title: Ten-year survival of hepatocellular carcinoma patients undergoing radiofrequency ablation as a first-line treatment.
abstract: OBJECTIVE
  To investigate the long-term survival and prognostic factors in hepatocellular carcinoma (HCC) patients undergoing radiofrequency ablation (RFA) as a first-line treatment.
  
  
  METHODS
  From 2000 to 2013, 316 consecutive patients with 404 HCC (1.0-5.0 cm; mean: 3.2 ± 1.1 cm) underwent ultrasonography-guided percutaneous RFA as a first-line treatment. There were 250 males and 66 females with an average age of 60.1 ± 10.8 years (24-87 years). Patients were followed for 1 year to > 10 years after RFA (234, 181, 136, and 71 for 3, 5, 7, and 10 years, respectively). Overall local response rates and long-term survival rates were assessed. Survival results were generated using Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model.
  
  
  RESULTS
  In total, 548 RFA sessions were performed and major complications occurred in 10 sessions (1.8%). Local tumor progression and/or new tumor development were observed in 43.3% (132/305) of the patients during the follow-up period. Overall 5- and 10-year survival rates were 49.7% and 28.4%, respectively. Based on multivariate analysis, three factors were identified as independent prognostic factors for overall survival: Child-Pugh classification (HR = 4.054, P < 0.001), portal vein hypertension (HR = 2.743, P = 0.002), and tumor number (HR = 2.693, P = 0.003). The local progression-free 5- and 10-year survival rates were 42.7% and 19.5%. In addition to the Child-Pugh classification and the number of tumors, the number of RFA sessions (HR = 1.550, P = 0.002) was associated with local progression-free survival.
  
  
  CONCLUSIONS
  RFA can achieve acceptable outcomes for HCC patients as a first-line treatment, especially for patients with Child-Pugh class A, patients with a single tumor and patients without portal vein hypertension.
authors.affiliation: Wei Yang, Kun Yan, Jung-Chieh Lee, Wei Wu, Zhong-Yi Zhang, Song Wang, Min-Hua Chen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: Wei Yang, Kun Yan, Jung-Chieh Lee, Wei Wu, Zhong-Yi Zhang, Song Wang, Min-Hua Chen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Yan
authors.affiliation: Wei Yang, Kun Yan, Jung-Chieh Lee, Wei Wu, Zhong-Yi Zhang, Song Wang, Min-Hua Chen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: S Nahum
authors.initials: SN
authors.lastname: Goldberg
authors.affiliation: Wei Yang, Kun Yan, Jung-Chieh Lee, Wei Wu, Zhong-Yi Zhang, Song Wang, Min-Hua Chen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Muneeb
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Wei Yang, Kun Yan, Jung-Chieh Lee, Wei Wu, Zhong-Yi Zhang, Song Wang, Min-Hua Chen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Jung-Chieh
authors.initials: JC
authors.lastname: Lee
authors.affiliation: Wei Yang, Kun Yan, Jung-Chieh Lee, Wei Wu, Zhong-Yi Zhang, Song Wang, Min-Hua Chen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wu
authors.affiliation: Wei Yang, Kun Yan, Jung-Chieh Lee, Wei Wu, Zhong-Yi Zhang, Song Wang, Min-Hua Chen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Zhong-Yi
authors.initials: ZY
authors.lastname: Zhang
authors.affiliation: Wei Yang, Kun Yan, Jung-Chieh Lee, Wei Wu, Zhong-Yi Zhang, Song Wang, Min-Hua Chen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Song
authors.initials: S
authors.lastname: Wang
authors.affiliation: Wei Yang, Kun Yan, Jung-Chieh Lee, Wei Wu, Zhong-Yi Zhang, Song Wang, Min-Hua Chen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Min-Hua
authors.initials: MH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hepatocellular carcinoma; Long term survival; Percutaneous; Radiofrequency ablation; Ultrasonography-guided