Radiofrequency Ablation for Intrahepatic Recurrent Hepatocellular Carcinoma: Long-Term Results and Prognostic Factors in 168 Patients with Cirrhosis

Abstract

To analyze the clinical outcome of radiofrequency ablation (RFA) for recurrent intrahepatic hepatocellular carcinoma (HCC) after variable first-line treatment. From January 2006 to December 2007, 168 consecutive patients (133 male, 35 female; mean age 66.7 ± 10.1 years) with cirrhosis (Child-Pugh class A/B [146/22]) who underwent RFA for treatment for recurrent intrahepatic HCC ≤5 cm, and in up to three nodules (214 HCCs; mean diameter 20.8 ± 7.5 mm; 38 multinodular forms), were included. Univariate and multivariate analyses for potential clinical, tumor-related, and radiologic factors affecting overall and recurrence-free patient survival were performed using the Cox proportional hazard model. Major complications occurred in 5 patients (5 of 168, 3.0 %), although there were no procedure-related deaths. Complete ablation was achieved in 161 patients (161 of 168, 95.8 %). After a mean follow-up period of 4 ± 21 months, local tumor progression, distant intrahepatic recurrence, and extrahepatic metastasis occurred in 22, 132, and 41 patients, respectively. Overall 5-year survival and recurrence-free survival were 48.0 and 11.9 %, respectively. Significant predicting factors for overall patient survival were Child-Pugh class B (relative risk [RR] = 4.52, 95 % confidence interval [CI] 1.97-10.34; P < 0.001), serum alpha-fetoprotein (AFP) level (RR = 1.01, 95 % CI 1.01-1.01; P < 0.001), number of HCC nodules (RR = 1.70, 95 % CI 1.04-2.76; P = 0.033), tumor size (RR = 1.40, 95 % CI 1.07-1.83; P = 0.014), and presence of portosystemic collaterals (RR = 1.78, 95 % CI 1.09-2.92; P = 0.022). RFA is a safe and effective treatment modality for recurrent intrahepatic HCC and has a 5-year survival rate of 48.0 %. Serum AFP level, Child-Pugh class, tumor number and size, and presence of portosystemic collaterals significantly affect overall patient survival.