Ten-year survival of hepatocellular carcinoma patients undergoing radiofrequency ablation as a first-line treatment

Abstract

Aim: To investigate the long-term survival and prognostic factors in hepatocellular carcinoma (HCC) patients undergoing radiofrequency ablation (RFA) as a first-line treatment.

Methods: From 2000 to 2013, 316 consecutive patients with 404 HCC (1.0-5.0 cm; mean: 3.2 ± 1.1 cm) underwent ultrasonography-guided percutaneous RFA as a first-line treatment. There were 250 males and 66 females with an average age of 60.1 ± 10.8 years (24-87 years). Patients were followed for 1 year to > 10 years after RFA (234, 181, 136, and 71 for 3, 5, 7, and 10 years, respectively). Overall local response rates and long-term survival rates were assessed. Survival results were generated using Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model.

Results: In total, 548 RFA sessions were performed and major complications occurred in 10 sessions (1.8%). Local tumor progression and/or new tumor development were observed in 43.3% (132/305) of the patients during the follow-up period. Overall 5- and 10-year survival rates were 49.7% and 28.4%, respectively. Based on multivariate analysis, three factors were identified as independent prognostic factors for overall survival: Child-Pugh classification (HR = 4.054, P < 0.001), portal vein hypertension (HR = 2.743, P = 0.002), and tumor number (HR = 2.693, P = 0.003). The local progression-free 5- and 10-year survival rates were 42.7% and 19.5%. In addition to the Child-Pugh classification and the number of tumors, the number of RFA sessions (HR = 1.550, P = 0.002) was associated with local progression-free survival.

Conclusion: RFA can achieve acceptable outcomes for HCC patients as a first-line treatment, especially for patients with Child-Pugh class A, patients with a single tumor and patients without portal vein hypertension.

Keywords: Hepatocellular carcinoma; Long term survival; Percutaneous; Radiofrequency ablation; Ultrasonography-guided.

Figure 1

Flow chart summarizing the patients selected for this study. HCC: Hepatocellular carcinoma; TACE: Transcatheter arterial chemoembolization; AFP: Alpha-fetoprotein.

Figure 2

Outcomes of radiofrequency ablation as a first-line treatment for 316 patients with liver cirrhosis and hepatocellular carcinoma. RFA: Radiofrequency ablation; HCC: Hepatocellular carcinoma; TACE: Transcatheter arterial chemoembolization.

Figure 3

Kaplan-Meier curve showing an overall 10-year survival. Overall estimated 1-, 3-, 5-, 7-, and 10-year survival rates are 90.0%, 70.8%, 49.7%, 41.1%, and 28.4%, respectively (n = 234, 181, 136, and 71 for 3, 5, 7, and 10 years, respectively).

Figure 4

Post-radiofrequency ablation overall survival curves in hepatocellular carcinoma patients with different independent prognostic factors. A: The 1-, 3-, 5-, 7-, and 10-year overall survival for patients with Child-Pugh class A liver function of were 94.1%, 78.9%, 60.1%, 50.5%, and 33.6%, whereas the overall survival rates were 82.5%, 46.8%, 25.9%, 17.2%, and 17.2%, respectively, for Child-Pugh class B, and 28.6%, 14.3%, 0%, 0%, and 0% for Child-Pugh class C, respectively (P < 0.001); B: The 1-, 3-, 5-, 7-, and 10-year overall survival rates were 94.2%, 78.5%, 63.0%, 51.8%, and 36.2%, respectively, for patients without portal vein hypertension and 79.8%, 53.2%, 30.2%, 20.4%, and 10.2%, respectively, for patients with portal vein hypertension (P = 0.002); C: The 1-, 3-, 5-, 7-, and 10-year survival rates were 90.6%, 75.3%, 59.3%, 46.8%, and 34.5%, respectively, for patients with a single tumor and 87.6%, 54.6%, 27.0%, 21.6%, and 10.8%, respectively, for patients with more than one tumor (P = 0.003).

Figure 5

Kaplan-Meier curve shows a local progression-free 10-year survival. The 1-, 3-, 5-, 7- and 10-year local progression-free survival rates were 83.2%, 59.3%, 42.7%, 35.1%, and 19.5%, respectively.

Figure 6

Post-radiofrequency ablation local progression-free survival curves in hepatocellular carcinoma patients with different independent prognostic factors. A: Patients with Child-Pugh class A had significantly greater local progression-free survival rate than patients with Child-Pugh class B and C (P < 0.001); B: Patients with a single tumor had a significantly higher local progression-free survival rate than patients with more tumors (P = 0.036); C: Patients who had one radiofrequency ablation session had a significantly greater local progression-free survival rate than patients who had multiple sessions (P = 0.002).