Radiofrequency ablation of hepatocellular carcinoma as first-line treatment: long-term results and prognostic factors in 162 patients with cirrhosis

Abstract

Purpose: To evaluate the long-term outcomes of radiofrequency ablation (RFA) as a first-line therapy for early-stage hepatocellular carcinoma (HCC) and determine the prognostic factors for survival.

Materials and methods: The institutional review board approved this retrospective study. From January 2006 to December 2007, 162 consecutive patients with cirrhosis (Child-Pugh class A and B, 137 and 25 patients, respectively) who underwent RFA as a first-line treatment for up to three HCCs with a maximum diameter of 5 cm (182 HCCs; mean diameter ± standard deviation, 2.59 cm ± 0.79; 17 multinodular forms) were included. After a mean follow-up of 50.3 months ± 19.9, results were analyzed for tumor recurrence, as well as overall and recurrence-free survival time. The Kaplan-Meier method and Cox proportional hazards regression model were used to evaluate the prognostic factors.

Results: The cumulative incidence of local tumor progression (LTP) was 14.5% at 5 years, with tumor size as the only significant predictive factor (relative risk = 2.13, P = .007). Overall 5-year survival and recurrence-free survival rates were 67.9% and 25.9%, respectively. Significant predictive factors for poor overall survival were Child-Pugh class B (relative risk = 2.43, P = .011), serum α-fetoprotein level (relative risk per 100 units = 1.01; P < .001), and presence of portosystemic collaterals (relative risk = 2.15, P = .025). The development of LTP significantly shortened median recurrence-free survival (28.0 months without LTP vs 12.0 months with LTP) and necessitated a higher number of interventional procedures (2.2 sessions without LTP vs 5.1 sessions with LTP).

Conclusion: RFA is a safe and effective first-line treatment for early-stage HCC, with a 5-year survival rate of 67.9%. High serum α-fetoprotein level, advanced Child-Pugh class, and presence of portosystemic collateral vessels had a significant negative effect on overall survival.