Skip to main content
Log in

Single-center analysis of percutaneous ablation in the treatment of hepatocellular carcinoma: long-term outcomes of a 7-year experience

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

Abstract

Purpose

The objective of this study is to examine the safety and efficacy of ablative therapy for hepatocellular carcinoma (HCC).

Methods

A retrospective review of 419 consecutive patients diagnosed with HCC, treated with percutaneous ablation at a tertiary academic medical center from June 2015 to June 2022, was conducted. Data evaluated included demographics, disease and tumor burden scores, and functional status. Procedural outcomes included procedural course, complication rates, biochemical and radiologic response, survival, and functional status.

Results

A total of 419 patients, including 313 males (74.7%) and 106 females (25.3%) with a mean age of 63.8 ± 6.64 years, made up the study cohort. 120 patients (28.6%) presented with solitary lesions and 299 patients (71.4%) had multifocal involvement, with a mean tumor size of 2.3 ± 0.92 cm. A majority of the interventions performed were microwave ablations (n = 413, 98.3%), with 6 radiofrequency ablations (1.4%). Treatment response was radiographically assessed up to 6 months post-ablation and graded as complete response (96.2%), partial response (2.6%), stable disease (0%), and progressive disease (1.2%). 97 (23.2%) of the treated patients went on to receive liver transplant. The average progression-free survival in the study population was 24 months with a survival of 85.9% (n = 360), 67.8% (n = 284), and 63.2% (n = 265) at 1 year, 3 years, and 5 years respectively. Functional outcomes, as defined by ECOG scores, were maintained or improved in 383 patients (91.4%) and 349 patients (83.3%) at 6 months and 12 months respectively.

Conclusions

This large institutional experience demonstrated safety and efficacy of ablation therapies for treatment of HCC with promising tumor response rates and enduring clinical outcomes including prolonged survival and preserved functional status.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Ryder SD, British Society of Gastroenterology. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults. Gut. 2003 May 01;52 Suppl 3:iii1–8.

  2. Sanyal AJ, Yoon SK, Lencioni R. The Etiology of Hepatocellular Carcinoma and Consequences for Treatment. Oncologist. 2010;15:14-22.

    Article  PubMed  Google Scholar 

  3. McWilliams JP, MD, Yamamoto S, BS, Raman SS, MD, Loh CT, MD, Lee EW, MD, Liu DM, MD, et al. Percutaneous Ablation of Hepatocellular Carcinoma: Current Status. Journal of vascular and interventional radiology. 2010;21(8):S204–13.

  4. Makary MS, Ramsell S, Miller E, Beal EW, Dowell JD. Hepatocellular carcinoma locoregional therapies: Outcomes and future horizons. World J Gastroenterol. 2021 November 21;27(43):7462-79.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Zhou Y, Zhang X, Li B, Sui C, Yang J. Postoperative complications affect early recurrence of hepatocellular carcinoma after curative resection. BMC Cancer. 2015;15(1):689.

    Article  PubMed  PubMed Central  Google Scholar 

  6. He Y, Liang T, Mo S, Chen Z, Zhao S, Zhou X, et al. Effect of timing of surgical resection of primary hepatocellular carcinoma on survival outcomes in elderly patients and prediction of clinical models. BMC Gastroenterology. 2021;21(1):230.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Zhou Y, Sui C, Li B, Yin Z, Tan Y, Yang J, et al. Repeat hepatectomy for recurrent hepatocellular carcinoma: a local experience and a systematic review. World Journal of Surgical Oncology. 2010;8(1):55.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Pasini F, Serenari M, Cucchetti A, Ercolani G. Treatment options for recurrence of hepatocellular carcinoma after surgical resection: review of the literature and current recommendations for management. Hepatoma Research. 2020;6:26.

    Google Scholar 

  9. Forner A, Reig ME, Rodriguez de Lope C, Bruix J. Current Strategy for Staging and Treatment: The BCLC Update and Future Prospects. Semin Liver Dis. 2010;30(01):61.

