Insufficient Ablative Margin Determined by Early Computed Tomography May Predict the Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation

Abstract

Tumor recurrence in hepatocellular carcinoma (HCC) patients after radiofrequency ablation (RFA) remains common; some studies have reported that insufficient ablative margin after RFA might contribute to HCC recurrence. The aim of this study was to investigate whether insufficient ablative safety margins determined by early computed tomography (CT) predicts HCC recurrence after RFA. This retrospective study recruited patients with a single HCC lesion after RFA in our department between May 2013 and March 2014. Early follow-up CT was performed within 7 days after RFA. An adequate ablative margin assessed by follow-up CT was defined as (maximum post-RFA CT radius)³/(maximum pre-RFA CT radius + 5 mm)³> 1. All patients in whom complete ablation was achieved underwent a CT scan every 3 months for early detection of HCC recurrence. In total, 72 patients (48 male, mean age 69.4 years) were analyzed. Of these, eight patients had local tumor progression, four had intra-hepatic distant recurrence, and two had extra-hepatic metastasis. Insufficient ablative margin, defined as an ablative volume with a safety margin of less than 5 mm, was an important predictor of local tumor progression (LTP) (p = 0.015) and overall recurrence (p = 0.012). The sensitivity, specificity, and positive and negative predictive values of an insufficient ablative margin for predicting LTP and overall recurrence were 36.4%, 97.2%, 50.0%, and 87.9%, and 46.2%, 89.7%, 42.9%, and 87.9%, respectively. An ablative volume with an ablative margin of less than 5 mm is associated with higher rates of both LTP and overall recurrence in HCC after RFA.

Transarterial Chemoembolization in Combination with a Molecular Targeted Agent: Lessons Learned from Negative Trials (Post-TACE, BRISK-TA, SPACE, ORIENTAL, and TACE-2)

“…However, in previous combination studies with TACE, the median OS ranged from 18 months (shortest) to 32 months (longest) ( Table 1 ), suggesting that the duration of the study needs to be extremely long when evaluating OS as a primary endpoint. In clinical studies that are terminated early because of tumor progression or adverse effects, patients often receive various post-trial treatments, such as hepatic artery infusion chemotherapy [20][21][22] , ablation [23][24][25] , or systemic therapy [26][27][28][29] . In such cases, post-trial treatment likely affects OS, making it difficult to evaluate treatment outcomes using OS, especially in studies of TACE in patients with intermediate-stage HCC.…”

Real-Life Clinical Practice with Sorafenib in Advanced Hepatocellular Carcinoma: A Single-Center Experience Second Analysis

“…Because most patients are diagnosed with advanced disease stages, only 30% of patients receive potentially curative therapies, such as surgical resection [2,3,4], transplantation [5,6,7,8] or percutaneous ablation [9,10,11,12,13]. A majority of patients with unresectable HCC usually undergo palliative treatments, such as transarterial chemoembolization (TACE) [14,15,16], hepatic arterial infusion chemotherapy (HAIC) [17] and systemic chemotherapy, including therapy using molecular targeted agents [17,18,19,20].…”

General Rules for the Clinical and Pathological Study of Primary Liver Cancer, Nationwide Follow-Up Survey and Clinical Practice Guidelines: The Outstanding Achievements of the Liver Cancer Study Group of Japan

“…This huge database is an extremely important asset that is not available in any other country. Because HCC was treated only by surgical resection [15,16,17] in the 1970s before locoregional therapy [18,19,20,21,22] was developed in the 1980s, the general rules describe surgery-related items and the macroscopic and histopathological findings of surgical specimens in immense detail. In contrast, descriptions of locoregional therapies, such as ablation [21] and transcatheter arterial chemoembolization (TACE) [13,23,24], were relatively scarce up until the fourth edition, which was published in 2001.…”