title: Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors.
abstract: BACKGROUND
  : Radiofrequency ablation (RFA) and microwave ablation (MWA) were found to be effective in treating hepatocellular carcinoma (HCC) smaller than 3 cm; however, to the authors' knowledge, the usefulness of thermal ablation in treating larger HCC, especially those >5 cm, has not been well documented. The present study evaluated the therapeutic efficacy of percutaneous thermal ablation with curative intention for HCC measuring between 3.0 cm and 7.0 cm.
  
  
  METHODS
  : Percutaneous RFA or MWA were used to treat 109 HCC patients with at least 1 tumor measuring between 3.0 cm and 7.0 cm. Fifty-eight patients received thermal ablation as the first treatment, and the remaining 51 were treated for posthepatectomy recurrent HCC. A total of 89 patients had a main tumor measuring 3.0 cm to 5.0 cm, and 20 patients had main tumors measuring 5.0 cm to 7.0 cm. Local therapeutic efficacy, long-term outcome, and prognostic factors were analyzed.
  
  
  RESULTS
  : There were no treatment-related deaths, and the major complication rate was 9.2%. Complete ablation rate was 92.6%. Local recurrence (LR) occurred in 22% patients, with a median time to LR of 4.6 months. Distant recurrences developed in 53.2% patients. The 1-year, 3-year, and 5-year survival rates were 75.8%, 30.9%, and 15.4%, respectively. Univariate analysis indicated that incomplete tumor ablation, posthepatectomy recurrence, and preablation alpha-fetoprotein (AFP) > or =200 ng/mL were 3 unfavorable prognostic factors for long-term survival (P = .000, .015, and .008, respectively). Cox regression analysis confirmed that incomplete tumor ablation, recurrent tumors, and preablation AFP > or =200 ng/mL were independent unfavorable prognostic factors, with an exp(B) of 4.158 (P = .001), 1.568 (P = .082), and 1.593 (P = .082), respectively.
  
  
  CONCLUSIONS
  : Percutaneous thermal ablation was effective and safe in treating HCC between 3 cm and 7 cm, with acceptable local tumor control and long-term outcomes. Completeness of ablation, previous history of treatment, and preablation AFP level were significant prognostic factors. Cancer 2009. (c) 2009 American Cancer Society.
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China.
authors.forename: Xiao-Yu
authors.initials: XY
authors.lastname: Yin
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Xie
authors.forename: Ming-De
authors.initials: MD
authors.lastname: Lu
authors.forename: Hui-Xiong
authors.initials: HX
authors.lastname: Xu
authors.forename: Zuo-Feng
authors.initials: ZF
authors.lastname: Xu
authors.forename: Ming
authors.initials: M
authors.lastname: Kuang
authors.forename: Guang-Jian
authors.initials: GJ
authors.lastname: Liu
authors.forename: Jin-Yu
authors.initials: JY
authors.lastname: Liang
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
mesh_terms: D000279:Administration, Cutaneous; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008872:Microwaves / Q000627:therapeutic use*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D015996:Survival Rate