Clinical and circulating biomarkers of survival and recurrence after radiofrequency ablation in patients with hepatocellular carcinoma (original) (raw)
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Hepatology, 2009
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.
Post-recurrence survival in hepatocellular carcinoma after percutaneous radiofrequency ablation
Digestive and Liver Disease, 2014
Background: Overall survival in hepatocellular carcinoma patients treated with percutaneous radiofrequency ablation is influenced by both recurrence and successive treatments. We investigated post-recurrence survival after radiofrequency ablation. Methods: Data on 103 early/intermediate patients initially treated with radiofrequency ablation and followed for a median of 78 months (range 68-82) were retrospectively analysed. If intrahepatic disease recurrence occurred within or contiguous to the previously treated area it was defined as local, otherwise as distant; recurrence classified as Barcelona Clinic Liver Cancer stage C was defined by neoplastic portal vein thrombosis or metastases. Results: A total of 103 patients were included (82.5% male; median age 70 years, range 39-86). During follow-up, 64 recurrences were observed. Median overall survival was 62 months (95% confidence interval: 54-78) and survival rates were 97%, 65% and 52% at 1, 4 and 5 years, respectively. Median postrecurrence survival was 22 months (95% confidence interval: 16-35). Child-Pugh score, performance status, sum of tumour diameters at recurrence and recurrence patterns were independent predictors of post-recurrence survival. Conclusions: In patients with hepatocellular carcinoma after radiofrequency ablation, clinical and tumour parameters assessed at relapse, in particular the type of recurrence pattern, influence post-recurrence survival.
Journal of Gastrointestinal Surgery, 2008
Background Radiofrequency ablation (RFA) is an effective local ablation therapy for hepatocellular carcinoma (HCC) with favorable long-term outcome. There is no data on the analysis of recurrence pattern and its influence on long-term survival outcome after RFA in HCC patients. Aim of Study To evaluate the tumor recurrence pattern and its influence on long-term survival in patients with HCC treated with RFA. Patients and Methods From April 2001 to January 2005, 209 patients received RFA using internally cooled electrode as the sole treatment modality for HCC. Among them, 117 patients (56%) had unresectable HCC because of bilobar disease, poor liver function, and/or high medical risk for resection; whereas 92 patients (44%) underwent RFA as the primary treatment for small resectable HCC. The ablation procedure was performed through percutaneous (n=101), laparoscopic , or open approaches (n=91). The tumor recurrence pattern and long-term survival were analyzed. Multivariate analysis was carried out to identify independent prognostic factors affecting the overall survival of patients.
Journal of Gastrointestinal and Liver Diseases, 2018
Aims: To report on the long-term impact of tumor and non-tumor related parameters on local recurrence, distant recurrence and survival in patients with naïve or recurrent type hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA).Methods: We performed 240 RFA sessions on 133 patients with 156 HCC nodules developed on a background of liver cirrhosis and analyzed the outcomes.Results: Contrast-enhanced ultrasound performed one month after RFA showed complete ablation in 119 out of 133 (89.65%) patients. With a median follow-up of 46 months, 3-, 5- and 7-year survival rates were 61.7%, 35.7%, and 22.6%, respectively. Previous ethanol injection and histological grade were significantly related to local tumor progression. Child-Pugh class, incomplete ablation, histological grade, previous ethanol injection, alpha-fetoprotein level before the treatment, and local recurrence were all significantly related to distant recurrence. Multivariate analysis demonstrated that age,...
Background: Despite the high complete necrosis rate of radiofrequency ablation (RFA), tumor recurrence, either local tumor recurrence or new tumor formation, remains a significant problem. Purpose of this study is to evaluate the pattern and risk factors for intrahepatic recurrence after percutaneous RFA for hepatocellular carcinoma (HCC). Methods: We studied 40 patients with 48 HCCs ( 3.5 cm) who were treated with percutaneous RFA. The mean follow-up period was 24.1 + 15.7 months. We evaluated the cumulative disease-free survival of overall intrahepatic recurrence, local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Thirty host, tumoral and therapeutic risk factors were reviewed for significant tie-in correlation with recurrence: age; gender; whether RFA was the initial treatment for HCC or not; severity of liver disease; cause of liver cirrhosis; contact of tumor to major hepatic vessels and liver capsule; degree of approximation of tumor to the liver hilum; ablation time; degree of benign pre-ablational enhancement; sufficient safety margin; tumor multinodularity; tumor histological differentiation; tumor segmental location; maximum tumor diameter; degree of tumor pre-ablational enhancement at arterial phase CT, MRI or CT-angiography; and laboratory markers pre-and post-ablation (AFP, PIVKA II, TP, AST, ALT, ALP and TB). Results: The incidence of overall recurrence, LTP and IDR was 65, 23 and 52.5%, respectively. The cumulative disease-free survival rates were 54.6, 74.8 and 78.3% at 1 year, 27.3, 71.9 and 46.3% at 2 years and 20, 71.9 and 29.4 at 3 years, respectively. Univariate and multivariate analysis showed that the significant risk factors for LTP were: tumor size 2.3 cm, insufficient safety margin, multinodular tumor, tumors located at segments 8 and 5, and patient's age . 65 years (P , 0.05). No significant risk factor relationship for IDR could be detected. Conclusion: Our results would have clinical implications for advance warning and appropriate management of patients scheduled for RFA. Patients at risk of LTP should be closely monitored in the first year. Furthermore, regular long-term surveillance is essential for early detection and eradication of IDR.
