Clinical effect and prognostic factors analysis of intraoperative radiofrequency ablation in treatment of hepatocellular carcinoma with severe cirrhosis

Abstract

Objective To investigate the clinical effect and prognostic factors of intraoperative radiofrequency ablation (RFA) in treatment of hepatocellular carcinoma (HCC) with severe cirrhosis. Methods The retrospective case-control study was conducted. The clinicopathological data of 188 HCC patients with severe cirrhosis who were admitted to the Zhongshan Hospital of Fudan University between January 2009 and December 2013 were collected. According to intraoperative exploration, tumor condition and liver cirrhosis situations, partial hepatectomy combined with intraoperative RFA or single RFA was selected. Observation indicators: (1) operation situations: operation time, volume of intraoperative blood loss, blood transfusion, hepatic inflow occlusion, number of tumors of surgical resection and number of tumors removed by RFA; (2) postoperative recovery situations: postoperative complications and duration of postoperative hospital stay; (3) follow-up; (4) factors analysis affecting tumor-free survival. Follow-up using outpatient examination and telephone interview was performed to detect tumor damage and survival of patients up to March 2016. Measurement data with normal distribution were represented as ±s. The survival rate was calculated by the Kaplan-Meier method. The univariate analysis was done by the the Log-rank test, and multivariate analysis was done using the COX regression model. Results (1) Operation situations: all the 188 HCC patients underwent successful operations, including 74 undergoing partial hepatectomy with intraoperative RFA and 114 undergoing single RFA. Of 188 patients, 11 were combined with cholecystectomy, 6 with right adrenalectomy and 1 with subtotal gastrectomy, without perioperative death. Operation time and volume of intraoperative blood loss in 188 patients were (2.3±1.4)hours and (64±4)mL, without blood transfusion and hepatic inflow occlusion. Numbers of patients with 1 tumor of surgical resection and with 2 tumors of surgical resection and total number of tumors of surgical resection were 61, 13, 87 in 74 patients undergoing partial hepatectomy with intraoperative RFA. Numbers of patients with 1, 2, 3 and 4 tumors removed by RFA and total number of tumors of RFA were 123, 58, 6, 1 and 261 in 114 patients undergoing single RFA. (2) Postoperative recovery situations: of 188 patients, 19 with severe complications were improved by symptomatic treatments, including 7 with massive pleural effusion, 5 with massive intra-abdominal effusion, 3 with intra-abdominal bleeding, 3 with severe local infection and 1 with massive pleural and intra-abdominal effusion. Duration of postoperative hospital stay was (7.61±0.20)days. (3) Follow-up: 182 of 188 patients were followed up for 21-85 months, with a median time of 41 months. Patients received enhanced rescans of magnetic resonance imaging (MRI) at 1 month postoperatively, 174 had complete tumor damage, with a tumor damage rate of 92.55%(174/188). During the follow-up, 46 patients died. The overall median survival time, 1-, 2-, 3-year overall survival rates, median tumor-free survival time and 1-, 2-, 3-year tumor-free survival rates were 38 months, 99%, 96%, 86%, 31 months, 92%, 77% and 41%, respectively. (4) Factors analysis affecting tumor-free survival: results of univariate analysis showed that preoperative alpha-fetoprotein (AFP), number of tumors and surgical procedures were relative factors affecting tumor-free survival of HCC patients with severe cirrhosis (χ2=5.623, 4.744, 7.293, P 20 μg/L and partial hepatectomy with intraoperative RFA were independent risk factors affecting tumor-free survival of HCC patients with severe cirrhosis after open RFA (RR=1.523, 1.615, 95% confidence interval: 1.056-2.198, 1.006-2.594, P<0.05). Conclusions Intraoperative RFA is safe and feasible in treatment of HCC with severe cirrhosis, with advantages of less postoperative complications and rapid recovery, and it can provide better long-term survival for patients. Preoperative AFP>20 μg/L and partial hepatectomy with intraoperative RFA are independent risk factors affecting tumor-free survival of HCC patients with severe cirrhosis after open RFA. Key words: Carcinoma, hepatocellular; Liver cirrhosis; Radiofrequency ablation; Hepatectomy; Prognosis