multivariate analysis, only the R grade was found to be a significant independent factor.


The proposed R grading method is a valid and useful method for assessing treatment efficacy, and for predicting local tumor progression after RFA.


Hepatocellular carcinoma Radiofrequency thermal ablation Treatment outcome Grading Local tumor progression 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer 2011

Authors and Affiliations

  • Hiroki Nishikawa
    • 1
    Email author
  • Tadashi Inuzuka
    • 1
  • Haruhiko Takeda
    • 1
  • Jun Nakajima
    • 1
  • Azusa Sakamoto
    • 1
  • Sinichiro Henmi
    • 1
  • Fumihiro Matsuda
    • 1
  • Yuji Eso
    • 1
  • Tetsuro Ishikawa
    • 1
  • Sumio Saito
    • 1
  • Ryuichi Kita
    • 1
  • Toru Kimura
    • 1
  • Yukio Osaki
    • 1
  1. 1.Department of Gastroenterology and HepatologyOsaka Red Cross HospitalOsakaJapan

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