Ten-year survival of hepatocellular carcinoma patients undergoing radiofrequency ablation as a first-line treatment

Table 1 Baseline characteristics of 316 patients with 404 hepatocellular carcinomas n (%)

Characteristics	Value
Age (yr)
Mean (range)	60.1 ± 10.8 (24-87)
Patients aged ≥ 60 yr	140 (44.3)
Sex
Males	250 (79.1)
Females	66 (20.9)
Etiology of cirrhosis
HBV	231 (86.6)
HCV	37 (10.2)
Alcohol	4 (1.9)
Others	6 (1.3)
Pre-RFA serum AFP
< 20 ng/mL	177 (56.0)
≥ 20 ng/mL	139 (44.0)
Child-Pugh class
A	250 (77.0)
B	57 (20.1)
C	9 (2.8)
Serum ALT/AST
Normal	229 (72.5)
Elevated	87 (27.5)
Tumor no
Single	248 (78.4)
≥ 2	68 (21.6)
Tumor size (cm)
Mean (range)	3.2 ± 1.1(1.0-5.0)
Tumor > 3 cm	169 (53.4)

HCC: Hepatocelluar carcinoma; RFA: Radiofrequency ablation; AFP: Alpha-fetoprotein; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase.

Table 2 Potential prognostic variables and their class scores in hepatocellular carcinomas patients

Variables	Definition	Class scores1
X1	Sex	Male (1), Female (2)
X2	Age (yr)	18-60 (1), ≥ 60 (2)
X3	Pathological grade	Well-Moderate differentiated (1), Poor-differentiated (2)
X4	Etiology of cirrhosis	HBV (1), HCV (2), Alcohol (3), Others (4)
X5	Portal vein hypertension	No (1), Yes (2)
X6	Liver function enzyme	Normal (1), Elevated (2)
	(serum AST/ALT)
X7	Child-Pugh classification	A (1), B (2), C (3)
X8	Serum AFP (ng/mL)	Normal < 20 (1), Abnormal ≥ 20 (2)
X9	CEUS pre-RFA	No (1), Yes (2)
X10	Number of tumors	Single (1), ≥ 2 (2)
X11	Tumor size (cm)	≤ 3.0 (1), 3.0-5.0 (2)
X12	Risky location	No (1), Yes (2)
X13	Type of RFA electrodes	Umbrella (1), single (2)
X14	Primary technical success	Yes (0), No (1)
X15	Number of RFA sessions	1 (0), ≥ 2 (1)

¹The number in parentheses in the class scores column means the classification of variables in statistical analysis. Liver function enzyme referred to ALT and AST value, normal range was 0-40 IU/L for ALT and 0-45 IU/L for AST. CEUS pre-RFA means CEUS was performed prior to RFA to instruct treatment plan. Based on needle shape, multi-tined RITA electrode was regarded as umbrella electrode, while both internally-cooled Tyco and multi-polar Celon electrodes were regarded as single electrode. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CEUS: Contrast enhanced ultrasound; RFA: Radiofrequency ablation.

Table 3 Number of patients followed up for 1-10 years

Follow-up (yr)	No. of patients	Cumulative frequency1
1	82	316 (100)
3	53	234 (74.1)
5	45	181 (57.3)
7	65	136 (43.0)
10	71	71 (22.5)

¹Numbers in parentheses are percentages.

Table 4 Kaplan meier univariate analysis of overall accumulative survival in 316 hepatocellular carcinoma patients after radiofrequency ablation

Variable	No. of patients	Survival rate (%)					P value
		1-yr	3-yr	5-yr	7-yr	10-yr
Sex							0.570
Male	250	89.8	70.4	53.2	44.8	33.0
Female	66	90.7	72.1	37.8	23.6	-
Age (yr)							0.163
< 60	176	90.3	67.6	48.0	31.7	26.4
≥ 60	140	89.6	75.8	58.0	55.4	25.2
Pathology grade							< 0.001
Well-Moderate differentiated	126	94.4	82.5	64.2	53.0	42.5
Poor-differentiated	78	83.6	51.9	33.1	26.5	16.1
Etiology of cirrhosis							0.474
HBV	231	91.2	72.8	55.1	36.1	21.7
HCV	37	95.8	76.7	57.5	57.5	-
Portal vein hypertension							< 0.001
No	211	94.2	78.5	63.0	51.8	36.2
Yes	103	79.8	53.2	30.2	20.4	10.2
Liver function enzyme							0.489
Normal	229	89.0	73.5	54.4	42.1	30.0
Elevated	87	92.2	64.1	45.6	40.5	-
Child-Pugh classification							< 0.001
A	250	94.1	78.9	60.1	50.5	33.6
B	57	82.5	46.8	25.9	17.2	17.2
C	9	28.6	14.3	0	0	0
Serum AFP (ng/mL)							0.037
Normal	177	88.4	75.1	59.2	53.3	35.4
Abnormal	139	91.8	66	42.1	25.7	22.1
CEUS pre-RFA							< 0.001
No	83	80.1	56.2	37.7	26.1	18.0
Yes	233	93.8	77.1	59.7	54.4	-
Number of tumors							< 0.001
Single	248	90.6	75.3	59.3	46.8	34.5
≥ 2	68	87.6	54.6	27.0	21.6	10.8
Tumor size (cm)							0.178
≤ 3.0	147	94.0	71.6	59.2	49.0	18.4
3.0-5.0	169	86.8	69.8	47.3	36.4	25.2
Risky location							0.668
No	152	91.4	71.5	48.6	41.6	32.7
Yes	164	88.6	70.0	53.1	40.6	27.7
Type of RFA electrodes							<0.001
Umbrella	213	86.8	64.3	45.7	36.7	23.6
Single	103	97.5	94.1	62.7	62.7	-
Primary technical success							0.006
Yes	301	89.9	69.1	51.4	39.6	30.6
No	15	54.5	36.4	18.2	0	0
Number of RFA sessions							0.793
1	256	90.2	70.1	53.4	40.3	31.0
≥ 2	60	89.3	73.4	49.0	42.4	30.3

