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Radiofrequency ablation of hepatocellular carcinoma: Long‐term results and prognostic factors in 235 Western patients with cirrhosis
Author(s) -
N'Kontchou Gisèle,
Mahamoudi Amel,
Aout Mounir,
GanneCarrié Nathalie,
Grando Véronique,
Coderc Emmanuelle,
Vicaut Eric,
Trinchet Jean Claude,
Sellier Nicolas,
Beaugrand Michel,
Seror Olivier
Publication year - 2009
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.23181
Subject(s) - medicine , radiofrequency ablation , hepatocellular carcinoma , cirrhosis , liver transplantation , gastroenterology , hazard ratio , hepatology , liver cancer , carcinoma , surgery , ablation , transplantation , confidence interval
For the treatment of small hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) is in some centers considered a first‐line therapeutic option. However, such a strategy is still under debate with regard to tumor and patient characteristics. In this single‐center study we assessed the 5‐year survival and prognosis factors in 235 consecutive patients with cirrhosis (Child‐Pugh A/B: 205/30) who received RFA as first‐line treatment for up to three HCC ≤5 cm (307 tumors; mean diameter: 29 ± 10 mm; 53 multinodular forms). Among these patients, 67 satisfied the criteria for resection according to the Barcelona Clinic Liver Cancer. Complete ablation was obtained in 222 patients (94%). Overall, 337 RFA sessions were performed including iterative RFA for recurrence. Major complications occurred in three patients (0.9%), including one treatment‐related death. After 27 ± 20 months of mean follow‐up, local or distant, or both, tumor recurrence occurred in 16, 88, and 11 patients, respectively. Twenty‐nine patients underwent transplantation and were removed from the study at this point. Overall 5‐year, recurrence‐free, and tumor‐free (including results of iterative RFA) survival rates were, respectively, 40%, 17%, and 32%. The overall 5‐year survival rate was 76% for operable patients. Factors associated with overall survival were prothrombin activity (hazard ratio [HR] = 0.97, 0.96–0.98; P < 0.0001) and serum levels of α‐fetoprotein (AFP) (HR = 1.02, 1.02–1.02; P < 0.0001), and factors associated with tumor recurrence were multinodular forms (HR = 2.34; 1.52–3.6; P = 0.0001) and serum AFP levels (HR = 1.015, 1.014–1.016; P = 0.015). Tumor size was associated with local recurrence but not with overall and tumor‐free survival. Conclusion: RFA is a safe and effective first‐line treatment of HCC up to 5 cm in diameter, especially for patients with a single tumor, a low serum AFP level, and well‐preserved liver function. (H EPATOLOGY 2009.)