Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 Western patients with cirrhosis.
For the treatment of small hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) is in some centers considered a first-line therapeutic option. However, such a strategy is still under debate with regard to tumor and patient characteristics. In this single-center study we assessed the 5-year survival and prognosis factors in 235 consecutive patients with cirrhosis (Child-Pugh A/B: 205/30) who received RFA as first-line treatment for up to three HCC <or=5 cm (307 tumors; mean diameter: 29 +/- 10 mm; 53 multinodular forms). Among these patients, 67 satisfied the criteria for resection according to the Barcelona Clinic Liver Cancer. Complete ablation was obtained in 222 patients (94%). Overall, 337 RFA sessions were performed including iterative RFA for recurrence. Major complications occurred in three patients (0.9%), including one treatment-related death. After 27 +/- 20 months of mean follow-up, local or distant, or both, tumor recurrence occurred in 16, 88, and 11 patients, respectively. Twenty-nine patients underwent transplantation and were removed from the study at this point. Overall 5-year, recurrence-free, and tumor-free (including results of iterative RFA) survival rates were, respectively, 40%, 17%, and 32%. The overall 5-year survival rate was 76% for operable patients. Factors associated with overall survival were prothrombin activity (hazard ratio [HR] = 0.97, 0.96-0.98; P < 0.0001) and serum levels of alpha-fetoprotein (AFP) (HR = 1.02, 1.02-1.02; P < 0.0001), and factors associated with tumor recurrence were multinodular forms (HR = 2.34; 1.52-3.6; P = 0.0001) and serum AFP levels (HR = 1.015, 1.014-1.016; P = 0.015). Tumor size was associated with local recurrence but not with overall and tumor-free survival.


CONCLUSIONS
RFA is a safe and effective first-line treatment of HCC up to 5 cm in diameter, especially for patients with a single tumor, a low serum AFP level, and well-preserved liver function.
N'Kontchou
Gisèle
G
Department of Hepatogastroenterology, Hôpital Jean Verdier (Assistance Publique-Hôpitaux de Paris), Bondy, France.
Mahamoudi
Amel
A
Aout
Mounir
M
Ganne-Carrié
Nathalie
N
Grando
Véronique
V
Coderc
Emmanuelle
E
Vicaut
Eric
E
Trinchet
Jean Claude
JC
Sellier
Nicolas
N
Beaugrand
Michel
M
Seror
Olivier
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000208:ethnology / Q000601:surgery*; D017115:Catheter Ablation; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000473:pathology / Q000601:surgery; D008103:Liver Cirrhosis; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013030:Spain; D015996:Survival Rate; D016896:Treatment Outcome