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The arterial tumor enhancement pattern on contrast-enhanced computed tomography is associated with primary cancer death after radiofrequency ablation for small hepatocellular carcinoma

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Abstract

Background/Purpose

Critical recurrences after radiofrequency ablation for hepatocellular carcinoma (HCC), such as intrahepatic metastases or dissemination, and extrahepatic metastases or seeding, which are difficult to treat radically, almost certainly lead to primary cancer death. The present study aimed to clarify whether the arterial tumor enhancement pattern on contrast-enhanced computed tomography (CECT) is associated with critical recurrence and cancer death after RFA for small HCC.

Methods

Between April 2001 and September 2011, 226 patients with initial small hypervascular HCC (≤3 cm in diameter and ≤3 tumors) were treated by RFA. Arterial tumor enhancement patterns on CECT before RFA were categorized by whether non-enhanced areas were included inside the tumor stain.

Results

The heterogeneous enhancement group included 44 patients, and the homogeneous enhancement group included 182 patients. The cumulative 5-year critical recurrence rates of the heterogeneous and homogeneous enhancement groups were 42 and 22 % (p = 0.005), respectively. Univariate analysis for factors related to critical recurrence showed significant differences in sex, arterial enhancement pattern, and response to antiviral therapy. These factors were independent on multivariate analysis. The cumulative 5-year primary cancer death rates of the heterogeneous and homogeneous enhancement groups were 29 and 13 % (p = 0.002), respectively. Univariate analysis for factors related to primary cancer death showed significant differences in arterial enhancement pattern and response to antiviral therapy. These factors were independent on multivariate analysis.

Conclusions

Arterial heterogeneous tumor enhancement on CECT is associated with critical recurrence and cancer death after RFA for small HCC.

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Authors and Affiliations

  1. Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan

    Ryo Shimizu, Hideyuki Tamai, Yoshiyuki Mori, Naoki Shingaki, Shuya Maeshima, Junya Nuta, Yoshimasa Maeda, Kosaku Moribata, Yosuke Muraki, Hisanobu Deguchi, Izumi Inoue, Takao Maekita, Mikitaka Iguchi, Jun Kato & Masao Ichinose

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  1. Ryo Shimizu
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Correspondence to Hideyuki Tamai.

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Conflict of interest

Ryo Shimizu, Hideyuki Tamai, Yoshiyuki Mori, Naoki Shingaki, Shuya Maeshima, Junya Nuta, Yoshimasa Maeda, Kosaku Moribata, Yosuke Muraki, Hisanobu Deguchi, Izumi Inoue, Takao Maekita, Mikitaka Iguchi, Jun Kato, and Masao Ichinose declare that they have no conflict of interest.

Ethical standard

This retrospective study was approved by the ethics committee of our institution, and conformed to the Helsinki Declaration of 1975, as revised in 2008. The need for patients to give written, informed consent was waived by the ethics committee.

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Shimizu, R., Tamai, H., Mori, Y. et al. The arterial tumor enhancement pattern on contrast-enhanced computed tomography is associated with primary cancer death after radiofrequency ablation for small hepatocellular carcinoma. Hepatol Int 10, 328–339 (2016). https://doi.org/10.1007/s12072-015-9678-1

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  • DOI: https://doi.org/10.1007/s12072-015-9678-1

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