title: Evaluation of the Effect of Cumulative Operator Experience on Hepatocellular Carcinoma Recurrence after Primary Treatment with Radiofrequency Ablation.
abstract: OBJECTIVE
  To investigate the association between cumulative operator volume and the risk of hepatocellular carcinoma (HCC) recurrence after potentially curative radiofrequency ablation (RFA).
  
  
  METHODS
  This study was approved by the Research Ethics Committee. By using the Taiwan National Health Insurance Research Database, 52 096 patients with HCC were identified between July 1, 2004, and December 31, 2011. In total, 2827 patients were selected who underwent potentially curative RFA for newly diagnosed HCC. These patients were grouped into quintiles according to the cumulative operator volumes. Patients in the lowest or the highest quintiles were 1:1 matched according to their propensity scores. Finally, two separate groups, each containing 406 patients, were recruited in the high- and low-volume groups (cumulative operator volume of ≥79 cases and ≤10 cases, respectively). Cumulative incidences of and hazard ratios for HCC recurrence were analyzed after adjusting for competing mortality.
  
  
  RESULTS
  The HCC recurrence rate of the high-volume group was significantly lower than that of the low-volume group (high-volume group 5-year recurrence rate of 65.8%, 95% confidence interval [CI]: 59.5%, 72.1%; low-volume group 5-year recurrence rate of 71.4%, 95% CI: 66.2%, 76.5%; P < .05). In modified Cox regression analysis, the highest cumulative operator volume was independently associated with a decreased risk of HCC recurrence (hazard ratio, 0.80; 95% CI: 0.67, 0.97; P < .05). Multivariable stratified analyses verified the association between the highest cumulative operator volume and decreased HCC recurrence in almost all subgroups.
  
  
  CONCLUSIONS
  The risk of HCC recurrence could be significantly decreased by experienced RFA operators. Further studies based on cumulative operator volume may be helpful in improving the quality of RFA for HCC.
authors.affiliation: From the Department of Medicine, Chung Shan Medical University, Taichung, Taiwan (T.Y.L.); Division of Gastroenterology, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung, Taiwan 40705 (T.Y.L., C.Y.W.); School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan (J.T.L., H.J.H.); Department of Internal Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (J.T.L.); Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan (J.T.L.); Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan (M.S.W.); Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (C.Y.W.); Graduate Institute of Clinical Medical Science and Department of Public Health, China Medical University, Taichung, Taiwan (C.Y.W.); and Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan (C.Y.W.).
authors.forename: Teng-Yu
authors.initials: TY
authors.lastname: Lee
authors.affiliation: From the Department of Medicine, Chung Shan Medical University, Taichung, Taiwan (T.Y.L.); Division of Gastroenterology, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung, Taiwan 40705 (T.Y.L., C.Y.W.); School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan (J.T.L., H.J.H.); Department of Internal Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (J.T.L.); Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan (J.T.L.); Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan (M.S.W.); Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (C.Y.W.); Graduate Institute of Clinical Medical Science and Department of Public Health, China Medical University, Taichung, Taiwan (C.Y.W.); and Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan (C.Y.W.).
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
authors.affiliation: From the Department of Medicine, Chung Shan Medical University, Taichung, Taiwan (T.Y.L.); Division of Gastroenterology, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung, Taiwan 40705 (T.Y.L., C.Y.W.); School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan (J.T.L., H.J.H.); Department of Internal Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (J.T.L.); Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan (J.T.L.); Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan (M.S.W.); Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (C.Y.W.); Graduate Institute of Clinical Medical Science and Department of Public Health, China Medical University, Taichung, Taiwan (C.Y.W.); and Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan (C.Y.W.).
authors.forename: Hsiu J
authors.initials: HJ
authors.lastname: Ho
authors.affiliation: From the Department of Medicine, Chung Shan Medical University, Taichung, Taiwan (T.Y.L.); Division of Gastroenterology, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung, Taiwan 40705 (T.Y.L., C.Y.W.); School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan (J.T.L., H.J.H.); Department of Internal Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (J.T.L.); Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan (J.T.L.); Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan (M.S.W.); Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (C.Y.W.); Graduate Institute of Clinical Medical Science and Department of Public Health, China Medical University, Taichung, Taiwan (C.Y.W.); and Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan (C.Y.W.).
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.affiliation: From the Department of Medicine, Chung Shan Medical University, Taichung, Taiwan (T.Y.L.); Division of Gastroenterology, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard, Sect. 4, Taichung, Taiwan 40705 (T.Y.L., C.Y.W.); School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan (J.T.L., H.J.H.); Department of Internal Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (J.T.L.); Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan (J.T.L.); Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan (M.S.W.); Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (C.Y.W.); Graduate Institute of Clinical Medical Science and Department of Public Health, China Medical University, Taichung, Taiwan (C.Y.W.); and Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan (C.Y.W.).
authors.forename: Chun-Ying
authors.initials: CY
authors.lastname: Wu
mesh_terms: D055011:Ablation Techniques / Q000706:statistics & numerical data*; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment