title: The arterial tumor enhancement pattern on contrast-enhanced computed tomography is associated with primary cancer death after radiofrequency ablation for small hepatocellular carcinoma.
abstract: OBJECTIVE
  Critical recurrences after radiofrequency ablation for hepatocellular carcinoma (HCC), such as intrahepatic metastases or dissemination, and extrahepatic metastases or seeding, which are difficult to treat radically, almost certainly lead to primary cancer death. The present study aimed to clarify whether the arterial tumor enhancement pattern on contrast-enhanced computed tomography (CECT) is associated with critical recurrence and cancer death after RFA for small HCC.
  
  
  METHODS
  Between April 2001 and September 2011, 226 patients with initial small hypervascular HCC (≤3 cm in diameter and ≤3 tumors) were treated by RFA. Arterial tumor enhancement patterns on CECT before RFA were categorized by whether non-enhanced areas were included inside the tumor stain.
  
  
  RESULTS
  The heterogeneous enhancement group included 44 patients, and the homogeneous enhancement group included 182 patients. The cumulative 5-year critical recurrence rates of the heterogeneous and homogeneous enhancement groups were 42 and 22% (p = 0.005), respectively. Univariate analysis for factors related to critical recurrence showed significant differences in sex, arterial enhancement pattern, and response to antiviral therapy. These factors were independent on multivariate analysis. The cumulative 5-year primary cancer death rates of the heterogeneous and homogeneous enhancement groups were 29 and 13% (p = 0.002), respectively. Univariate analysis for factors related to primary cancer death showed significant differences in arterial enhancement pattern and response to antiviral therapy. These factors were independent on multivariate analysis.
  
  
  CONCLUSIONS
  Arterial heterogeneous tumor enhancement on CECT is associated with critical recurrence and cancer death after RFA for small HCC.
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Shimizu
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan. tamahide@wakayama-med.ac.jp.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tamai
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Mori
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Shingaki
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Shuya
authors.initials: S
authors.lastname: Maeshima
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Nuta
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Maeda
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Moribata
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Muraki
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Deguchi
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Inoue
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Maekita
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Mikitaka
authors.initials: M
authors.lastname: Iguchi
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kato
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000401:mortality* / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply* / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000098:blood supply / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: Computed tomography; Hepatocellular carcinoma; Radiofrequency ablation