title: High local recurrence of early-stage hepatocellular carcinoma after percutaneous thermal ablation in routine clinical practice.
abstract: OBJECTIVE
  The risk of local tumour progression (LTP) and factors predicting LTP following percutaneous thermal ablation (PTA) of early-stage hepatocellular carcinoma (HCC) have not been well studied in non-trial settings and may be underestimated. We aimed to assess these outcomes in a multicentre study.
  
  
  METHODS
  This was a retrospective review of consecutive patients with early-stage HCC treated with a curative intent across three tertiary Australian centres between 2006 and 2012 with either radiofrequency ablation or microwave ablation. The primary endpoint was LTP and multivariate analysis was carried out to identify the independent predictors of LTP.
  
  
  RESULTS
  In total 145 HCC nodules were treated in 126 patients (78% men, mean±SD age 62±10 years) with a mean±SD follow-up of 13.5±13 months. Local recurrence was observed in 23.4% (34/145). Mean±SD LTP-free survival was 46.9±3.6 months. For HCC nodules 2 cm or less, local recurrence rates were lower (15.9%), with a mean±SD LTP-free survival of 48.8±4.2 months. Poorly differentiated HCC [hazard ratio (95% confidence interval)=4.8 (1.1-20.4), P=0.032] and pretreatment α-fetoprotein more than 50 kIU/l [8.2 (1.7-39.0), P=0.008] were independent predictors of LTP. LTP rates were not significantly different between the radiofrequency ablation and the microwave ablation groups (22.8 vs. 25.8%, P=0.7). There were six (4.8%) procedure-related adverse events, but no deaths.
  
  
  CONCLUSIONS
  Local recurrence after PTA for early-stage HCC is high in routine clinical practice. Poorly differentiated HCC and pretreatment α-fetoprotein are important, independent predictors of LTP. Further well-designed randomized controlled trials with larger sample sizes using adjuvant therapies in combination with PTA to decrease LTP rates are warranted.
authors.affiliation: aHepatology and Liver Transplant Medicine Unit bDepartment of Medical Imaging, Flinders Medical Centre, Bedford Park cDepartment of Gastroenterology/Hepatology dDepartment of Radiology, Royal Adelaide Hospital eSchool of Medicine, Flinders University of South Australia, Adelaide, South Australia fDepartment of Gastroenterology/Hepatology, Sir Charles Gairdner Hospital, Nedlands gSchool of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Chinnaratha
authors.forename: Dharshan
authors.initials: D
authors.lastname: Sathananthan
authors.forename: Puraskar
authors.initials: P
authors.lastname: Pateria
authors.forename: Edmund
authors.initials: E
authors.lastname: Tse
authors.forename: Gerry
authors.initials: G
authors.lastname: MacQuillan
authors.forename: Leigh
authors.initials: L
authors.lastname: Mosel
authors.forename: Ramon
authors.initials: R
authors.lastname: Pathi
authors.forename: Dan
authors.initials: D
authors.lastname: Madigan
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Wigg
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008872:Microwaves / Q000627:therapeutic use; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology*; D009367:Neoplasm Staging; D012307:Risk Factors; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins