Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2015; 21(5): 1554-1566
Published online Feb 7, 2015. doi: 10.3748/wjg.v21.i5.1554
Radiofrequency ablation of hepatocellular carcinoma in difficult locations: Strategies and long-term outcomes
Wei Yang, Kun Yan, Gong-Xiong Wu, Wei Wu, Ying Fu, Jung-Chieh Lee, Zhong-Yi Zhang, Song Wang, Min-Hua Chen
Wei Yang, Kun Yan, Wei Wu, Ying Fu, Jung-Chieh Lee, Zhong-Yi Zhang, Song Wang, Min-Hua Chen, Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
Gong-Xiong Wu, Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, United States
Gong-Xiong Wu, Department of Cardiovascular, The Second Hospital Affiliated to Guangzhou Medical University, Guangzhou Institute of Cardiovascular Disease, Guangzhou 510182, Guangdong Province, China
Author contributions: Yang W, Yan K, Wu GX, Wu W, Fu Y, Lee JC and Chen MH designed the study; Yang W, Yan K, Wu W and Chen MH performed the operation; Wu GX and Fu Y contributed new analytic tools; Zhang ZY and Wang S analyzed the data; and Yang W, Yan K, Wu GX and Chen MH wrote the paper.
Supported by National Natural Science Foundation of China, No. 81101745; Grants from Beijing Municipal Health System Special Funds of High-Level Medical Personnel Construction, No. 2013-3-086; and the Training Program of the Health Research Plan of the Capital Citizens, No. Z111107067311026.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Min-Hua Chen, MD, Professor, Chief Expert, Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. minhuachen@vip.sina.com
Telephone: +86-10-88196299 Fax: +86-10-88196195
Received: May 17, 2014
Peer-review started: May 18, 2014
First decision: June 27, 2014
Revised: July 29, 2014
Accepted: September 19, 2014
Article in press: September 19, 2014
Published online: February 7, 2015
Processing time: 267 Days and 21.8 Hours
Abstract

AIM: To investigate the treatment strategies and long-term outcomes of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in difficult locations and to compare the results with non-difficult HCC.

METHODS: From 2004 to 2012, a total of 470 HCC patients underwent ultrasound-guided percutaneous RFA. Among these HCC patients, 382 with tumors located ≤ 5 mm from a major vessel/bile duct (n = 87), from peripheral important structures (n = 232) or from the liver capsule (n = 63) were regarded as difficult cases. There were 331 male patients and 51 female patients, with an average age of 55.3 ± 10.1 years old. A total of 235 and 147 patients had Child-Pugh class A and class B liver function, respectively. The average tumor size was 3.4 ± 1.2 cm. Individual treatment strategies were developed to treat these difficult cases. During the same period, 88 HCC patients with tumors that were not in difficult locations served as the control group. In the control group, 74 patients were male, and 14 patients were female, with an average age of 57.4 ± 11.8 years old. Of these, 62 patients and 26 patients had Child-Pugh class A and class B liver function, respectively. Regular follow-up after RFA was performed to assess treatment efficacy. Survival results were generated from Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model.

RESULTS: Early tumor necrosis rate in the difficult group was similar to that in the control group (97.6% vs 94.3%, P = 0.080). The complication rate in the difficult group was significantly higher than that in the control group (4.9% vs 0.8%, P = 0.041). The follow-up period ranged from 6 to 116 mo, with an average of 28 ± 22.4 mo. Local progression rate in the difficult group was significantly higher than that in the control group (12.7% vs 7.1%, P = 0.046). However, the 1-, 3-, 5-, and 7-year overall survival rates in the difficult group were not significantly different from those in the control group (84.3%, 54.4%, 41.2%, and 29.9% vs 92.5%, 60.3%, 43.2%, and 32.8%, respectively, P = 0.371). Additionally, a multivariate analysis revealed that tumor location was not a significant risk factor for survival.

CONCLUSION: There was no significant difference in long-term overall survival between the two groups even though the local progression rate was higher in the difficult group.

Keywords: Radiofrequency ablation; Ultrasound guidance; Hepatocellular carcinoma; Difficult location; Long-term outcome

Core tip: Recently, many studies have reported the increasing treatment success rate and reduced frequency of complications following RFA treatment of tumors in difficult locations. However, the long-term outcomes of patients with tumors in difficult locations have been rarely reported. Our studies showed no difference in 5- or 7-year overall survival between the difficult location group and the control group even though the local progression rate was higher in the difficult group. These results highlight that optimized individual strategies could achieve acceptable efficacy and safety and could help to expand RFA indications and improve overall outcome.