Radiofrequency ablation of hepatocellular carcinoma: Long-term results and prognostic factors in 235 Western patients with cirrhosis #

Abstract

For the treatment of small hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) is in some centers considered a first-line therapeutic option. However, such a strategy is still under debate with regard to tumor and patient characteristics. In this single-center study we assessed the 5-year survival and prognosis factors in 235 consecutive patients with cirrhosis (Child-Pugh A/B: 205/30) who received RFA as first-line treatment for up to three HCC <5 cm (307 tumors; mean diameter: 29 ؎ 10 mm; 53 multinodular forms). Among these patients, 67 satisfied the criteria for resection according to the Barcelona Clinic Liver Cancer. Complete ablation was obtained in 222 patients (94%). Overall, 337 RFA sessions were performed including iterative RFA for recurrence. Major complications occurred in three patients (0.9%), including one treatmentrelated death. After 27 ؎ 20 months of mean follow-up, local or distant, or both, tumor recurrence occurred in 16, 88, and 11 patients, respectively. Twenty-nine patients underwent transplantation and were removed from the study at this point. Overall 5-year, recurrence-free, and tumor-free (including results of iterative RFA) survival rates were, respectively, 40%, 17%, and 32%. The overall 5-year survival rate was 76% for operable patients. Factors associated with overall survival were prothrombin activity (hazard ratio [HR] ‫؍‬ 0.97, 0.96-0.98; P < 0.0001) and serum levels of ␣-fetoprotein (AFP) (HR ‫؍‬ 1.02, 1.02-1.02; P < 0.0001), and factors associated with tumor recurrence were multinodular forms (HR ‫؍‬ 2.34; 1.52-3.6; P ‫؍‬ 0.0001) and serum AFP levels (HR ‫؍‬ 1.015, 1.014-1.016; P ‫؍‬ 0.015). Tumor size was associated with local recurrence but not with overall and tumor-free survival. Conclusion: RFA is a safe and effective first-line treatment of HCC up to 5 cm in diameter, especially for patients with a single tumor, a low serum AFP level, and well-preserved liver function.

Radiofrequency Ablation Must Be Assessed by Pathological Methods

“…We fully agree with Dr. Rodriguez-Sanjùn et al 1 concerning the importance of pathological examination after radiofrequency ablation (RFA), and we recognize the importance of their work that confirms previous reports. 2 Nevertheless, we cannot endorse their comment about our article 3 which suggest that RFA is only a palliative method in terms of completeness of tumor ablation.…”

“…

We read with interest the article by N'Kontchou et al 1 concerning hepatocellular carcinoma treatment by radiofrequency ablation (RFA). They report an excellent series with impressive results in terms of both very low major complication and tract seeding rates as well as a considerable long-term survival.

…”

Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: A long-term cohort study

“…[5][6][7][8] One of the most effective is radiofrequency ablation (RFA), 9 which is now considered potentially curative for early-stage HCCs in patients with or without surgical prospects. 3,4,[10][11][12] Local tumor control and survival are the parameters most widely used to assess the efficacy of surgical and nonsurgical treatments for HCC. [6][7][8][9][10][11][12][13][14][15][16] Data on local control are fairly easy to interpret: disease relapse at the treated tumor site is regarded as a treatment failure.…”

Living donor liver transplantation for hepatocellular carcinoma achieves better outcomes

“…The complete pathologic response (cPR) was around 27% to 57% of patients after TACE and 47% to 75% after radiofrequency ablation (RFA) (31,32). Recent report demonstrated that cPR reduced the recurrence of HCC after transplant and almost reduced to below 3% (33).…”