title: Comparison of no-touch multi-bipolar vs. monopolar radiofrequency ablation for small HCC.
abstract: The primary aim of this study was to compare the rate of global radiofrequency ablation (RFA) failure between monopolar RFA (MonoRFA) vs. no-touch multi-bipolar RFA (NTmbpRFA) for small hepatocellular carcinoma (HCC) ⩽5cm in cirrhotic patients.
  
  
  
  A total of 362 cirrhotic patients were included retrospectively across four French centres (181 per treatment group). Global RFA failure (primary RFA failure or local tumour progression) was analysed using the Kaplan-Meier method after coarsened exact matching. Cox regression models were used to identify factors associated with global RFA failure and overall survival (OS).
  
  
  
  Patients were well matched according to tumour size (⩽30/>30mm); tumour number (one/several); tumour location (subcapsular and near large vessel); serum AFP (<10; 10-100; >100ng/ml); Child-Pugh score (A/B) and platelet count (</⩾100G/L), p=1 for all. One case of perioperative mortality was observed in the NTmbpRFA group and the rate of major complications was 7.2% in both groups (p=1). The cumulative rates of global RFA failure at 1, 3 and 5years were respectively 13.3%, 31% and 36.7% for MonoRFA vs. 0.02%, 7.9% and 9.2% for NTmbpRFA, p<0.001. Monopolar RFA, tumour size >30mm and HCC near large vessel were independent factors associated with global RFA failure. Five-year OS was 37.2% following MonoRFA vs. 46.4% following NTmbpRFA p=0.378.
  
  
  
  This large multicentre case-matched study showed that NTmbpRFA provided better primary RFA success and sustained local tumour response without increasing severe complications rates, for HCC ⩽5cm.
  
  
  
  Using no-touch multi-bipolar radiofrequency ablation for hepatocellular carcinoma ⩽5cm provide a better sustained local tumour control compared to monopolar radiofrequency ablation.
authors.affiliation: Service de Radiologie de l'Hôpital Haut-lévêque, CHU de Bordeaux, Avenue Magellan, 33600 Pessac, France; EA IMOTION (Imagerie moléculaire et thérapies innovantes en oncologie), Université de Bordeaux, 146 rue Leo Saignat, Case 127, 33076 Bordeaux, France. Electronic address: arnaud.hocquelet@gmail.com.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Hocquelet
authors.affiliation: Département de radiologie, CHU d'Angers, LUNAM Université, 49933 Angers, France; Laboratoire HIFIH, UPRES 3859, LUNAM Université, Université d'Angers, 49045 Angers, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Aubé
authors.affiliation: Service d'imagerie Médicale, Hôpital de la Croix Rousse, Lyon, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Rode
authors.affiliation: Département de radiologie, CHU d'Angers, LUNAM Université, 49933 Angers, France.
authors.forename: Victoire
authors.initials: V
authors.lastname: Cartier
authors.affiliation: Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Sutter
authors.affiliation: Service d'imagerie Médicale, Hôpital de la Croix Rousse, Lyon, France.
authors.forename: Anne Frederique
authors.initials: AF
authors.lastname: Manichon
authors.affiliation: Laboratoire HIFIH, UPRES 3859, LUNAM Université, Université d'Angers, 49045 Angers, France; Service de Gastroenterologie et Hépatologie, LUNAM Université, CHU d'Angers, 49933 Angers, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Boursier
authors.affiliation: Service d'Hepatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bondy, France.
authors.forename: Gisèle
authors.initials: G
authors.lastname: N'kontchou
authors.affiliation: Service d'Hépatologie, Hôpital de la Croix Rousse, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Merle
authors.affiliation: Service d'Hépatologie de l'Hôpital Haut-lévêque, CHU de Bordeaux, Avenue Magellan, 33600 Pessac, France.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Blanc
authors.affiliation: Service de Radiologie de l'Hôpital Haut-lévêque, CHU de Bordeaux, Avenue Magellan, 33600 Pessac, France; EA IMOTION (Imagerie moléculaire et thérapies innovantes en oncologie), Université de Bordeaux, 146 rue Leo Saignat, Case 127, 33076 Bordeaux, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Trillaud
authors.affiliation: Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Seror
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005602:France; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D047368:Tumor Burden
keywords: Coarsened exact matching; Hepatocellular carcinoma; Monopolar RFA; No-touch multi-bipolar RFA; Radiofrequency ablation; Tumour recurrence