Analysis of Recurrence Pattern and Its Influence on Survival Outcome After Radiofrequency Ablation of Hepatocellular Carcinoma |
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Authors: | Kelvin K Ng Ronnie T Poon Chung-Mau Lo Jimmy Yuen Wai Kuen Tso Sheung-Tat Fan |
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Institution: | (1) Department of Surgery, The University of Hong Kong Medical Center, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China;(2) Department of Radiology, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China |
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Abstract: | Background Radiofrequency ablation (RFA) is an effective local ablation therapy for hepatocellular carcinoma (HCC) with favorable long-term
outcome. There is no data on the analysis of recurrence pattern and its influence on long-term survival outcome after RFA
in HCC patients.
Aim of Study To evaluate the tumor recurrence pattern and its influence on long-term survival in patients with HCC treated with RFA.
Patients and Methods From April 2001 to January 2005, 209 patients received RFA using internally cooled electrode as the sole treatment modality
for HCC. Among them, 117 patients (56%) had unresectable HCC because of bilobar disease, poor liver function, and/or high
medical risk for resection; whereas 92 patients (44%) underwent RFA as the primary treatment for small resectable HCC. The
ablation procedure was performed through percutaneous (n = 101), laparoscopic (n = 17), or open approaches (n = 91). The tumor recurrence pattern and long-term survival were analyzed. Multivariate analysis was carried out to identify
independent prognostic factors affecting the overall survival of patients.
Results The mortality and morbidity rates were 0.9 and 15.7%, respectively. Complete tumor ablation was achieved in 192 patients (92.7%).
With a median follow-up period of 26 months, local recurrence occurred in 28 patients (14.5%). Same segment and different
segment intrahepatic recurrence occurred in 30 patients (15.6%) and 78 patients (40.6%), respectively. Twenty patients (10.4%)
developed distant extrahepatic metastases. The overall 1-, 3-, and 5-year survival rates were 87.2, 66.6, and 42%, respectively.
Different segment intrahepatic recurrence and distant recurrence after RFA carried significant poor prognostic influence on
overall survival outcome. Using multivariate analysis, Child–Pugh grade (risk ratio RR] = 2.918, 95% confident interval CI]
1.704–4.998, p = 0.000), tumor size (RR = 1.231, 95% CI 1.031–1.469, p = 0.021), and pattern of recurrence (risk ratio RR] = 1.464, 95% CI 1.156–1.987, P = 0.020) were identified as independent prognostic factors for overall survival.
Conclusion The tumor recurrence pattern after RFA carries significant prognostic value in relation to overall survival. Long-term regular
surveillance and aggressive treatment strategy are required for patients with different segment intrahepatic recurrence to
optimize the benefits of RFA. |
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Keywords: | Recurrence Pattern Radiofrequency Ablation Hepatocellular Carcinoma |
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