Treatment strategy for hepatocellular carcinoma: expanding the indications for radiofrequency ablation.
BACKGROUND
Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is ordinarily indicated for those with three or fewer nodules, none of which exceeds 3 cm in diameter. This study investigated whether an apparent threshold exists in the diameter and number of nodules in terms of the prognosis of patients with HCC.


METHODS
We enrolled 663 naïve patients with HCC who were treated with RFA at our hospital between 1999 and 2005. We analyzed the patients' prognosis using multivariate Cox proportional regression with the diameter and number of nodules as covariates and Child-Pugh class as a stratification factor. The diameter and number were categorized as <or=2.0, 2.1-3.0, 3.1-4.0, 4.1-5.0, and >5 cm and 1, 2-3, 4-5, and >5, respectively.


RESULTS
The adjusted hazard ratio of patients whose largest nodule was <or=2.0, 2.1-3.0, 3.1-4.0, 4.1-5.0, and >5 cm was 1, 1.51, 2.56, 2.25, and 2.71, respectively. The adjusted hazard ratio of patients with one, two or three, four or five, and more than five nodules was 1, 1.35, 1.70, and 2.12, respectively. Therefore, patients with three or fewer nodules, none of which exceeds 5 cm in diameter, have a 5-year survival of 40%.


CONCLUSIONS
The prognosis of the patients worsened gradually as the diameter and number of nodules increased. No apparent threshold in the diameter or number of HCC nodules was detected. RFA can be applied beyond the conventional indications.
Tateishi
Ryosuke
R
Department of Gastroenterology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Shiina
Shuichiro
S
Ohki
Takamasa
T
Sato
Takahisa
T
Masuzaki
Ryota
R
Imamura
Jun
J
Goto
Eriko
E
Goto
Tadashi
T
Yoshida
Hideo
H
Obi
Shuntaro
S
Sato
Shinpei
S
Kanai
Fumihiko
F
Yoshida
Haruhiko
H
Omata
Masao
M
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome