Prognostic value of enhancement rate by enhanced ultrasound in hepatitis B virus‐positive hepatocellular carcinoma undergoing radiofrequency ablation

Aim To assess the prognostic significance of enhancement rate (ER) measured by contrast‐enhanced ultrasonography (CEUS) in patients with hepatocellular carcinoma (HCC) undergoing radiofrequency ablation (RFA). Materials and methods A total of 253 patients with single primary HCC undergoing preoperative CEUS and RFA were enrolled in this study. The ER were evaluated though pretreatment CEUS. After a mean follow‐up of 36.8 ± 10.2 months, the correlation of ER measured by CEUS and survival after RFA was analyzed by univariate and multivariate analysis. The optimal cutoff ER value to predict survival was determined using receiver‐operating characteristic analysis. Results Mean follow‐up period for all 253 patients was 36.8 ± 10.2 months, 31.2% of patients had died at endpoint. The optimal cutoff ER value predicting survival was 2.2 dB/s. Univariate analysis demonstrated that patients with a high ER level had poorer OS (62.8 months vs 48.8 months, P  = 0.02) and recurrence‐free survival (RFS = 60.2 months vs 47.4 months, P  = 0.03) than patients with a low ER level. ER measured by CEUS also been confirmed as independent risk factor for overall survival (hazard ratio [HR], 1.87; 95% confidence interval [95% CI], 1.21–7.25; P  < 0.01) and RFS (HR, 1.67; 95% CI, 1.08–6.21; P  < 0.01) in multivariate analysis enrolling gender, BMI, tumor size, antiviral therapy, HBV DNA, histological differentiation, Child–Pugh score and tumor node metastasis (TNM) stage. Conclusions ER measured by CEUS was a significant predictive factor for survival after RFA for HCC.