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Radio Frequency Ablation for Hepatocellular Carcinoma in Cirrhotic Patients: Prognostic Factors for Survival

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Radio frequency ablation (RFA) of hepatocellular carcinoma has proved to be useful in local control of tumor. A few data on survival after treatment are available in literature. The aim of the study was to evaluate factors related to survival and to identify different classes of risk after radio frequency ablation.

Methods

Ninety-eight cirrhotic patients with 145 hepatocellular carcinomas were treated with radio frequency ablation from January 1998 to May 2004. In 55 patients, cirrhosis was in Child-Pugh class A, and in 43, in class B. Tumor was single in 60 and multiple in 38; mean tumor number was 1.5 (range 1–3). Tumor size ranged from 1.5 to 6.0 cm, mean 3.8 cm. Mean follow up period was 24.9 months. Radio frequency ablation was performed with expandable type needle with percutaneous approach under real-time ultrasound guidance. For statistical analysis, univariate and multivariate analysis were performed.

Results

Complete ablation of the tumor was achieved in 85.5% of lesions. Survival, 1 and 3 years, was 76.7 and 36.6%, respectively. Univariate analysis showed that Cancer of the Liver Italian Program (CLIP) score, tumor growth pattern, α-fetoprotein level, and complete tumor necrosis, were factors significantly related to poor survival. Multivariate analysis identified that factors related to poor survival were α-fetoprotein level >100 ng/ml, Child-Pugh class B, and incomplete tumor necrosis with a hazard ratio of 4.0, 2.7, and 3.8, respectively. After complete ablation, median survival was 38 months in patients with Child-Pugh class A cirrhosis and α-fetoprotein level ≤100 ng/ml, 22 months for patient with Child-Pugh class B cirrhosis and α-fetoprotein ≤100 ng/ml, and 9 months for patient with Child-Pugh class A cirrhosis and α-fetoprotein >100 ng/ml (P < 0.01).

Conclusions

Complete necrosis and absence of residual tumor positively affect survival after RFA. In patients with Child-Pugh A cirrhosis and α-fetoprotein level ≤100 radio frequency, ablation have results, 55% after 3 years, that are comparable to those of surgical resection. Patients with Child-Pugh B cirrhosis and/or α-fetoprotein >100 ng/ml showed less satisfactory results, and in these patients, multimodality treatment or other treatments should be considered.

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Abbreviations

(HCC):

Hepatocellular carcinoma

(RFA):

Radio frequency ablation

(WHO):

World Health Organization

(HRs):

Hazard ratio estimates

(PH):

Proportional hazard

(UICC):

International Union Against Cancer

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Authors and Affiliations

  1. Department of Surgery and Gastroenterology, University of Verona, Ospedale Policlinico “G. B. Rossi”, Piazzale Scuro, 37134, Verona, Italy

    Alfredo Guglielmi, Andrea Ruzzenente, Marco Sandri, Silvia Pachera, Corrado Pedrazzani, Sebastiano Tasselli & Calogero Iacono

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  1. Alfredo Guglielmi
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  2. Andrea Ruzzenente
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  3. Marco Sandri
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Correspondence to Alfredo Guglielmi.

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Guglielmi, A., Ruzzenente, A., Sandri, M. et al. Radio Frequency Ablation for Hepatocellular Carcinoma in Cirrhotic Patients: Prognostic Factors for Survival. J Gastrointest Surg 11, 143–149 (2007). https://doi.org/10.1007/s11605-006-0082-y

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  • DOI: https://doi.org/10.1007/s11605-006-0082-y

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