title: Stage progression of small hepatocellular carcinoma after radical therapy: comparisons of radiofrequency ablation and surgery using the Markov model.
abstract: BACKGROUND
  Stage progression of 374 small hepatocellular carcinomas (HCC) was retrospectively analysed.
  
  
  METHODS
  During 8 years, 236 patients with the early stage of HCC received radiofrequency ablation (RFA), and 138 underwent surgery as an initial therapy. More patients of young age and with better liver function tended to undergo surgical treatment. Based on 1892 patient-year data, the Markov model analysed the stepwise progression of early stage (multiple up to three nodules, 3 cm or less each) to intermediate stage (four nodules or more, or larger than 3 cm), to advanced stage (portal invasion, extrahepatic metastasis or Child-Pugh C) and to death.
  
  
  RESULTS
  The recurrence rates after RFA and surgery were 53.3 and 40.6% in the third year. The annual progression rates from the early stage to the intermediate stage, advanced stage and death were 5.40, 1.63 and 1.73% in the RFA group and 3.90, 1.87 and 0.62% in the surgery group respectively. The progression rate from the early to the intermediate stage was significantly lower (2.34% annually) in the younger patient group (<60 years) than that in the older group (≥ 60 years, 5.70%, P=0.0053). In contrast, the progression rate from the intermediate to the advanced stage was significantly higher in the younger patient group (<60 years, 37.50% annually) than that in the older groups (60-69 years, 30.30%, 70 years or older 22.09%, P=0.0011). Multivariate hazard analysis showed that initial treatment did not significantly affect the stage progression rate (hazard ratio of RFA 1.09, P=0.70) and the survival rate (hazard ratio of RFA 1.09, P=0.73).
  
  
  CONCLUSIONS
  Although the recurrence rate was slightly higher in the RFA group, additional ablation procedures could control the progression of HCC, with a rate comparable to the surgical group.
authors: Department of Hepatology, Toranomon Hospital, Tokyo, Japan. ikedakenji@tora.email.ne.jp
authors: Kenji
authors: K
authors: Ikeda
authors: Masahiro
authors: M
authors: Kobayashi
authors: Yusuke
authors: Y
authors: Kawamura
authors: Norihiro
authors: N
authors: Imai
authors: Yuya
authors: Y
authors: Seko
authors: Miharu
authors: M
authors: Hirakawa
authors: Tetsuya
authors: T
authors: Hosaka
authors: Hitomi
authors: H
authors: Sezaki
authors: Norio
authors: N
authors: Akuta
authors: Satoshi
authors: S
authors: Saitoh
authors: Fumitaka
authors: F
authors: Suzuki
authors: Yoshiyuki
authors: Y
authors: Suzuki
authors: Yasuji
authors: Y
authors: Arase
authors: Hiromitsu
authors: H
authors: Kumada
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome