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Percutaneous thermal ablation of medium and large hepatocellular carcinoma
Author(s) -
Yin XiaoYu,
Xie XiaoYan,
Lu MingDe,
Xu HuiXiong,
Xu ZuoFeng,
Kuang Ming,
Liu GuangJian,
Liang JinYu,
Lau Wan Yee
Publication year - 2009
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24196
Subject(s) - medicine , microwave ablation , hepatocellular carcinoma , ablation , percutaneous , thermal ablation , radiofrequency ablation , proportional hazards model , univariate analysis , complication , radiology , surgery , nuclear medicine , multivariate analysis
Abstract BACKGROUND: Radiofrequency ablation (RFA) and microwave ablation (MWA) were found to be effective in treating hepatocellular carcinoma (HCC) smaller than 3 cm; however, to the authors' knowledge, the usefulness of thermal ablation in treating larger HCC, especially those >5 cm, has not been well documented. The present study evaluated the therapeutic efficacy of percutaneous thermal ablation with curative intention for HCC measuring between 3.0 cm and 7.0 cm. METHODS: Percutaneous RFA or MWA were used to treat 109 HCC patients with at least 1 tumor measuring between 3.0 cm and 7.0 cm. Fifty‒eight patients received thermal ablation as the first treatment, and the remaining 51 were treated for posthepatectomy recurrent HCC. A total of 89 patients had a main tumor measuring 3.0 cm to 5.0 cm, and 20 patients had main tumors measuring 5.0 cm to 7.0 cm. Local therapeutic efficacy, long‐term outcome, and prognostic factors were analyzed. RESULTS: There were no treatment‐related deaths, and the major complication rate was 9.2%. Complete ablation rate was 92.6%. Local recurrence (LR) occurred in 22% patients, with a median time to LR of 4.6 months. Distant recurrences developed in 53.2% patients. The 1‐year, 3‐year, and 5‐year survival rates were 75.8%, 30.9%, and 15.4%, respectively. Univariate analysis indicated that incomplete tumor ablation, posthepatectomy recurrence, and preablation α‐fetoprotein (AFP) ≥200 ng/mL were 3 unfavorable prognostic factors for long‐term survival ( P = .000, .015, and .008, respectively). Cox regression analysis confirmed that incomplete tumor ablation, recurrent tumors, and preablation AFP ≥200 ng/mL were independent unfavorable prognostic factors, with an exp(B) of 4.158 ( P = .001), 1.568 ( P = .082), and 1.593 ( P = .082), respectively. CONCLUSIONS: Percutaneous thermal ablation was effective and safe in treating HCC between 3 cm and 7 cm, with acceptable local tumor control and long‐term outcomes. Completeness of ablation, previous history of treatment, and preablation AFP level were significant prognostic factors. Cancer 2009. © 2009 American Cancer Society.