Repeated Radiofrequency Ablation Combined With Ablated Lesion Elimination and Transarterial Chemoembolization Improves the Outcome of Solitary Huge Hepatocellular Carcinomas 10 m or Larger.
This study investigated the effectiveness of a new strategy, repeated radiofrequency (RF) ablation combined with ablated lesion elimination following transarterial chemoembolization (TACE)/transarterial embolization (TAE), for solitary huge hepatocellular carcinoma (SHHCC) 10 cm or larger. From July 2008 to October 2015, 39 consecutive patients with SHHCC were screened. Of these, 12 were treated with TACE/TAE and repeated RF ablation (TACE/TAE + RF ablation group) and the remaining 27 patients were treated with the aforementioned new strategy (new strategy group). Local tumor progression (LTP)-free survival, intrahepatic distant recurrence (IDR)-free survival, and overall survival (OS) rates were obtained using the Kaplan-Meier method. Univariate and multivariate analyses were performed on several clinicopathological variables to identify factors affecting long-term outcome and intrahepatic recurrence. Correlation analysis was also performed. The 1-, 2-, and 3-year LTP-free survival rates and OS rates were significantly higher in the new strategy group than in the TACE/TAE + RF ablation group (82.9% vs 58.3%, 73.9% vs 29.2%, 18.5% vs 9.7%, P = 0.002; 92.0% vs 75.0%, 84.0% vs 33.3%, 32.7% vs 16.7%, P = 0.025). However, there was no significant difference between the 2 groups in the 1-, 2-, and 3-year IDR-free survival rates (P = 0.108). Using univariate analysis, alpha-fetoprotein (AFP > 200 ng/mL), ablative margin (AM > 1.0 cm), and well-differentiated cells were found to be significant factors for predicting LTP, IDR, and OS. Surgical elimination was found to be a significant factor only for predicting OS. In multivariate analyses, AFP (>200 ng/mL), AM (>1.0 cm), and well-differentiated cells were found to be significant independent factors linked to LTP, IDR, and OS. Correlation analysis indicated that AM > 1.0 cm was strongly associated with surgical elimination (P < 0.001, correlation coefficient = 0.877). For patients with SHHCC who were initially excluded from surgery, the new strategy including repeated RF ablation combined with ablated lesion elimination following TACE/TAE should now be considered as an alternative treatment.
From the Department of Hepatobiliary Surgery, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, Beijing (SK, JG, JK, X-MD, W-BS); Department of General Surgery, Fenyang Hospital, Shanxi (H-GN); Department of General Surgery, Zhanhua People's Hospital, Shandong (Z-HX); Department of General Surgery, Chaoyang Central Hospital, Liaoning (C-MN, S-GG); Department of General Surgery, Affiliated Hospital of Chifeng University, Neimenggu (X-LL, LZ); and Department of General Surgery, Shanxi Provincial People's Hospital, Shanxi (Y-HD), China.
Shan
S
Ke
Jun
J
Gao
Jian
J
Kong
Xue-Mei
XM
Ding
Hai-Gang
HG
Niu
Zong-Hai
ZH
Xin
Chun-Min
CM
Ning
Shi-Gang
SG
Guo
Xiao-Long
XL
Li
Long
L
Zhang
Yong-Hong
YH
Dong
Wen-Bing
WB
Sun
D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D002681:China / Q000453:epidemiology; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D007269:Injections, Intra-Arterial; D008113:Liver Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D009017:Morbidity / Q000639:trends; D009367:Neoplasm Staging / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D047368:Tumor Burden
D000970:Antineoplastic Agents