Abstract
Radiofrequency ablation (RFA) is a standard therapy for the treatment of hepatocellular carcinoma (HCC) with 3 or fewer tumors of up to 3 cm (early-stage HCC); when RFA is unsuccessful or unfeasible, transcatheter arterial chemoembolization (TACE) has often been performed. However, little information about the outcome of TACE for early-stage HCC has been reported and it is hard to decide whether to perform additional treatment following TACE in these difficult conditions. The aim of this study was to determine the risk factors for local or intrahepatic distant recurrence after TACE in early-stage HCC. Among 1,560 newly diagnosed HCC patients who were admitted to Okayama University Hospital, 43 patients with early-stage HCC who received only TACE in at least one nodule were enrolled in this study. We analyzed the risk factors for local and distant recurrence by the Cox proportional hazard model. The local recurrence rates and intrahepatic distant recurrence rates at 3 months, 6 months, and 1 year were 18.6, 33.4, and 61.8%, and 2.8, 2.8, and 34.3%, [corrected] respectively.Among 12 parameters examined as possible risk factors for recurrence, heterogeneous Lipiodol uptake (risk ratio 3.38; 95% confidence interval 1.14-10.60) and high serum des-gamma-carboxy prothrombin (DCP) (2.58; 1.03-7.14) were significantly correlated with local recurrence, and the presence of multiple tumors (10.64; 1.76-93.75) was significantly correlated with intrahepatic distant recurrence. Heterogeneous Lipiodol uptake, high serum DCP, and multiple tumors are risk factors for recurrence in patients with early-stage HCC who have undergone palliative TACE.
Highlights
Hepatocellular carcinoma (HCC) has become increasingly detected at an early stage with the growing use of surveillance systems
Radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) has been reported to be an efficient and safe treatment that provides an overall survival rate similar to those achieved with surgical resection [5,6,7]
While RFA is considered as the first choice for the treatment of early stage hepatocellular carcinoma (HCC), TACE could be another option when RFA is unsuccessful or unfeasible
Summary
Hepatocellular carcinoma (HCC) has become increasingly detected at an early stage with the growing use of surveillance systems. If HCC is hypervascular tumor, most cases of HCCs numbering 3 tumors or fewer of up to 3 cm are often subjected to sequential TACE followed by RFA, percutaneous ethanol injection therapy (PEIT), or operation regardless of the size because TACE is expected to enhance the efficacy of local therapy by reducing arterial blood flow [8]. Several factors such as poor liver functional reserve, difficult location for RFA treatment, and presence of severe associated diseases in the elderly or those rejecting treatment result in the selection of only TACE, even in candidates for local therapies.
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