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Prognosis following non-surgical second treatment in patients with recurrent hepatocellular carcinoma after percutaneous ablation therapy


Manabu Morimoto, MD, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
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Objective: The aims of this study were to identify prognostic factors in patients who received a non-surgical second treatment for the development of recurrent hepatocellular carcinoma (HCC) after an initial percutaneous ablation therapy.

Methods: We retrospectively studied 147 patients with HCC who had received an initially successful percutaneous ablation therapy. The patients were followed up using computed tomography and/or ultrasound every 3 months and a second treatment was performed for subsequent recurrent tumours.

Results: The 3- and 5-year survival rates of the 147 patients were 90 and 65% respectively. During a mean follow-up period of 33 months, local or distant tumour recurrences developed in 77 of the 147 patients, and the 3- and 5-year survival rates after a second treatment in these 77 patients were 73 and 44% respectively. Forty-six of the 77 patients with up to three recurrent tumours received percutaneous ablation therapy for the second treatment, and the remaining 31 patients with more than three (multiple) recurrent tumours received transcatheter arterial chemoembolization for their second treatment. A multivariate analysis revealed the serum α-fetoprotein level at the time of the appearance of the recurrent HCC (<100 ng/ml vs ≥100 ng/ml, P=0.009) and the number of recurrent tumours (up to three vs more than three, P=0.009) to be independent prognostic factors after the second treatment.

Conclusions: The serum α-fetoprotein level and recurrent tumour number were prognostic factors following the second treatment in patients with recurrent HCC who had received an initially successful ablation therapy.