Frequency of and predictive factors for vascular invasion after radiofrequency ablation for hepatocellular carcinoma.
BACKGROUND
Vascular invasion in patients with hepatocellular carcinoma (HCC) is representative of advanced disease with an extremely poor prognosis. The detailed course of its development has not been fully elucidated.


METHODS
We enrolled 1057 consecutive patients with HCC who had been treated with curative intent by radiofrequency ablation (RFA) as an initial therapy from 1999 to 2008 at our department. We analyzed the incidence rate of and predictive factors for vascular invasion. The survival rate after detection of vascular invasion was also analyzed.


RESULTS
During a mean follow-up period of 4.5 years, 6075 nodules including primary and recurrent lesions were treated by RFA. Vascular invasion was observed in 97 patients. The rate of vascular invasion associated with site of original RFA procedure was 0.66% on a nodule basis. The incidence rates of vascular invasion on a patient basis at 1, 3, and 5 years were 1.1%, 5.9%, and 10.4%, respectively. Univariate analysis revealed that tumor size, tumor number, alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP), and Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein were significant risk predictors of vascular invasion. In multivariate analysis, DCP was the most significant predictor for vascular invasion (compared with a DCP of ≤100 mAu/mL, the hazard ratio was 1.95 when DCP was 101-200 mAu/mL and 3.22 when DCP was >200 mAu/mL). The median survival time after development of vascular invasion was only 6 months.


CONCLUSIONS
Vascular invasion occurs during the clinical course of patients initially treated with curative intent. High-risk patients may be identified using tumor markers.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Yoshinari
Y
Asaoka
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Ryosuke
R
Tateishi
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Ryo
R
Nakagomi
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Mayuko
M
Kondo
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Naoto
N
Fujiwara
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Tatsuya
T
Minami
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Masaya
M
Sato
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Koji
K
Uchino
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Kenichiro
K
Enooku
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Hayato
H
Nakagawa
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Yuji
Y
Kondo
Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
Shuichiro
S
Shiina
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Haruhiko
H
Yoshida
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Kazuhiko
K
Koike
D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008113:Liver Neoplasms / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D008297:Male; D009361:Neoplasm Invasiveness; D009389:Neovascularization, Pathologic / Q000473:pathology*; D011498:Protein Precursors / Q000378:metabolism; D011516:Prothrombin / Q000378:metabolism; D016019:Survival Analysis; D000509:alpha-Fetoproteins / Q000378:metabolism
D015415:Biomarkers; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin