Differences in Patient Characteristics and Midterm Outcome Between Asian and European Patients Treated with Radiofrequency Ablation for Hepatocellular Carcinoma.
OBJECTIVE
The aim of this study was to compare patient characteristics and midterm outcomes after RFA for unresectable Hepatocellular carcinoma (HCC) in Asian and European cohorts.


METHODS
The study was based on retrospective analysis of 279 patients (mean 64.8 ± 12.1 years; 208 males) treated with RFA for de novo HCC in tertiary referral centers in Singapore and the Netherlands, with median follow-up of 28.2 months (quartiles: 13.1-40.5 months). Cumulative incidence of recurrence and death were analyzed using a competing risk model.


RESULTS
Age was higher in the Asian group: 66.5 versus 60.1 years (p < 0.0001). The most common etiology was hepatitis B in the Asian group (48.0 %) and alcohol-induced cirrhosis in Europeans (54.4 %); p < 0.001. Asian patients had less advanced disease: 35.5, 55.0, and 3.0 %, respectively, had BCLC 0, A, and B versus 21.5, 58.2, and 15.2 % in the European group (p = 0.01). The cumulative incidences of recurrence in the Asian group at 1, 2, 3, and 5 years were 37.0, 56.4, 62.3, and 67.7 %, respectively, compared to 32.6, 47.2, 49.7, and 53.4 % in the European group (p = 0.474). At 1, 2, 3, and 5 years, the cumulative incidence rates of death in the Asian group were 2.0, 3.9, 4.9, and 4.9 %, respectively, corresponding to 7.7, 9.2, 14.1, and 21.0 % in the European group (p = 0.155).


CONCLUSIONS
Similar short-term treatment outcomes are achieved with RFA in HCC patients in the South-East Asian and Northern-European populations. Midterm recurrence and death rates differ between the groups as a result of differences in baseline patient characteristics and patient selection. Our study provides insight relevant to the design of future international studies.
Department of Radiology, Leiden University Medical Centre, Postal Zone C2-S, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. m.c.burgmans@lumc.nl.
Mark Christiaan
MC
Burgmans
Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
Chow Wei
CW
Too
Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.|Institute of Mathematics, Leiden University Medical Centre, Leiden University, Niels Bohrweg 1, 2333 CA, Leiden, The Netherlands.
Marta
M
Fiocco
Department of Hepatology and Gastroenterology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
Annarein J C
AJ
Kerbert
Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
Richard Hoau Gong
RH
Lo
Department of Radiology, Leiden University Medical Centre, Postal Zone C2-S, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
Jelte J
JJ
Schaapman
Department of Hepatology and Gastroenterology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
Arian R
AR
van Erkel
Department of Radiology, Leiden University Medical Centre, Postal Zone C2-S, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
Minneke J
MJ
Coenraad
Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
Bien Soo
BS
Tan
D000367:Age Factors; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015984:Causality; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008104:Liver Cirrhosis, Alcoholic / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data
Asian; European; Hepatocellular carcinoma; Radiofrequency ablation; Recurrence; Survival
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