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Updated 10-year outcomes of percutaneous radiofrequency ablation as first-line therapy for single hepatocellular carcinoma < 3 cm: emphasis on association of local tumor progression and overall survival

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Abstract

Objectives

The purpose of this study was to evaluate the 10-year overall survival and local tumor progression (LTP) of percutaneous radiofrequency ablation (RFA) for single nodular hepatocellular carcinoma (HCC) < 3 cm using a large longitudinal hospital registry and clinical factors associated with overall survival and LTP.

Methods

A total of 467 newly diagnosed patients with single nodular HCC < 3 cm who underwent RFA as first-line therapy between January 2008 to December 2016 were analyzed. Overall survival and LTP were estimated using the Kaplan-Meier method. Cox regression and competing risks Cox regression analysis were performed to identify prognostic factors for overall survival and LTP, respectively.

Results

The 5- and 10-year overall survival rates after RFA were 83.7% and 74.2%, respectively. LTP (hazard ratio (HR), 2.03; 95% confidence interval (CI), 1.19–3.47) was one of the important factors for overall survival after RFA. The 5- and 10-year LTP rates after RFA were 20.4% and 25.1%, respectively. Periportal location (subdistribution HR, 2.29; 95% CI, 1.25–4.21), subphrenic location (2.25, 1.34–3.86), size ≥ 1.5–< 2.0 cm (1.88, 1.05–3.39), and size ≥ 2.0 cm (2.10, 1.14–3.86) were independent factors for LTP.

Conclusion

Ten-year therapeutic outcomes of percutaneous RFA as first-line therapy were excellent for single HCC < 3 cm. LTP was an important prognostic factor for overall survival after RFA. Periportal and subphrenic location of HCCs and tumor size were predictors for the development of LTP after RFA.

Key Points

• Updated 10-year survival outcome of percutaneous radiofrequency ablation as first-line therapy for single hepatocellular carcinoma < 3 cm was higher than previously reported.

• Local tumor progression was an important prognostic factor for overall survival after percutaneous radiofrequency ablation.

• Periportal and subphrenic location of hepatocellular carcinomas and tumor size were predictors for the development of local tumor progression after percutaneous radiofrequency ablation.

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Abbreviations

AFP:

Alpha-fetoprotein

AIR:

Aggressive intrasegmental recurrence

CI:

Confidence interval

EM:

Extra-hepatic metastasis

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

IDR:

Intra-hepatic distant recurrence

LTP:

Local tumor progression

RFA:

Radiofrequency ablation

US:

Ultrasound

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Funding

This study has received funding by Johnson and Johnson Medical Devices in the data collection.

Author information

Author notes

  1. Min Woo Lee and Danbee Kang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea

    Min Woo Lee, Hyo Keun Lim, Tae Wook Kang, Kyoung Doo Song, Hyunchul Rhim & Dong Ik Cha

  2. Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea

    Min Woo Lee, Hyo Keun Lim & Hyunchul Rhim

  3. Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea

    Danbee Kang & Juhee Cho

  4. Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Danbee Kang & Juhee Cho

  5. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea

    Dong Hyun Sinn

  6. Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA

    David S. K. Lu

Authors
  1. Min Woo Lee
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Corresponding author

Correspondence to Hyo Keun Lim.

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Guarantor

The scientific guarantor of this publication is Hyo Keun Lim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Danbee Kang, one of the authors, has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval of the Samsung Medical Center was obtained.

Study subjects or cohorts overlap

Not applicable

Methodology

• Retrospective

• Observational

• Performed at one institution

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Lee, M.W., Kang, D., Lim, H.K. et al. Updated 10-year outcomes of percutaneous radiofrequency ablation as first-line therapy for single hepatocellular carcinoma < 3 cm: emphasis on association of local tumor progression and overall survival. Eur Radiol 30, 2391–2400 (2020). https://doi.org/10.1007/s00330-019-06575-0

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