Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2016; 22(10): 2993-3005
Published online Mar 14, 2016. doi: 10.3748/wjg.v22.i10.2993
Ten-year survival of hepatocellular carcinoma patients undergoing radiofrequency ablation as a first-line treatment
Wei Yang, Kun Yan, S Nahum Goldberg, Muneeb Ahmed, Jung-Chieh Lee, Wei Wu, Zhong-Yi Zhang, Song Wang, Min-Hua Chen
Wei Yang, Kun Yan, Jung-Chieh Lee, Wei Wu, Zhong-Yi Zhang, Song Wang, Min-Hua Chen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing 100142, China
S Nahum Goldberg, Division of Image-guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem 91120, Israel
S Nahum Goldberg, Muneeb Ahmed, Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States
Author contributions: Yang W, Chen MH, Goldberg SN, Ahmed M, Lee JC, Wang S, Zhang ZY, Wu W and Yan K designed the study; Yang W, Chen MH, Wu W and Yan K performed the operation; Goldberg SN and Ahmed M contributed new analytic tools; Zhang ZY and Wang S analyzed the data; and Yang W, Chen MH, Goldberg SN and Yan K wrote the paper.
Supported by the National Natural Science Foundation of China, No. 81471768; the Natural Science Foundation of Beijing Municipality, No. 7152031; and the Beijing Municipal Health System Special Funds of High-Level Medical Personnel Construction, No. 2013-3-086.
Institutional review board statement: The study was reviewed and approved for publication by the Institutional Reviewer Board of Peking University Cancer Hospital and Institute, Beijing, China.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: One author (Goldberg SN) receives consulting fees from Angiodynamics and Cosman Company. These companies had no control or involvement in data collection, data analysis, or manuscript preparation. All the other authors have no conflict of interest related to this study.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at minhuachen@vip.sina.com.
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, Professor, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing 100142, China. minhuachen@vip.sina.com
Telephone: +86-10-88196299 Fax: +86-10-88196195
Received: August 31, 2015
Peer-review started: September 1, 2015
First decision: October 15, 2015
Revised: November 15, 2015
Accepted: December 12, 2015
Article in press: December 14, 2015
Published online: March 14, 2016
Processing time: 185 Days and 22.1 Hours
Abstract

AIM: To investigate the long-term survival and prognostic factors in hepatocellular carcinoma (HCC) patients undergoing radiofrequency ablation (RFA) as a first-line treatment.

METHODS: From 2000 to 2013, 316 consecutive patients with 404 HCC (1.0-5.0 cm; mean: 3.2 ± 1.1 cm) underwent ultrasonography-guided percutaneous RFA as a first-line treatment. There were 250 males and 66 females with an average age of 60.1 ± 10.8 years (24-87 years). Patients were followed for 1 year to > 10 years after RFA (234, 181, 136, and 71 for 3, 5, 7, and 10 years, respectively). Overall local response rates and long-term survival rates were assessed. Survival results were generated using Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model.

RESULTS: In total, 548 RFA sessions were performed and major complications occurred in 10 sessions (1.8%). Local tumor progression and/or new tumor development were observed in 43.3% (132/305) of the patients during the follow-up period. Overall 5- and 10-year survival rates were 49.7% and 28.4%, respectively. Based on multivariate analysis, three factors were identified as independent prognostic factors for overall survival: Child-Pugh classification (HR = 4.054, P < 0.001), portal vein hypertension (HR = 2.743, P = 0.002), and tumor number (HR = 2.693, P = 0.003). The local progression-free 5- and 10-year survival rates were 42.7% and 19.5%. In addition to the Child-Pugh classification and the number of tumors, the number of RFA sessions (HR = 1.550, P = 0.002) was associated with local progression-free survival.

CONCLUSION: RFA can achieve acceptable outcomes for HCC patients as a first-line treatment, especially for patients with Child-Pugh class A, patients with a single tumor and patients without portal vein hypertension.

Keywords: Radiofrequency ablation; Hepatocellular carcinoma; Percutaneous; Ultrasonography-guided; Long term survival

Core tip: Numerous large series have shown that percutaneous radiofrequency ablation (RFA) is safe and effective, with minimal morbidity and mortality in hepatocellular carcinoma (HCC) treatment. However, few studies had follow-up time that was adequate to rival that of surgery and percutaneous ethanol injection. In our long-term follow-up study on a large group of HCC patients, we further confirmed that RFA could achieve a 10-year survival in HCC patients as a first-line treatment, especially for patients with liver function of Child-Pugh class A, a single tumor, and without portal vein hypertension.