Clin Mol Hepatol.  2016 Dec;22(4):477-486. 10.3350/cmh.2016.0048.

Clinical significance and predictive factors of early massive recurrence after radiofrequency ablation in patients with a single small hepatocellular carcinoma

• Cho JY
• Choi MS
• Lee GS
• Sohn W
• Ahn J
• Sinn DH
• Gwak GY
• Paik YH
• Lee JH
• Koh KC
• Paik SW

• KMID: 2373152
• DOI: http://doi.org/10.3350/cmh.2016.0048

Abstract

BACKGROUND/AIMS
Radiofrequency ablation (RFA) is one of the most frequently applied curative treatments in patients with a single small hepatocellular carcinoma (HCC). However, the clinical significance of and risk factors for early massive recurrence after RFA"”a dreadful event limiting further curative treatment"”have not been fully evaluated.
METHODS
In total, 438 patients with a single HCC of size ≤3 cm who underwent percutaneous RFA as an initial treatment between 2006 and 2009 were included. Baseline patient characteristics, overall survival, predictive factors, and recurrence after RFA were evaluated. In addition, the incidence, impact on survival, and predictive factors of early massive recurrence, and initial recurrence beyond the Milan criteria within 2 years were also investigated.
RESULTS
During the median follow-up of 68.4 months, recurrent HCC was confirmed in 302 (68.9%) patients, with early massive recurrence in 27 patients (6.2%). The 1-, 3-, and 5-year overall survival rates were 95.4%, 84.7%, and 81.8%, respectively, in patients with no recurrence, 99.6%, 86.4%, and 70.1% in patients with recurrence within the Milan criteria or late recurrence, and 92.6%, 46.5%, and 0.05% in patients with early massive recurrence. Multivariable analysis identified older age, Child-Pugh score B or C, and early massive recurrence as predictive of poor overall survival. A tumor size of ≥2 cm and tumor location adjacent to the colon were independent risk factors predictive of early massive recurrence.
CONCLUSIONS
Early massive recurrence is independently predictive of poor overall survival after RFA in patients with a single small HCC. Tumors sized ≥2 cm and located adjacent to the colon appear to be independent risk factors for early massive recurrence.

Keyword

Hepatocellular carcinoma; Radiofrequency ablation; Milan criteria; Early recurrence

MeSH Terms

Aged
Carcinoma, Hepatocellular/mortality/pathology/*surgery
Catheter Ablation
Female
Hepatitis B/complications
Hepatitis C/complications
Humans
Liver Neoplasms/mortality/pathology/*surgery
Male
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Retrospective Studies
Risk Factors
Survival Rate
Treatment Outcome