Abstract
ObjectivesTo classify hepatocellular carcinoma (HCC) recurrence patterns after radiofrequency ablation (RFA) or transarterial chemoembolization (TACE) combined with RFA (TACE-RFA) and analyze their risk factors and impacts on survival.MethodsWe retrospectively evaluated the medical records of HCC patients who underwent RFA or TACE-RFA from January 2006 to December 2016. HCC recurrences were classified into four patterns: local tumor progression (LTP), intra-segmental recurrence, extra-segmental recurrence, and aggressive recurrence. Risk factors, overall survival (OS), and post-recurrence survival of each pattern were evaluated.ResultsA total of 249 patients with a single, hepatitis-B virus (HBV)-related HCC ≤ 5.0 cm who underwent RFA (HCC ≤ 3.0 cm) or TACE-RFA (HCC of 3.1-5.0 cm) were included. During follow-up (median, 53 months), 163 patients experienced HCC recurrence: 40, 43, 62 and 18 patients developed LTP, intra-segmental recurrence, extra-segmental recurrence, and aggressive recurrence, respectively; the median post-recurrence survival was 49, 37, 25 and 15 months, respectively (P < .001); the median OS was 65, 56, 58 and 28 months, respectively (P < .001). Independent risk factors for each pattern were as follows: tumor sized 2.1-3.0 cm undergoing RFA alone and insufficient ablative margin for LTP, periportal tumor and non-smooth tumor margin for intra-segmental recurrence, HBV-DNA ≥ 2000 IU/mL for extra-segmental recurrence, and periportal tumor and α-fetoprotein ≥ 100 ng/mL for aggressive recurrence. Recurrence pattern (P < .001) and Child-Pugh class B (P = .025) were independent predictors for OS.ConclusionsBased on our classification, each recurrence pattern had different recurrence risk factors, OS, and post-recurrence survival.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second most frequent cause of cancer-related death globally [1]
We retrospectively evaluated the medical records of hepatocellular carcinoma (HCC) patients who underwent Radiofrequency ablation (RFA) or transarterial chemoembolization (TACE)-RFA from January 2006 to December 2016
For patients with intermediatesized tumor that is between 3.1 cm and 5.0 cm in diameter, results from randomized trials indicate the survival benefit associated with the combination approach with transarterial chemoembolization (TACE) and RFA (TACE-RFA) compared with RFA alone [9,10,11], the 3-year local tumor progression (LTP) rate still reached 28%-40% [9, 10]
Summary
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second most frequent cause of cancer-related death globally [1]. Radiofrequency ablation (RFA) is the preferred treatment approach for hepatocellular carcinoma (HCC) patients who are not amenable to surgery or liver transplantation [1]. RFA has been considered as a curative treatment in patients with small HCC that is 3.0 cm or less in diameter [2,3,4]. For patients with intermediatesized tumor that is between 3.1 cm and 5.0 cm in diameter, results from randomized trials indicate the survival benefit associated with the combination approach with transarterial chemoembolization (TACE) and RFA (TACE-RFA) compared with RFA alone [9,10,11], the 3-year local tumor progression (LTP) rate still reached 28%-40% [9, 10]. HCC recurrence after RFA or TACE-RFA is very common, which limits the improvement of long-term survival
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