title: Treatment strategy for hepatocellular carcinoma: expanding the indications for radiofrequency ablation.
abstract: 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.
authors.affiliation: Department of Gastroenterology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tateishi
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Shiina
authors.forename: Takamasa
authors.initials: T
authors.lastname: Ohki
authors.forename: Takahisa
authors.initials: T
authors.lastname: Sato
authors.forename: Ryota
authors.initials: R
authors.lastname: Masuzaki
authors.forename: Jun
authors.initials: J
authors.lastname: Imamura
authors.forename: Eriko
authors.initials: E
authors.lastname: Goto
authors.forename: Tadashi
authors.initials: T
authors.lastname: Goto
authors.forename: Hideo
authors.initials: H
authors.lastname: Yoshida
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Obi
authors.forename: Shinpei
authors.initials: S
authors.lastname: Sato
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Kanai
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: 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