Hepatology, 2007
If liver transplantation is not feasible, partial resection is considered the treatment of choice for hepatocellular carcinoma (HCC) in patients with cirrhosis. However, in some centers the firstline treatment for small, single, operable HCC is now radiofrequency ablation (RFA). In the current study, 218 patients with single HCC < 2.0 cm (very early or T1 stage) underwent RFA. We assessed 2 primary end points that could be easily compared with those reported for resective surgery: (1) the rate of sustained, local, complete response and (2) the rate of treatment-related complications. The secondary end point was 5-year survival in the 100 patients whose tumors had been considered potentially operable. After a median follow-up of 31 months, sustained complete response was observed in 216 patients (97.2%). In the remaining 6, percutaneous ethanol injection, selective intraarterial chemoembolization, or resection were used as salvage therapy. Perioperative mortality, major complication, and 5-year survival rates were 0%, 1.8%, and 68.5%, respectively. Conclusion: Compared with resection, RFA is less invasive and associated with lower complication rate and lower costs. RFA is also just as effective for ensuring local control of stage T1 HCC, and it is associated with similar survival rates (as recently demonstrated by 2 randomized trials). These data indicate that RFA can be considered the treatment of choice for patients with single HCC < 2.0 cm, even when surgical resection is possible. Other approaches can be used as salvage therapy for the few cases in which RFA is unsuccessful or unfeasible. (HEPATOLOGY 2008;47:82-89.) See Editorial on Page 5 R esective surgery, when feasible, is considered the treatment of choice for hepatocellular carcinoma (HCC) in patients with cirrhosis who are not candidates for liver transplantation. 1 This position is based
Journal of Digestive Diseases, 2014
OBJECTIVE: Early tumor recurrence, either local or intrahepatic distant recurrence (IDR), after successful radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) remains a significant problem. The study aimed to determine the potential risk factors for IDR within one year after successful RFA in HCC patients. METHODS: In total, 105 patients with 138 lesions who underwent RFA and were followed up for at least one year were included in this study. The patients' data was retrospectively reviewed. Multiple host and tumoral potential risk factors were analyzed. RESULTS: IDR was found in 62 (59.0%) of all patients. Cumulative IDR-free survival rates in all patients studied were 81.9%, 45.4% and 35.2% at 1, 2 and 3 years, respectively, after RFA. Univariate and multivariate analysis showed that both tumor size >2.8 cm and primary multinodular tumors were significant risk factors for IDR within one year after RFA. CONCLUSIONS: Patients with tumors of >2.8 cm in diameter or multinodular HCC should be closely monitored for early recurrence after RFA. Combined or systemic therapies should be tried for these patients to improve their disease-free and overall survival.
Radiofrequency ablation for hepatocellular carcinoma: a survival analysis of 117 patients
ANZ Journal of Surgery, 2010
ABSTRACT Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world especially in Asia. Radiofrequency ablation is now commonly use as either first line or in combination with other treatment modality for patients with HCC. It is the objective of this article to report our experience in a tertiary referral hospital. Patients who diagnosed with HCC and underwent RFA in Queen Elizabeth Hospital during the period from May 2002 to February 2009 were included and analyzed. During this period, 138 sessions of RFA were performed in 117 consecutive patients with HCC. The calculated rate of primary (single attempt) successful ablation during this entire period was 89.2%. The in-hospital/30-day mortality rate was zero, and morbidity was 24.1%. Hospital stays were significantly longer in the open group (4.4 days versus 8.9 days, P = 0.000). Median follow-up in this study was 21 months. 11 (9.4%), 10 (8.5%) and 49 (41.0%) patients developed local tumor progression (LTP), systemic recurrence and Intrahepatic distant recurrence (IDR), respectively. The mean and median times to recurrence were 15.4 and 11 months, respectively. Most patients (91%) with LTP developed in the first 24 months. Disease-free survival was 65% at 1 year, 40% at 3 years and 25% at 5 years. Overall survival at 1, 3 and 5 years was 85, 66 and 40%, respectively. Alpha fetoprotein, aFP > 1,000 ng/ml and multiple tumor ablation predicted increased risk of recurrence. Radiofrequecy ablation is useful tool in treating patients with HCC with high successful rate. However, intrahepatic recurrence is common and a well designed post ablation follow up protocol based on a sound knowledge of recurrence pattern is vital.
Journal of Hepatology, 2013
Background & Aims: The aim of this study was to compare liver resection and radiofrequency ablation in patients with single hepatocellular carcinoma 63 cm and compensated cirrhosis. Methods: The study involved 544 Child-Pugh A cirrhotic patients (246 in the resection group and 298 in the radiofrequency group) observed in 15 Italian centers. Overall survival and tumor recurrence rates were analyzed using the Kaplan Meier method before and after propensity score matching. Cox regression models were used to identify factors associated with overall survival and tumor recurrence. Results: Two cases of perioperative mortality were observed in the resection group and the rate of major complications was 4.5% in the resection group and 2.0% in the radiofrequency group (p = 0.101). Four-year overall survival rates were 74.4% in the resection group and 66.2% in the radiofrequency group (p = 0.353). Four-year cumulative HCC recurrence rates were 56% in the resection group and 57.1% in the radiofrequency group (p = 0.765). Local tumor progression was detected in 20.5% of ablated patients and in one resected patient (p <0.001). After propensity score matching, both survival and tumor recurrence were still not significantly different although a trend towards lower recurrence was observed in resected patients. Older age and higher alpha-fetoprotein levels were independent predictors of poor overall survival while older age and higher alanine-aminotransferase levels resulted to be independent factors associated with higher recurrence rate. Conclusions: In spite of a higher rate of local tumor progression, radiofrequency ablation can provide results comparable to liver resection in the treatment of single hepatocellular carcinoma 63 cm occurring in compensated cirrhosis.