Long-term outcome and eligibility of radiofrequency ablation for hepatocellular carcinoma over 3.0 cm in diameter

Abstract

Percutaneous radiofrequency ablation (RFA) is effective for the treatment of small hepatocellular carcinoma (HCC) with a diameter ≤ 3.0 cm. The present study aimed to elucidate the prognostic factors and clarify the indication of treatment for RFA outcomes in patients with HCC with a diameter > 3.0 cm. Among 2188 patients with HCC who underwent RFA, 100 patients with HCC with a diameter > 3.0 cm were enrolled in this study between August, 2000 and August, 2021. We analyzed local therapeutic efficacy, long-term outcomes, and prognostic factors in patients with HCC with a diameter > 3.0 cm. Among all patients, 77 patients achieved complete ablation in one session. There were no treatment-related deaths or major complications. Local tumor recurrence occurred in 48% (n = 48) of the patients, and distant tumor recurrence occurred in 82% (n = 82) of the patients during the study period. The survival rates at 1-, 3-, 5-, 10-, and 15- years were 93.0%, 66.0%, 40.0%, 15.5%, and 10.2%, respectively. Cox proportional hazards regression analysis confirmed that distant tumor recurrence, Child-Pugh class B, and pre-ablation des-γ-carboxy prothrombin (DCP) levels ≥ 200 mAU/mL were independent unfavorable prognostic factors with a hazard ratio of 3.34 (95% CI, 1.57-7.11; P = 0.002), 2.43 (95% CI, 1.35-4.37; P = 0.003), and 1.83 (95% CI, 1.14-2.93; P = 0.012), respectively. In conclusion, patients with HCC with a diameter > 3.0 cm with Child-Pugh class A and DCP levels < 200 mAU/mL might be eligible for RFA treatment.

Figure 1

Patient selection process and the study groups.

Figure 2

Kaplan–Meier curves for overall survival of patients with hepatocellular carcinoma with a diameter > 3.0 cm who were treated with radiofrequency ablation. (a) Cumulative overall survival rates at 1-, 3-, 5-, 10-, and 15- years were 93%, 66%, 40%, 15.5%, and 10.2%, respectively. (b) Difference in overall survival rates for distant tumor recurrence Yes (n = 82) vs. No (n = 18), (c) Child–Pugh class A (n = 78) vs. B (n = 22), (d) des-gamma-carboxy prothrombin levels < 200 mAU/mL (n = 61) vs. ≥ 200 mAU/mL (n = 35) were statistically significant based on the log-rank test (P < 0.001, P = 0.001, P = 0.016, respectively).

Figure 3

Kaplan–Meier curves for progression-free survival of patients with hepatocellular carcinoma with a diameter > 3.0 cm who were treated with radiofrequency ablation. (a) Cumulative progression-free survival rates at 1-, 3-, 5-, 10-, and 15- years were 43%, 15%, 12%, 6.7%, and 6.7%, respectively. (b) Difference in progression-free survival rates for combination with TACE; Yes (n = 63) vs. No (n = 37) and (c) the number of tumors; single (n = 56) vs. multiple (n = 44) were statistically significant based on the log-rank test (P = 0.016 and P = 0.049, respectively).

Figure 4

Kaplan–Meier curves for overall survival of patients with hepatocellular carcinoma with a diameter > 3.0 cm based on Child Pugh class and des-gamma-carboxy prothrombin levels. Cumulative overall survival rates for the combination of Child Pugh class A and des-gamma-carboxy prothrombin (DCP) levels < 200 mAU/mL group (n = 46) at 1-, 3-, 5-, 10-, and 15- years were 97.8%, 78.3%, 56.5%, 23.3%, and 15.5%, respectively. Difference in overall survival rates among the three groups, viz., Child Pugh class A and DCP levels < 200 mAU/mL group, Child Pugh class B and DCP levels < 200 mAU/mL or Child Pugh class A and DCP levels ≥ 200 mAU/mL group (n = 43), and Child Pugh class B and DCP levels ≥ 200 mAU/mL group (n = 7), were statistically significant based on the log-rank test (P < 0.001).