Yoon JH, Goo YJ, Lim CJ, Choi SK, Cho SB, Shin SS, Jun CH. Features of extrahepatic metastasis after radiofrequency ablation for hepatocellular carcinoma. World J Gastroenterol 2020; 26(32): 4833-4845 [PMID: 32921960 DOI: 10.3748/wjg.v26.i32.4833]
Corresponding Author of This Article
Chung H Jun, MD, Doctor, Professor, Department of Internal Medicine, Mokpo Hankook Hospital, 483 Yeongsan-ro, Mokpo 58643, South Korea. estevanj@naver.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
World J Gastroenterol. Aug 28, 2020; 26(32): 4833-4845 Published online Aug 28, 2020. doi: 10.3748/wjg.v26.i32.4833
Features of extrahepatic metastasis after radiofrequency ablation for hepatocellular carcinoma
Jae H Yoon, Young J Goo, Chae-Jun Lim, Sung K Choi, Sung B Cho, Sang S Shin, Chung H Jun
Jae H Yoon, Young J Goo, Chae-Jun Lim, Sung K Choi, Department of Gastroenterology, Chonnam National University Hospital and Medical School, Gwangju 61469, South Korea
Sung B Cho, Department of Gastroenterology, Hwasun Chonnam National University Hospital and Medical School, Hwasun 58128, South Korea
Sang S Shin, Department of Radiology, Chonnam National University Hospital and Medical School, Gwangju 61469, South Korea
Chung H Jun, Department of Internal Medicine, Mokpo Hankook Hospital, Mokpo 58643, South Korea
Author contributions: Yoon JH and Jun CH designed and performed the research and wrote the paper; Choi SK designed the research and supervised the report; Lim CJ and Goo YJ contributed to the analysis; Cho SB and Shin SS provided clinical advice.
Supported bythe Research Supporting Program of The Korean Association for the Study of the Liver and the Korean Liver Foundation, No. KASLKLF2019-06.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of Chonnam National University Hospital (CNUH-2019-203). Research was conducted in accordance with the 1964 Declaration of Helsinki and its later amendments.
Informed consent statement: Informed consent requirement was waived because the patient data were de-identified.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Chung H Jun, MD, Doctor, Professor, Department of Internal Medicine, Mokpo Hankook Hospital, 483 Yeongsan-ro, Mokpo 58643, South Korea. estevanj@naver.com
Received: April 2, 2020 Peer-review started: April 2, 2020 First decision: April 29, 2020 Revised: May 4, 2020 Accepted: August 12, 2020 Article in press: August 12, 2020 Published online: August 28, 2020 Processing time: 148 Days and 7.3 Hours
ARTICLE HIGHLIGHTS
Research background
Extrahepatic metastasis (EHM) of hepatocellular carcinoma (HCC) is related to dismal prognosis.
Research motivation
The characteristics and risk factors of EHM of HCC after radiofrequency ablation are not elucidated.
Research objectives
To investigate the clinical features and risk factors of EHM after radiofrequency ablation for HCC.
Research methods
Patients who underwent radiofrequency ablation for HCC were identified from the two tertiary hospitals in South Korea from 2008 to 2017. Univariate analyses were performed using the chi-squared test or Student’s t-test, and univariate and multivariate analyses were performed via logistic regression, as appropriate.
Research results
During a median follow-up period of 1,204 days, EHM was diagnosed in 44 patients (6.7%). The 10-year cumulative rate of HCC recurrence and EHM was 92.7% and 33.7%, respectively. The median time to the diagnosis of EHM was 2.68 years, and 68.2% of patients developed EHM within 2 years of the first recurrence, regardless of recurrence-free survival. EHM was mostly diagnosed via abdominal CT/MRI in 33 (75.0%) and 38 of 44 patients (86.4%) with EHM had either positive abdominal CT scan results or serum alpha-fetoprotein (AFP) level elevation. In multivariate analysis, recurrence-free survival < 2 years, ablation zone/tumor size < 2, and alpha-fetoprotein level > 400 IU/mL were associated with a high EHM risk.
Research conclusions
EHM occurs following multiple intrahepatic recurrences after radiofrequency ablation and combined contrast-enhanced abdominal CT and serum AFP were useful for surveillance.
Research perspectives
Patients especially with high-risk factors such as recurrence-free survival < 2 years, ablation zone/tumor size < 2, and alpha-fetoprotein level > 400 IU/mL, require close follow-up for EHM.