Table 5 Cox survival analysis of predictors of overall accumulative survival in 316 hepatocelluar carcinom patients after radiofrequency ablation

Characteristic	Univariate			Multivariate
	HR	95%CI	P value	HR	95%CI	P value
Sex	1.149	0.709-1.862	0.572
Age	0.754	0.506-1.125	0.166
Pathology grade	2.509	1.593-3.952	< 0.001
Etiology of cirrhosis	0.862	0.720-1.031	0.105
Portal vein hypertension	2.686	1.826-3.951	< 0.001	2.743	1.462-5.149	0.002
Liver function enzyme (AST/ALT)	1.162	0.758-1.780	0.491
Child-Pugh classification	3.210	2.297-4.488	< 0.001	4.054	2.346-7.005	< 0.001
Serum AFP	1.501	1.021-2.206	0.039
CEUS pre-RFA	0.438	0.295-0.651	< 0.001
Number of tumor	2.293	1.518-3.463	< 0.001	2.693	1.399-5.185	0.003
Tumor size	1.318	0.879-1.978	0.181
Risky location	1.090	0.735-1.616	0.670
Type of RFA electrodes	0.191	0.077-0.473	< 0.001
Primary technical success	2.592	1.269-5.296	0.009
Number of RFA sessions	0.955	0.703-1.298	0.769

HCC: Hepatocelluar carcinoma; HR: Hazard ratio; AFP: Alpha–fetoprotein; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CEUS: Contrast enhanced ultrasound; RFA: Radiofrequency ablation.

Table 6 Cox survival analysis of predictors of local progression-free survival in 316 patients with 404 hepatocelluar carcinomas after radiofrequency ablation

Characteristic	Univariate			Multivariate
	HR	95%CI	P value	HR	95%CI	P value
Sex	1.073	0.691-1.667	0.753
Age	0.796	0.559-1.133	0.205
Pathological grade	2.258	1.506-3.385	< 0.001
Etiology of cirrhosis	0.851	0.725-0.999	0.048
Portal vein hypertension	1.826	1.288-2.589	0.001
Liver function enzyme	1.082	0.740-1.583	0.684
(AST/ALT)
Child-Pugh classification	2.930	2.169-3.958	< 0.001	2.416	1.713-3.409	< 0.001
Serum AFP	1.425	1.010-2.011	0.044
CEUS pre-RFA	0.421	0.297-0.598	< 0.001
Number of tumors	1.765	1.212-2.570	0.003	1.588	1.031-2.447	0.036
Tumor size	1.587	1.104-2.283	0.013
Risky location	1.442	1.013-2.054	0.042
Type of RFA electrodes	0.449	0.264-0.764	0.003
Primary technical success	1.772	0.877-3.583	0.111
Number of RFA sessions	1.574	1.201-2.061	0.001	1.550	1.183-2.033	0.002

HCC: Hepatocelluar carcinoma; HR: Hazard ratio; AFP: Alpha–fetoprotein; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CEUS: Contrast enhanced ultrasound; RFA: Radiofrequency ablation.

Table 7 Incidence of major complications in 548 treatment sessions

Type of procedure-related complications1	No. of events	Managements
Major complications	10 (1.8)
Bowel perforation	1	Surgically repaired
Seeding metastasis	3	Surgical resection
Pneumothorax or hemothorax	3	Drainage
Intraperitoneal hemorrhage	1	Ablation in site
Liver abscess	1	PTCD2
Biliary stenosis	1	PTCD
No. of deaths	1 (0.2)	(Bowel perforation) Surgically repaired

¹Definition of a major complication was a complication that, if left untreated, might threaten the patient’s life, lead to substantial morbidity and disability, or result in a lengthened hospital stay. All other complications were considered minor;

²PTCD: percutaneous transhepatic cholangial drainage.