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Limitation of repeated radiofrequency ablation in hepatocellular carcinoma: Proposal of a three (times) × 3 (years) index
Author(s) -
Yokoyama Keiji,
Anan Akira,
Iwata Kaoru,
Nishizawa Shinya,
Morihara Daisuke,
Ueda Shuichi,
Sakurai Kunitoshi,
Iwashita Hideyuki,
Hirano Genryu,
Sakamoto Masaharu,
Takeyama Yasuaki,
Irie Makoto,
Shakado Satoshi,
Sohda Tetsuro,
Sakisaka Shotaro
Publication year - 2012
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2012.07134.x
Subject(s) - medicine , radiofrequency ablation , hepatocellular carcinoma , percutaneous , gastroenterology , multivariate analysis , surgery , ablation , radiology
Background and Aim: Percutaneous radiofrequency ablation (RFA) has been shown to be a highly effective treatment for hepatocellular carcinoma (HCC). We investigated the controllability of HCC and explored the algorithm of therapeutic strategy for HCC in patients who met the RFA criteria. Methods: We enrolled 472 patients with HCC who met the RFA criteria (≤ 3 nodules, ≤ 3 cm) and underwent RFA for initial therapy. Patients who underwent repeated RFA were evaluated retrospectively when HCC exceeded the RFA criteria, or the functional hepatic reserve progressed to Child–Pugh grade C. Results: Overall survival rates were: 1 year, 96%; 3 years, 79%; and 5 years, 56%. In 5 years, 14% of patients progressed to Child–Pugh grade C. Meanwhile, 47% of patients exceeded the RFA criteria. Annually, 8% of patients deviated from the RFA criteria. The percentage of patients who were able to receive RFA significantly decreased at the fourth session compared with up to the third session. The survival rates decreased at the rate of 7% annually until the third year after the initial RFA. Afterwards, it shifted to a decrease at the rate of 12% annually. In a multivariate analysis, the presence of hepatitis C virus infection and the existence of a single tumor were identified as significant independent factors contributing to probabilities exceeding the RFA criteria. Conclusions: HCC was controlled by RFA up to three RFA treatments and 3 years from the initial therapy. On this basis, we propose a “three (times) × 3 (years) index” for considering a shift from RFA to other treatment modalities.