    Article  CAS  PubMed  Google Scholar 

  10. Xu Z, Xie H, Zhou L, Chen X, Zheng S. The Combination Strategy of Transarterial Chemoembolization and Radiofrequency Ablation or Microwave Ablation against Hepatocellular Carcinoma. Analytical cellular pathology (Amsterdam). 2019;2019:8619096.

    PubMed  Google Scholar 

  11. Puijk RS, Ruarus AH, Scheffer HJ, Vroomen, Laurien G. P. H., van Tilborg, Aukje A. J. M., de Vries, Jan J. J., et al. Percutaneous Liver Tumour Ablation: Image Guidance, Endpoint Assessment, and Quality Control. Canadian Association of Radiologists Journal. 2018;69(1):51–62.

  12. Poggi G, Tosoratti N, Montagna B, Picchi C. Microwave ablation of hepatocellular carcinoma. World J Hepatol. 2015 Nov 8;7(25):2578-89.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Shiina S, Tateishi R, Arano T, Uchino K, Enooku K, Nakagawa H, et al. Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol. 2012 Apr;107(4):569,77; quiz 578.

  14. Chen M, Li J, Zheng Y, Guo R, Liang H, Zhang Y, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006;243(3):321-8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hong S, Lee S, Choi M, Lee J, Koh K, Paik S, et al. Comparing the Outcomes of Radiofrequency Ablation and Surgery in Patients With a Single Small Hepatocellular Carcinoma and Well-Preserved Hepatic Function. Journal of clinical gastroenterology. 2005 Mar;39(3):247-52.

    Article  PubMed  Google Scholar 

  16. LUPO L, PANZERA P, GIANNELLI G, MEMEO M, GENTILE A, MEMEO V. Single hepatocellular carcinoma ranging from 3 to 5 cm: radiofrequency ablation or resection? HPB. 2007 Dec;9(6):429-34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Montorsi M, Santambrogio R, Bianchi P, Donadon M, Moroni E, Spinelli A, et al. Survival and recurrences after hepatic resection or radiofrequency for hepatocellular carcinoma in cirrhotic patients: a multivariate analysis. Journal of gastrointestinal surgery. 2005;9(1):62-8.

    Article  PubMed  Google Scholar 

  18. Yamakado K, Takaki H, Nakatsuka A, Yamaknaka T, Fujimori M, Hasegawa T, et al. Radiofrequency ablation for hepatocellular carcinoma. Gastrointestinal Intervention. 2014;3(1):35-9.

    Article  Google Scholar 

  19. Chen S, Peng Z, Xiao H, Lin M, Chen Z, Jiang C, et al. Combined radiofrequency ablation and ethanol injection versus repeat hepatectomy for elderly patients with recurrent hepatocellular carcinoma after initial hepatic surgery. International journal of hyperthermia. 2018 Oct 3,;34(7):1029-37.

    Article  PubMed  Google Scholar 

  20. Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19(3):329-38.

    Article  CAS  PubMed  Google Scholar 

  21. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982 Dec;5(6):649-55.

    Article  CAS  PubMed  Google Scholar 

  22. Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg. 1964;1:1-85.

    CAS  PubMed  Google Scholar 

  23. Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015 Feb 20;33(6):550-8.

    Article  PubMed  Google Scholar 

  24. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009 January 01;45(2):228–47.

  25. Mazzaferro V, Bhoori S, Sposito C, Bongini M, Langer M, Miceli R, et al. Milan criteria in liver transplantation for hepatocellular carcinoma: an evidence-based analysis of 15 years of experience. Liver Transpl. 2011 October 01;17 Suppl 2:44.

    Article  Google Scholar 

  26. Villanueva A. Hepatocellular Carcinoma. N Engl J Med. 2019 April 11;380(15):1450-62.

    Article  CAS  PubMed  Google Scholar 

  27. Byam J, Renz J, Millis JM. Liver transplantation for hepatocellular carcinoma. Hepatobiliary Surg Nutr. 2013 February 01;2(1):22-30.

