Local recurrence of hepatocellular carcinoma in the tumor blood drainage area following radiofrequency ablation

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. HCC is generally considered to spread via the bloodstream and local recurrence often occurs in the blood drainage area determined by computed tomography during hepatic arteriography (CTHA), despite complete ablation of the primary nodule. This study was conducted in order to prospectively assess the rate of local recurrence in the blood drainage area depicted by delayed-phase CTHA. The participants comprised 364 consecutive patients (260 men and 104 women; mean age, 67.4±8.6 years), enrolled between April, 2002 and December, 2011. The participants were divided into two groups, according to whether the ablation area covered the entire blood drainage area as defined by delayed-phase CTHA (group A) or not (group B). Local tumor progression was compared between the two groups. The median time to recurrence was significantly shorter for group B (434 days) compared to that for group A (1,474 days; P=0.0037). The cumulative local recurrence rates for group A were 0, 0 and 1.5% at 1, 3 and 5 years postoperatively, respectively, whereas the recurrence rates for group B were 3.8, 17.0 and 22.8% at 1, 3 and 5 years, respectively (P<0.0001). In conclusion, the safety margin for radiofrequency ablation should be defined as the blood drainage area and ablation should aim at acquiring adequate safety margins.