Abstract
Background and purpose
Radiofrequency ablation (RFA) is the standard of care for early stage hepatocellular carcinoma (HCC). However, the clinical outcomes of iodized oil computed tomography (IoCT) versus ultrasound (US)-guided RFA for HCC remain unclear.
Methods
We retrospectively analyzed consecutive treatment-naïve patients who received curative RFA for HCC within Milan criteria from January 2016 to December 2018. Patients who underwent either IoCT-guided RFA (IoCT group) or US-guided RFA (US group) were included. Various clinical factors, including tumor location, were adjusted with a 1:1 propensity score matching. Subsequently, the cumulative incidence rates for recurrence and hazard ratios for survival were calculated.
Results
We included 184 (37.9%) and 301 (62.1%) patients who received IoCT- and US-guided RFA, respectively. Before propensity score matching, IoCT guidance was significantly associated with multiple tumors, higher body mass index, lower albumin level, and tumors located at S8. After matching, the 1-, 2-, and 3-year local tumor progression rates of the IoCT group were significantly lower than those of the US group (4.4%, 6.9%, and 7.5% vs. 14.4%, 16.3%, and 16.3%, respectively, at p = 0.002, 0.009, and 0.016, respectively). In univariate analyses and multivariate analyses that adjusted for clinical and tumor location-related parameters, the IoCT group had better recurrence-free survival (hazard ratio = 0.581, 95% confidence interval 0.375–0.899) than those with US guidance but not overall survival.
Conclusion
IoCT-guided RFA had a lower local tumor progression rate and better recurrence-free survival than did US-guided RFA for HCC within the Milan criteria.
Graphic abstract
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CT-guide RFA is a safe and effective alternative to US-guided with similar overall survival.
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IoCT-guided RFA might have a better local tumor control than US-guided.
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IoCT-guided RFA may be more suitable for male patients, aged < 70 years, a single tumor measuring 2–5 cm, and a tumor located at the subdiaphragmatic/subcardiac region.
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Acknowledgements
The study was financially sponsored by National Taiwan University Hospital (108-M4430, 109-M4557), Industrial Technology Research Institute cooperation research project (PC1231-108, PC1281-109) and 2020 scholarship of Taiwan Health Foundation. Part of this study was presented as oral presentations at the 6th Asian Conference on Tumor Ablation in Taiwan (ACTA 2019), October 26-27, 2019, Chiayi County, Taiwan and at the 15th Annual Scientific Meeting of Asia Pacific Society of Cardiovascular and Interventional Radiology (APSCVIR 2021), February 26-28, 2021, virtual congress, Taipei, Taiwan.
Funding
The study was financially sponsored by National Taiwan University Hospital (108-M4430, 109-M4557), Industrial Technology Research Institute cooperation research project (PC1231-108, PC1281-109) and 2020 scholarship of Taiwan Health Foundation.
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All authors were aware of and agree to the submission and that they had all contributed to the work described sufficiently to be named as authors. C-HW was responsible for manuscript writing, statistical analysis. T-HS was contributed clinical data collection. P-CL and M-CL gave help to the image collecting and RFA technique. Y-HC illustrated Fig. 1 and gave help to the data analysis. TT-TS and J-HK designed the study and revise the manuscript.
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The authors Chih-Horng Wu, Po-Chin Liang, Tung-Hung Su, Ming-Chi Lin, Yu-Hsuan Chang, Tiffany Ting-Fang Shih, Jia-Horng Kao declare that they have no conflict of interest.
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All clinical information, laboratory data, and images were collected under routine workup. This study followed the Health Insurance Portability and Accountability Act guidelines, Declaration of Helsinki of 1975, as revised in 2008 and Institutional Review Board of National Taiwan University Hospital approval was obtained (NTUH-201904025RINA).
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Wu, CH., Liang, PC., Su, TH. et al. Iodized oil computed tomography versus ultrasound-guided radiofrequency ablation for early hepatocellular carcinoma. Hepatol Int 15, 1247–1257 (2021). https://doi.org/10.1007/s12072-021-10236-0
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DOI: https://doi.org/10.1007/s12072-021-10236-0