    PubMed  PubMed Central  Google Scholar 

  28. Ahmed M, Goldberg SN. Thermal Ablation Therapy for Hepatocellular Carcinoma. Journal of vascular and interventional radiology. 2002;13(9):S231-43.

    Article  PubMed  Google Scholar 

  29. Huo YR, Eslick, Guy D., DrPH, PhD. Microwave Ablation Compared to Radiofrequency Ablation for Hepatic Lesions: A Meta-Analysis. Journal of vascular and interventional radiology. 2015;26(8):1139,1146.e2.

  30. Flanders VL, MD, Gervais DA, MD. Ablation of Liver Metastases: Current Status. Journal of vascular and interventional radiology. 2010;21(8):S214–22.

  31. Lahat E, Eshkenazy R, Zendel A, Zakai BB, Maor M, Dreznik Y, et al. Complications after percutaneous ablation of liver tumors: a systematic review. Hepatobiliary surgery and nutrition. 2014;3(5):317-23.

    PubMed  PubMed Central  Google Scholar 

  32. Kang TW, Lim HK, Lee MW, Kim Y, Rhim H, Lee WJ, et al. Long-term Therapeutic Outcomes of Radiofrequency Ablation for Subcapsular versus Nonsubcapsular Hepatocellular Carcinoma: A Propensity Score Matched Study. Radiology. 2016;280(1):300-12.

    Article  PubMed  Google Scholar 

  33. Rhim H. Complications of radiofrequency ablation in hepatocellular carcinoma. Abdom Imaging. 2005;30(4):409-18.

    Article  CAS  PubMed  Google Scholar 

  34. Izzo F, Granata V, Grassi R, Fusco R, Palaia R, Delrio P, et al. Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update. Oncologist. 2019;24(10):e990-e1005.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Bertot LC, Sato M, Tateishi R, Yoshida H, Koike K. Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: a systematic review. Eur Radiol. 2011 Aug 20,;21(12):2584-96.

    Article  PubMed  Google Scholar 

  36. Livraghi T, Meloni F, Solbiati L, Zanus G. Complications of Microwave Ablation for Liver Tumors: Results of a Multicenter Study. Cardiovasc Intervent Radiol. 2011 Aug 11,;35(4):868-74.

    Article  PubMed  Google Scholar 

  37. Shiina S, Sato K, Tateishi R, Shimizu M, Ohama H, Hatanaka T, et al. Percutaneous Ablation for Hepatocellular Carcinoma: Comparison of Various Ablation Techniques and Surgery. Canadian journal of gastroenterology & hepatology. 2018;2018:4756147.

    Article  Google Scholar 

  38. Levi Sandri GB, Spoletini G, Vennarecci G, Francone E, Abu Hilal M, Ettorre GM. Laparoscopic liver resection for large HCC: short- and long-term outcomes in relation to tumor size. Surg Endosc. 2018 Dec;32(12):4772-9.

    Article  PubMed  Google Scholar 

  39. Dong BW, Liang P, Yu XL, Zeng XQ, Wang PJ, Su L, et al. Sonographically guided microwave coagulation treatment of liver cancer: an experimental and clinical study. American journal of roentgenology (1976). 1998 Aug 1,;171(2):449-54.

    Article  CAS  PubMed  Google Scholar 

  40. Groeschl RT, Pilgrim CHC, Hanna EM, Simo KA, Swan RZ, Sindram D, et al. Microwave Ablation for Hepatic Malignancies: A Multiinstitutional Analysis. Ann Surg. 2014;259(6).

  41. Lu M, Xu H, Xie X, Yin X, Chen J, Kuang M, et al. Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: A retrospective comparative study. Journal of gastroenterology. 2005 Nov;40(11):1054-60.

