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Radiofrequency ablation using a 10‐mm target margin for small hepatocellular carcinoma in patients with liver cirrhosis: A prospective randomized trial
Author(s) -
Liao Mingheng,
Zhong Xiaofei,
Zhang Jingyi,
Liu Yangyang,
Zhu Zexin,
Wu Hong,
Zeng Yong,
Huang Jiwei
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24607
Subject(s) - medicine , hepatocellular carcinoma , cirrhosis , radiofrequency ablation , univariate analysis , ablation , prospective cohort study , gastroenterology , multivariate analysis , subgroup analysis , confidence interval
Background And Objectives To compare 3‐year clinical outcomes of radiofrequency ablation (RFA) targeting 5‐ or 10‐mm margins for small hepatocellular carcinomas (HCCs) in cirrhotic patients. Methods In total, 96 cirrhotic patients with a small solitary HCC (diameter ≤3 cm) were included in this prospective trial (ChiCTRTRC‐10000954). Patients were stratified by Child‐Pugh class and randomly allocated into groups targeting either wide margins (≥10 mm, WM) or narrow margins (≥5 mm but <10 mm, NM). RFA was performed under real‐time monitoring, and ablative margins were evaluated by pre‐ and post‐operative three‐dimensional registration on CT. Results The mean follow‐up time was 38.3 ± 4.8 months, 83.3% (40/48) of patients succeeded in obtaining a 10‐mm margin in WM group. Based on intention‐to‐treat analysis, the 3‐year incidences of local tumor progression (LTP) (14.9% vs 30.2%), intrahepatic recurrence (IHR) (15.0% vs 32.7%), and recurrence‐free survival (RFS) (31.7 ± 12.1 vs 24.0 ± 11.7 months) for WM group were significantly improved compared to NM group. Several prognostic factors were identified from univariate and multivariate analyses. Additionally, cirrhosis‐stratified subgroup analyses demonstrated significant survival benefits of WM in patients with Child‐Pugh class B cirrhosis. Conclusions RFA treatment targeting 10‐mm margin may reduce the risk of tumor recurrence in cirrhotic patients with a single small HCC.