Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors

Shuichiro Shiina, Ryosuke Tateishi, Toru Arano, Koji Uchino, Kenichiro Enooku, Hayato Nakagawa, Yoshinari Asaoka, Takahisa Sato, Ryota Masuzaki, Yuji Kondo, Tadashi Goto, Haruhiko Yoshida, Masao Omata, Kazuhiko Koike, Shuichiro Shiina, Ryosuke Tateishi, Toru Arano, Koji Uchino, Kenichiro Enooku, Hayato Nakagawa, Yoshinari Asaoka, Takahisa Sato, Ryota Masuzaki, Yuji Kondo, Tadashi Goto, Haruhiko Yoshida, Masao Omata, Kazuhiko Koike

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.

Figures

Figure 1
Figure 1
Flow of patients in this study. HCC, hepatocellular carcinoma.
Figure 2
Figure 2
Overall survival in 1,170 primary hepatocellular carcinoma patients who underwent radiofrequency ablation.
Figure 3
Figure 3
Local tumor progression and distant recurrence in patients who underwent radiofrequency ablation.

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