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.
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.
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.
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.