Radiofrequency Ablation for Hepatocellular Carcinoma: 10-Year Outcome and Prognostic Factors

Abstract

OBJECTIVES:Radiofrequency ablation (RFA) is widely performed for hepatocellular carcinoma (HCC). However, there has been no report on 10-year outcome of RFA. The objective of this study was to report a 10-year consecutive case series at a tertiary referral center.METHODS:We performed 2,982 RFA treatments on 1,170 primary HCC patients and analyzed a collected database.RESULTS:Final computed tomography images showed complete tumor ablation in 2,964 (99.4%) of 2,982 treatments performed for the 1,170 primary HCC patients. With a median follow-up of 38.2 months, 5- and 10-year survival rates were 60.2% (95% confidence interval (CI): 56.7–63.9%) and 27.3% (95% CI: 21.5–34.7%), respectively. Multivariate analysis demonstrated that age, antibody to hepatitis C virus (anti-HCV), Child-Pugh class, tumor size, tumor number, serum des-γ-carboxy-prothrombin (DCP) level, and serum lectin-reactive α-fetoprotein level (AFP-L3) were significantly related to survival. Five- and 10-year local tumor progression rates were both 3.2% (95% CI: 2.1–4.3%). Serum DCP level alone was significantly related to local tumor progression. Five- and 10-year distant recurrence rates were 74.8% (95% CI: 71.8–77.8%) and 80.8% (95% CI: 77.4–84.3%), respectively. Anti-HCV, Child-Pugh class, platelet count, tumor size, tumor number, serum AFP level, and serum DCP level were significantly related to distant recurrence. There were 67 complications (2.2%) and 1 death (0.03%).CONCLUSIONS:RFA could be locally curative for HCC, resulting in survival for as long as 10 years, and was a safe procedure. RFA might be a first-line treatment for selected patients with early-stage HCC.

Management of hepatocellular carcinoma in the elderly

“…In the study by Nishikawa et al [26] , the reduction in OS observed in elderly patients compared with their younger counterpart was primarily due to the higher rate of early recurrence. Conversely, other studies have reported that old age was not a independent predictor of reduced survival after RFA [60][61][62] . Good safety profile of RFA is maintained in elderly and the rate of major complications was found to be similar in elderly and in younger cirrhotic patients [32] .…”

“…Studies on outcome after radiofrequency ablation (RFA) in elderly patients yielded conflicting results ( Table 2). In two retrospective studies performed on large series from Japan, old age emerged as an independent predictor of poor prognosis at multivariate analysis [61] . In the study by Nishikawa et al [26] , the reduction in OS observed in elderly patients compared with their younger counterpart was primarily due to the higher rate of early recurrence.…”

Thrombocytopenia in Patients with Chronic Liver Disease: What’s in a Name?

“…This versatile use of platelet count and thrombocytopenia is supported by the multi-faceted etiology of decreased platelet count in chronic liver disease patients [1,5]. Indeed, the platelet count is incorporated into numerous diagnostic algorithms aimed at non-invasively assessing the severity of chronic liver diseases and features of portal hypertension, can be used to pinpoint patients at higher risk of developing hepatocellular carcinoma in population studies, and is a predictor of death in cirrhotic patients with and without hepatocellular carcinoma [6][7][8][9][10][11][12].…”

Risk factors for deterioration of long-term liver function after radiofrequency ablation therapy

“…Radiofrequency ablation (RFA) is currently recognized as an effective local treatment for HCC [5,6] and has been shown to be a relatively low risk procedure [7][8][9] . However, deterioration of liver function has been observed during the long-term follow-up of these patients [10][11][12] .…”