Radiofrequency ablation (RFA) is a potentially curative therapy for hepatocellular carcinoma (HCC). However, incomplete RFA can induce accelerated invasive growth at the periphery. The mechanisms underlying the RFA-induced tumor promotion remain largely unexplored. Three human HCC cell lines were exposed to 45 C-55 C for 10 minutes, simulating the marginal zone of RFA treatment. At 5-12 days posttreatment cell proliferation, parameters of epithelial-mesenchymal transition (EMT), and activation of mitogen-activated protein kinases were analyzed. Livers from patients with viral hepatitis without and with HCC (n 5 114) were examined to confirm the relevance of altered kinase patterns. In vivo tumorigenic potential of heat-treated versus untreated HCC cells was studied in nude mice. Heating to 55 C killed all HCC cells, whereas 65%-85% of cells survived 48 C-50 C, developing spindle-like morphology and expressing CD133, cytokeratin (CK)7, CK19, procollagen-a1(I), and Snail at day 5 after heat exposure, which returned to baseline at day 12. Heat-exposed HCC cells showed enhanced proliferation and prominent activation of p46-Shc (Src homology and collagen) and downstream extracellular signalrelated kinase (Erk)1/2. In patients, Shc expression correlated with malignant potential and overall survival. Blocking Erk1/2 reduced proliferation and EMT-like changes of heat-treated HCC cells. Implantation of heat-exposed HEPG2 cells into nude mice induced significantly larger, more aggressive tumors than untreated cells. Conclusions: Sublethal heat treatment skews HCC cells toward EMT and transforms them to a progenitor-like, highly proliferative cellular phenotype in vitro and in vivo, which is driven significantly by p46Shc-Erk1/2. Suboptimal RFA accelerates HCC growth and spread by transiently inducing an EMT-like, more aggressive cellular phenotype. (HEPATOLOGY 2013;58:1667-1680 R adiofrequency ablation (RFA) is accepted as a potentially curative therapy for the early stages of primary hepatocellular carcinoma (HCC). 1 RFA induces tumor necrosis with low complication rates and is superior to percutaneous ethanol injection in tumor ablation.2 However, suboptimal RFA treatment for HCC has been reported as a risk factor of early diffuse recurrence.3 Large tumor size is a major risk factor of Abbreviations: 7-AAD, 7-aminoactinomycin D; AFP, alpha-fetaprotein; ALB, albumin; BSA, bovine serum albumin; CFSE, carboxyfluorescein succinimidyl ester; CHC, chronic hepatitis C; CK, cytokeratin; COL1A1, type I procollagen; Ct, cycle threshold; DI, division indices; DMEM, Dulbecco's modified Eagle's medium; EGFR, epidermal growth factor receptor; EMT, epithelial-mesenchymal transition; Erk, extracellular signal-related kinase; ETW, estimated tumor weight; FACS, fluorescein-activated cell sorting; FBS, fetal bovine serum; FCM, flow cytometry; FGFR, fibroblast growth factor receptor; HCC, hepatocellular carcinoma; HSP, heat shock protein; IGF-1R, insulin-like growth factor 1 receptor; JNK, c-Jun N-terminal kinase; LI, labeling indices; MAP...