Percutaneous thermal ablation of medium and large hepatocellular carcinoma

Long-term outcome and prognostic factors

Authors

  • Xiao-Yu Yin MD, PhD,

    1. Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
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  • Xiao-Yan Xie MD, PhD,

    1. Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
    2. Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, P.R. China
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  • Ming-De Lu MD, DMSc,

    Corresponding author
    1. Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
    2. Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, P.R. China
    • Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080 P.R. China===

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    • Fax: (011) 86-20-87765183

  • Hui-Xiong Xu MD, PhD,

    1. Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
    2. Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, P.R. China
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  • Zuo-Feng Xu MD,

    1. Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
    2. Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, P.R. China
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  • Ming Kuang MD, PhD,

    1. Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
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  • Guang-Jian Liu MD,

    1. Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
    2. Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, P.R. China
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  • Jin-Yu Liang MD,

    1. Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
    2. Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, P.R. China
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  • Wan Yee Lau MD

    1. Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, P.R. China
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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.

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