title: Percutaneous radiofrequency ablation as first-line treatment for small hepatocellular carcinoma: results and prognostic factors on long-term follow up.
abstract: OBJECTIVE
  We evaluated the prognosis and associated factors in patients with small hepatocellular carcinoma (HCC; up to 3 nodules, each up to 3 cm in diameter) treated with percutaneous radiofrequency ablation (RFA) as first-line treatment.
  
  
  METHODS
  Eighty-eight consecutive patients who underwent percutaneous RFA as first-line treatment were enrolled, among whom 70 who had hypervascular HCC nodules which were treated by a combination of transcatheter arterial chemoembolization and RFA. RFA was repeated until an ablative margin was obtained.
  
  
  RESULTS
  The rate of local tumor progression at 1 and 3 years was 4.8% and 4.8%, respectively. The rate of overall survival at 3 and 5 years was 83.0% and 70.0%, and the rate of disease-free survival at 3 and 5 years was 34.0% and 24.0%, respectively. On multivariate analysis, age (< 70 years; hazard ratio [HR] = 2.341, 95% confidence interval [CI] = 1.101-4.977, P = 0.027) and indocyanine green retention rate at 15 min (< 15%; HR = 3.621, 95% CI = 1.086-12.079, P = 0.036) were statistically significant determinants of overall survival, while tumor number (solitary, HR = 2.465, 95% CI = 1.170-5.191, P = 0.018) was identified for disease-free survival. Overall survival of patients with early recurrence after RFA was significantly worse than that of patients with late recurrence. Tumor size was the only independent risk factor of early recurrence after RFA of HCC (tumor size > 2 cm; risk ratio [RR] = 4.629, 95% CI = 1.241-17.241, P = 0.023).
  
  
  CONCLUSIONS
  Percutaneous RFA under the protocol reported here has the potential to provide local tumor control for small HCC. In addition to host factors, time interval from RFA to recurrence was an important determinant of prognosis.
authors.affiliation: Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Waki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aikata
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Katamura
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Kawaoka
authors.forename: Shintaro
authors.initials: S
authors.lastname: Takaki
authors.forename: Akira
authors.initials: A
authors.lastname: Hiramatsu
authors.forename: Shoichi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Toyota
authors.forename: Katsuhide
authors.initials: K
authors.lastname: Ito
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D017115:Catheter Ablation / Q000379:methods*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome