Aggressive Intrasegmental Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation: Risk Factors and Clinical Significance.
OBJECTIVE
To evaluate the frequency, risk factors, and clinical significance of aggressive intrasegmental recurrence (AIR) found after radiofrequency (RF) ablation for hepatocellular carcinoma (HCC).


METHODS
Institutional review board approval was obtained for this retrospective study. Between March 2005 and December 2010, 539 patients (414 men, 125 women; mean age, 57.91 years; age range, 30-82 years) underwent ultrasonography-guided percutaneous RF ablation as a first-line treatment for a single HCC classified as Barcelona Clinic Liver Cancer (BCLC) stage 0 or A. AIR of HCC was defined as (a) initial tumor recurrence with disease-free status at least 6 months after initial RF ablation and (b) the simultaneous development of multiple nodular (at least three) or infiltrative tumor recurrence in the treated segment. Patients were stratified into two groups: those with AIR (n = 20) and those without AIR (n = 519) during follow-up. Risk factors for AIR were assessed with logistic regression analysis, and risk factors for long-term overall survival were assessed with time-dependent Cox proportional hazard models.


RESULTS
In a median follow-up period of 49 months (range, 6-95 months), AIR was observed in 3.7% of the patients (20 of 539 patients), with the frequency increasing to 15% in the subgroup with periportal HCC (11 of 72 patients). AIRs manifested as either multiple nodular type (n = 14, BCLC stage A or B) or diffusely infiltrative type with tumor thrombus formation (n = 6, BCLC stage C). At multivariate analysis, periportal tumor location and younger patient age were significant risk factors for AIR. The presence of AIR during the follow-up period has a significant effect on the overall survival rate (hazard ratio = 5.72, P = .002).


CONCLUSIONS
The overall frequency of AIR after RF ablation for HCC was low, with periportal location and patient age showing a significant relationship to the development of AIR. The occurrence of AIR had an adverse effect on overall survival rate.
From the Department of Radiology and Center for Imaging Science (T.W.K., H.K.L., M.W.L., Y.S.K., H.R., W.J.L.), Division of Hepatology, Department of Medicine (G.Y.G., Y.H.P.), Division of Hematology-Oncology, Department of Medicine (H.Y.L.), and Biostatics Unit, Samsung Biomedical Research Institute (M.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Irwonro 81, Seoul 135-710, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul Republic of Korea (H.K.L., W.J.L., Y.H.P., H.Y.L.).
Tae Wook
TW
Kang
From the Department of Radiology and Center for Imaging Science (T.W.K., H.K.L., M.W.L., Y.S.K., H.R., W.J.L.), Division of Hepatology, Department of Medicine (G.Y.G., Y.H.P.), Division of Hematology-Oncology, Department of Medicine (H.Y.L.), and Biostatics Unit, Samsung Biomedical Research Institute (M.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Irwonro 81, Seoul 135-710, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul Republic of Korea (H.K.L., W.J.L., Y.H.P., H.Y.L.).
Hyo Keun
HK
Lim
From the Department of Radiology and Center for Imaging Science (T.W.K., H.K.L., M.W.L., Y.S.K., H.R., W.J.L.), Division of Hepatology, Department of Medicine (G.Y.G., Y.H.P.), Division of Hematology-Oncology, Department of Medicine (H.Y.L.), and Biostatics Unit, Samsung Biomedical Research Institute (M.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Irwonro 81, Seoul 135-710, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul Republic of Korea (H.K.L., W.J.L., Y.H.P., H.Y.L.).
Min Woo
MW
Lee
From the Department of Radiology and Center for Imaging Science (T.W.K., H.K.L., M.W.L., Y.S.K., H.R., W.J.L.), Division of Hepatology, Department of Medicine (G.Y.G., Y.H.P.), Division of Hematology-Oncology, Department of Medicine (H.Y.L.), and Biostatics Unit, Samsung Biomedical Research Institute (M.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Irwonro 81, Seoul 135-710, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul Republic of Korea (H.K.L., W.J.L., Y.H.P., H.Y.L.).
Young-Sun
YS
Kim
From the Department of Radiology and Center for Imaging Science (T.W.K., H.K.L., M.W.L., Y.S.K., H.R., W.J.L.), Division of Hepatology, Department of Medicine (G.Y.G., Y.H.P.), Division of Hematology-Oncology, Department of Medicine (H.Y.L.), and Biostatics Unit, Samsung Biomedical Research Institute (M.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Irwonro 81, Seoul 135-710, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul Republic of Korea (H.K.L., W.J.L., Y.H.P., H.Y.L.).
Hyunchul
H
Rhim
From the Department of Radiology and Center for Imaging Science (T.W.K., H.K.L., M.W.L., Y.S.K., H.R., W.J.L.), Division of Hepatology, Department of Medicine (G.Y.G., Y.H.P.), Division of Hematology-Oncology, Department of Medicine (H.Y.L.), and Biostatics Unit, Samsung Biomedical Research Institute (M.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Irwonro 81, Seoul 135-710, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul Republic of Korea (H.K.L., W.J.L., Y.H.P., H.Y.L.).
Won Jae
WJ
Lee
From the Department of Radiology and Center for Imaging Science (T.W.K., H.K.L., M.W.L., Y.S.K., H.R., W.J.L.), Division of Hepatology, Department of Medicine (G.Y.G., Y.H.P.), Division of Hematology-Oncology, Department of Medicine (H.Y.L.), and Biostatics Unit, Samsung Biomedical Research Institute (M.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Irwonro 81, Seoul 135-710, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul Republic of Korea (H.K.L., W.J.L., Y.H.P., H.Y.L.).
Geum-Youn
GY
Gwak
From the Department of Radiology and Center for Imaging Science (T.W.K., H.K.L., M.W.L., Y.S.K., H.R., W.J.L.), Division of Hepatology, Department of Medicine (G.Y.G., Y.H.P.), Division of Hematology-Oncology, Department of Medicine (H.Y.L.), and Biostatics Unit, Samsung Biomedical Research Institute (M.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Irwonro 81, Seoul 135-710, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul Republic of Korea (H.K.L., W.J.L., Y.H.P., H.Y.L.).
Yong Han
YH
Paik
From the Department of Radiology and Center for Imaging Science (T.W.K., H.K.L., M.W.L., Y.S.K., H.R., W.J.L.), Division of Hepatology, Department of Medicine (G.Y.G., Y.H.P.), Division of Hematology-Oncology, Department of Medicine (H.Y.L.), and Biostatics Unit, Samsung Biomedical Research Institute (M.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Irwonro 81, Seoul 135-710, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul Republic of Korea (H.K.L., W.J.L., Y.H.P., H.Y.L.).
Ho Yeong
HY
Lim
From the Department of Radiology and Center for Imaging Science (T.W.K., H.K.L., M.W.L., Y.S.K., H.R., W.J.L.), Division of Hepatology, Department of Medicine (G.Y.G., Y.H.P.), Division of Hematology-Oncology, Department of Medicine (H.Y.L.), and Biostatics Unit, Samsung Biomedical Research Institute (M.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Irwonro 81, Seoul 135-710, Republic of Korea; and Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul Republic of Korea (H.K.L., W.J.L., Y.H.P., H.Y.L.).
Min Ji
MJ
Kim
D055011:Ablation Techniques; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors