TITLE:
Effectiveness of Radiofrequency Ablation of Initial Recurrent Hepatocellular Carcinoma after Hepatectomy: Long-Term Results and Prognostic Factors
AUTHORS:
Ken Shinozuka, Toshiya Shibata, Rinpei Imamine, Masako Kataoka, Kaori Togashi
KEYWORDS:
Hepatocellular Carcinoma (HCC), Recurrent HCC, Radiofrequency Ablation (RFA)
JOURNAL NAME:
Open Journal of Radiology,
Vol.7 No.3,
August
31,
2017
ABSTRACT: Background: Intrahepatic recurrence of hepatocellular carcinoma (HCC) is frequently noted in patients after hepatectomy of HCC. Recurrence HCC is usually diagnosed as small nodule ≤ 2 cm in diameter due to the frequent postoperative check up with US, dynamic CT, or dynamic EOB-MRI. Radiofrequency ablation (RFA) is recommended for these small HCCs, because RFA is minimally invasive, effective, and repeatedly performed. Purpose: To investigate the long-term outcome and prognostic factors of RFA in recurrent HCC after heaptectomy. Material and Methods: Between February 2002 and October 2011, 75 patients with initial intrahepatic recurrence of HCC after hepatectomy underwent RFA. The 57 patients were men and 18 women, whose age ranged from 44 years to 83 years (median, 69 years). Sixty-nine patients had a single nodule and 6 patients had two nodules. The size of the 81 nodules ranged 5 - 30 mm (median, 15 mm). Regular follow-up after RFA was performed to evaluate rates of local tumor progression, overall survival rates, and disease-free survival rates. Prognostic factors related to overall survivals and disease-free survivals were evaluated, too. Results: During follow-up periods after RFA (3 to 151 months, median, 55 months), local recurrence was noted in 10 nodules of 10 patients (10/81 nodules = 12.3%). The rates of local recurrence of 1-yr, 3-yr, 5-yr, and 8-yr were 7.6%, 12.0%, 12.0%, and 12.0%, respectively. During the follow-up periods, 36 patients were alive and 39 died. The cumulative overall survival rates of 1-yr, 3-yr, 5-yr, and 10-yr were 97.3%, 79.1%, 56.6%, and 32.2%, respectively. The cumulative disease-free survival rates of 1-yr, 3-yr, and 5-yr were 42.7%, 18.8%, and 12.6%, respectively. Child-Pugh Class (A or B) before RFA for a recurrent HCC was a significant prognostic predictor of overall survival rates (p = 0.007), and Child-Pugh class (A or B) before hepatectomy was that of disease-free survival rates (p = 0.004). Conclusion: RFA was an effective, useful therapeutic option for treatment of recurrent HCC after hepatectomy. Child-Pugh Class (A or B) before RFA was a significant prognostic predictor of long-term survival, and Child-Pugh class (A or B) before hepatectomy was a significant prognostic predictor of disease-free survival.