Percutaneous radiofrequency ablation and transcatheter arterial chemoembolization for hypervascular hepatocellular carcinoma: rate and risk factors for local recurrence.
OBJECTIVE
To analyze local recurrence-free rates and risk factors for recurrence following percutaneous radiofrequency ablation (RFA) or transcatheter arterial chemoembolization (TACE) for hypervascular hepatocellular carcinoma (HCC).


METHODS
One hundred and nine nodules treated by RFA and 173 nodules treated by TACE were included. Hypovascular nodules were excluded from this study. Overall local recurrence-free rates of each treatment group were calculated using the Kaplan-Meier method. The independent risk factors of local recurrence and the hazard ratios were analyzed using Cox's proportional-hazards regression model. Based on the results of multivariate analyses, we classified HCC nodules into four subgroups: central nodules < or =2 cm or >2 cm and peripheral nodules < or =2 cm or >2 cm. The local recurrence-free rates of these subgroups for each treatment were also calculated.


RESULTS
The overall local recurrence-free rate was significantly higher in the RFA group than in the TACE group (p = 0.013). The 24-month local recurrence-free rates in the RFA and TACE groups were 60.0% and 48.9%, respectively. In the RFA group, the only significant risk factor for recurrence was tumor size >2 cm in greatest dimension. In the TACE group, a central location was the only significant risk factor for recurrence. In central nodules that were < or =2 cm, the local recurrence-free rate was significantly higher in the RFA group than in the TACE group (p < 0.001). In the remaining three groups, there was no significant difference in local recurrence-free rate between the two treatment methods.


CONCLUSIONS
A tumor diameter of >2 cm was the only independent risk factor for local recurrence in RFA treatment, and a central location was the only independent risk factor in TACE treatment. Central lesions measuring < or =2 cm should be treated by RFA.
Murakami
Tomonori
T
Department of Radiology, National Nagasaki Medical Center, 2-1001-1 Kubara, Omura, 856-8562, Japan. tomonorimurakami@yahoo.co.jp
Ishimaru
Hideki
H
Sakamoto
Ichiro
I
Uetani
Masataka
M
Matsuoka
Yohjiro
Y
Daikoku
Manabu
M
Honda
Sumihisa
S
Koshiishi
Takeshi
T
Fujimoto
Toshifumi
T
D000328:Adult; D000368:Aged; D000792:Angiography; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D018572:Disease-Free Survival; D004564:Electrocoagulation / Q000379:methods*; D015251:Epirubicin / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000209:etiology*; D009378:Neoplasms, Multiple Primary / Q000098:blood supply / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000532:radiotherapy*; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D015251:Epirubicin; D016685:Mitomycin