We read with interest the article by N'Kontchou et al.1 The authors concluded that radiofrequency ablation (RFA) appeared to be a safe and effective treatment in patients with early-stage hepatocellular carcinoma (HCC) up to 5 cm in diameter.1 We write regarding several concerns.
First, start dates that allow measurement of intervals between treatment and death or the last or most recent follow-up visits were not defined.1
Second, the authors reported that 50% of patients had cirrhosis secondary to chronic hepatitis C (HCV) infection.1 Previous reports indicate that more than 30% of patients with alcoholic liver disease are infected with HCV.2, 3 The authors commented on the good outcome of patients with HCV who underwent HCV eradication in addition to RFA for treatment of HCC.1 Given the overlap between alcoholic liver disease and chronic HCV, it is important to report the proportion of patients who had both HCV and alcohol-associated cirrhosis as well as the proportion of patients who achieved sustained virologic response among the overlap cases.
Third, over the course of the study, RFA was performed using three types of electrodes (Cool Tip, HIIT, and Prosurge).1 Inclusion of the electrode type as a predictor of overall, recurrence-free, and tumor-free survival in multivariate analysis would be informative.
Finally, although data on survival after RFA were informative, the study lacked a control group that were undergoing alternative treatment (e.g., chemoembolization).1 There is need for case-control studies to evaluate further the use of RFA as a down-staging intervention in similar patients.