Original Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 14, 2013; 19(42): 7389-7398
Published online Nov 14, 2013. doi: 10.3748/wjg.v19.i42.7389
Radiofrequency ablation of hepatocellular carcinoma sized > 3 and ≤ 5 cm: Is ablative margin of more than 1 cm justified?
Shan Ke, Xue-Mei Ding, Xiao-Jun Qian, Yi-Ming Zhou, Bao-Xin Cao, Kun Gao, Wen-Bing Sun
Shan Ke, Xue-Mei Ding, Wen-Bing Sun, Department of Hepatobiliary Surgery, Chao-yang Hospital Affiliated to Capital Medical University, Beijing 100043, China
Xiao-Jun Qian, Bao-Xin Cao, Department of Radiology, Chao-yang Hospital Affiliated to Capital Medical University, Beijing 100043, China
Yi-Ming Zhou, Kun Gao, Department of Interventional Medicine, Chao-yang Hospital Affiliated to Capital Medical University, Beijing 100043, China
Author contributions: Ke S and Sun WB designed the research, analyzed and interpreted the data, and drafted the manuscript; Ding XM, Qian XJ, Zhou YM, Cao BX and Gao K performed the study, analyzed the data and helped draft the manuscript; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 30872490 and 81172320; Dr. Wu Jie-Ping Medical Foundation, No. 320675012712 and 320675007131
Correspondence to: Wen-Bing Sun, MD, PhD, Department of Hepatobiliary Surgery, Chao-yang Hospital Affiliated to Capital Medical University, Beijing Gongren Tiyuchang Nan Road No. 8, Beijing 100043, China. cyhswb@qq.com
Telephone: +86-10-51718372 Fax: +86-10-51718017
Received: June 29, 2013
Revised: September 10, 2013
Accepted: September 29, 2013
Published online: November 14, 2013
Processing time: 142 Days and 4.2 Hours
Abstract

AIM: To investigate whether an ablative margin (AM) > 1.0 cm might reduce chance of recurrence for patients with hepatocellular carcinoma (HCC) tumors 3.1 to 5.0 cm in size, compared with an AM of 0.5-1.0 cm.

METHODS: From October 2005 to December 2012, 936 consecutive patients with HCC who received radiofrequency ablation were screened. Of these, 281 patients, each with a single primary HCC tumor of 3.1 to 5.0 cm in size on its greatest diameter, were included in the study. Based on the AM width, we categorized patients into the 0.5-1.0 cm group and the > 1.0 cm group. Local tumor progression (LTP)-free survival, intrahepatic distant recurrence (IDR)-free survival and overall survival (OS) rates were obtained using the Kaplan-Meier method.

RESULTS: The 1-, 2-, 3-, 4-, and 5-year LTP-free survival rates and IDR-free survival rates were significantly higher in the > 1.0 cm group compared with the 0.5-1.0 cm group (97.5%, 86.3%, 73.6%, 49.5% and 26.4% vs 91.3%, 78.4%, 49.5%, 27.8%, and 12.8%; 95.1%, 90.3%, 77.0%, 61.0% and 48.3% vs 95.2%, 85.9%, 62.6%, 47.2% and 28.5%; P < 0.05). The 1-, 2-, 3-, 4-, and 5-year OS rates were 98.6%, 91.5%, 69.2%, 56.0% and 42.2%, respectively, in the 0.5-1.0 cm group and 100%, 98.9%, 90.1%, 68.7% and 57.4%, respectively, in the > 1.0 cm group (P = 0.010). There were no significant differences in complication rates between the two groups. Both univariate and multivariate analyses identified AM as an independent prognostic factor linked to LTP, IDR, and OS.

CONCLUSION: For HCC tumors > 3.0 cm and ≤ 5.0 cm, AM > 1.0 cm could reduce chances of recurrence compared with AM of 0.5-1.0 cm, emphasizing the need for a more defensive strategy using AMs > 1.0 cm for ablating HCC tumors of 3.1 to 5.0 cm.

Keywords: Hepatocellular carcinoma; Radiofrequency ablation; Ablative margin; Recurrence; Survival

Core tip: Recurrence is the most important factor for prognosis of hepatocellular carcinoma (HCC) after radiofrequency ablation. Although a sufficient ablative margin (AM) is an essential way to minimize recurrence risk, the optimal AM for HCC tumors 3.1 to 5.0 cm remains controversial. This study provides evidence that, for HCC tumors 3.1 to 5.0 cm, AMs > 1.0 cm could reduce chance of recurrence compared to AMs of 0.5-1.0 cm, which emphasizes the need for more strategic AMs that are > 1.0 cm for ablation of HCC tumors of 3.1 to 5.0 cm.