    Article  PubMed  Google Scholar 

  42. Cabibbo G, Maida M, Genco C, Alessi N, Peralta M, Butera G, et al. Survival of Patients with Hepatocellular Carcinoma (HCC) Treated by Percutaneous Radio-Frequency Ablation (RFA) Is Affected by Complete Radiological Response. PLOS ONE. 2013;8(7):e70016.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Yang W, Yan K, Wu G, Wu W, Fu Y, Lee J, et al. Radiofrequency ablation of hepatocellular carcinoma in difficult locations: Strategies and long-term outcomes. World journal of gastroenterology. 2015;21(5):1554-66.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Peng ZW, Zhang YJ, Chen MS, Xu L, Liang HH, Lin XJ, et al. Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma: a prospective randomized trial. J Clin Oncol. 2013 Feb 1;31(4):426-32.

    Article  PubMed  Google Scholar 

  45. Johnson EW, Holck PS, Levy AE, Yeh MM, Yeung RS. The Role of Tumor Ablation in Bridging Patients to Liver Transplantation. Archives of surgery (Chicago. 1960). 2004 Aug 1,;139(8):825-30.

    Article  Google Scholar 

  46. Llovet JM, Mas X, Aponte JJ, Fuster J, Navasa M, Christensen E, et al. Cost effectiveness of adjuvant therapy for hepatocellular carcinoma during the waiting list for liver transplantation. Gut. 2002 Jan;50(1):123-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. PEREIRA SP, WILLIAMS R. Limits to liver transplantation in the UK. Gut. 1998 Jun;42(6):883-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Fontana RJ, Hamidullah H, Nghiem H, Greenson JK, Hussain H, Marrero J, et al. Percutaneous radiofrequency thermal ablation of hepatocellular carcinoma: A safe and effective bridge to liver transplantation. Liver transplantation. 2002;8(12):1165-74.

    Article  PubMed  Google Scholar 

  49. Lee MW, Raman SS, Asvadi NH, Siripongsakun S, Hicks RM, Chen J, et al. Radiofrequency ablation of hepatocellular carcinoma as bridge therapy to liver transplantation: A 10‐year intention‐to‐treat analysis. Hepatology (Baltimore, Md.). 2017 Jun;65(6):1979-90.

    Article  CAS  PubMed  Google Scholar 

  50. Pompili M, Mirante VG, Rondinara G, Fassati LR, Piscaglia F, Agnes S, et al. Percutaneous ablation procedures in cirrhotic patients with hepatocellular carcinoma submitted to liver transplantation: Assessment of efficacy at explant analysis and of safety for tumor recurrence. Liver transplantation. 2005 Sep;11(9):1117-26.

    Article  PubMed  Google Scholar 

  51. Bharat A, Brown DB, Crippin JS, Gould JE, Lowell JA, Shenoy S, et al. Pre-Liver Transplantation Locoregional Adjuvant Therapy for Hepatocellular Carcinoma as a Strategy to Improve Longterm Survival. Journal of the American College of Surgeons. 2006;203(4):411-20.

    Article  PubMed  Google Scholar 

  52. DiNorcia J, Florman S, Haydel B, Tabrizian P, Ruiz R, Klintmalm G, et al. Pathologic Response to Pretransplant Locoregional Therapy is Predictive of Patient Outcome After Liver Transplantation for Hepatocellular Carcinoma: Analysis From the US Multicenter HCC Transplant Consortium. Annals of surgery. 2020 Apr;271(4):616-24.

    Article  PubMed  Google Scholar 

  53. Chan K, Yu M, Chou H, Wu T, Lee C, Lee W. Significance of Tumor Necrosis for Outcome of Patients with Hepatocellular Carcinoma Receiving Locoregional Therapy Prior to Liver Transplantation. Ann Surg Oncol. 2011 May 17,;18(9):2638-46.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mina S. Makary.

Ethics declarations

Competing interest

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Domini, J., Makary, M.S. Single-center analysis of percutaneous ablation in the treatment of hepatocellular carcinoma: long-term outcomes of a 7-year experience. Abdom Radiol 48, 1173–1180 (2023). https://doi.org/10.1007/s00261-023-03819-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-023-03819-y

Keywords

Navigation