Radiofrequency Ablation for Hepatocellular Carcinoma Measuring 2 cm or Smaller: Results and Risk Factors for Local Recurrence

Abstract

Objective: The purpose of this study was to evaluate the risk factors for local recurrence with radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) measuring ≤2 cm. Methods: This study involved 234 patients with 274 HCCs measuring ≤2 cm who had undergone RFA as the initial treatment. The mean tumor diameter was 1.478 cm. The median follow-up period was 829 days. We evaluated the post-RFA cumulative local recurrence rate and analyzed the risk factors contributing to clinical outcomes. Results: Cumulative local recurrence rates were 9, 19 and 19% at 1, 2 and 3 years, respectively. Among the 145 cases with a complete safety margin (SM) after RFA, only 4 developed local tumor recurrence and the cumulative rates of local tumor recurrence at 1, 2 and 3 years were 2, 3 and 3%, respectively. Among the 129 cases with incomplete SM, local tumor recurrence developed in 34 and the cumulative rates of local tumor progression at 1, 2 and 3 years were 14, 36 and 36%, respectively. In multivariate analysis, significant risk factors were tumor location (liver surface), irregular gross type and SM <5 mm. Conclusion: Even with HCC measuring ≤2 cm, location and gross type of tumor should be carefully evaluated before RFA is performed.

Radiotherapy for Hepatocellular Carcinoma Results in Comparable Survival to Radiofrequency Ablation: A Propensity Score Analysis

“…This finding suggests that RFA can be used to achieve a high local control rate when ablation is judged to be possible, even if the tumors are located adjacent to vessels. In previous literature, many risk factors of local recurrence have been reported including location (adjacent to a major vessel/bile duct, (21) on the liver surface, (22,23) subcapsular (23) ), irregular gross type, (22) small ablative margin, (21,22) and large tumor size. (24) In clinical practice, tumors with such risk factors may be judged as For all patients' analysis, the rates of liver toxicities defined as Child-Pugh score deterioration ≥2 in acute and late phases following RFA and SBRT-HFRT were similar.…”

Irregular vascular pattern by contrast‐enhanced ultrasonography and high serum Lens culinaris agglutinin‐reactive fraction of alpha‐fetoprotein level predict poor outcome after successful radiofrequency ablation in patients with early‐stage hepatocellular carcinoma

“…Local tumor progression after RFA was investigated in many studies, and the rate of progression differed in all studies [2][3][4][5]20]. Siina et al [3].…”

“…showed that 5-and 10-year local tumor progression rates were both 3.2%, and the serum DCP level alone was significantly related to local tumor progression. Kono et al [20]. reported the outcome of RFA in patients with 2-cm or smaller HCC.…”

Gross classification of solitary small hepatocellular carcinoma on preoperative computed tomography: Prognostic significance after radiofrequency ablation

“… proposed a new gross classification (single nodular type, single nodular type with extranodular growth, confluent multinodular type and infiltrative type), which was accepted by the Liver Cancer Study Group of Japan and has been widely used. A recent study reported that even for HCC of 2 cm or less, the gross type was significantly associated with local recurrence after RFA . However, the survival significance of gross classification in single small HCC treated with RFA has not been previously reported.…”