title: Predictive factors for distant recurrence of HCV-related hepatocellular carcinoma after radiofrequency ablation combined with chemoembolization.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) therapy for hepatocellular carcinoma has enabled good local control to be possible. However, after successful local control, distant recurrences frequently occur in the remnant liver.
  
  
  OBJECTIVE
  To identify the predictive factors for distant recurrence after RFA.
  
  
  METHODS
  A total of 117 patients with initial non-advanced hepatocellular carcinoma with HCV who underwent RFA in our hospital were selected for this study. After transcatheter chemoembolization, RFA was performed under real-time computed tomography-fluoroscopic guidance. We studied survival rates, local (adjacent to treated tumour) and distant (intrahepatic site distant from the treated tumours) recurrence rates, as well as predictive factors for distant recurrence.
  
  
  RESULTS
  After RFA, survival rates were 98.2% and 64.7% at 1 and 5 years, respectively. Child B patients had a significantly worse survival than Child A. Recurrence rates were 2.4% at 5 years for local, and 17.1% and 76.9% at 1 and 5 years, respectively, for distant. The Kaplan-Meier method revealed significantly high recurrence rates in cases with low albumin levels (Alb < 3.5 g/dL), high aspartate aminotransferase levels (AST > 60 IU/L), high alanine aminotransferase levels (ALT > 60 IU/L), low platelet counts (Plt < 10 x 10(4)/microL), and high alpha-fetoprotein levels (AFP > 50 ng/mL). On multivariate analysis, low Alb levels and high AST levels were independent predictive factors for distant recurrence.
  
  
  CONCLUSIONS
  Although RFA enables good local control for initial hepatocellular carcinoma, distant recurrence is observed at high rates in HCV patients. Low albumin and high AST levels are predictive factors for distant recurrence.
authors.affiliation: Department of Gastroenterology, Mie University School of Medicine, Tsu, Mie, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Fuke
authors.forename: K
authors.initials: K
authors.lastname: Sugimoto
authors.forename: K
authors.initials: K
authors.lastname: Shiraki
authors.forename: J
authors.initials: J
authors.lastname: Tanaka
authors.forename: T
authors.initials: T
authors.lastname: Beppu
authors.forename: K
authors.initials: K
authors.lastname: Yoneda
authors.forename: N
authors.initials: N
authors.lastname: Yamamoto
authors.forename: K
authors.initials: K
authors.lastname: Ito
authors.forename: H
authors.initials: H
authors.lastname: Takaki
authors.forename: A
authors.initials: A
authors.lastname: Nakatsuka
authors.forename: K
authors.initials: K
authors.lastname: Yamakado
authors.forename: K
authors.initials: K
authors.lastname: Takeda
authors.forename: Y
authors.initials: Y
authors.lastname: Takei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011379:Prognosis