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Article 10, 4/2018

ORIGINAL PAPER

Prognostic Factors after Percutaneous Radiofrequency Ablation in the Treatment of Hepatocellular Carcinoma. Impact of Incomplete Ablation on Recurrence and Overall Survival Rates
Zeno Sparchez1,2, Tudor Mocan1,2, Pompilia Radu2, Lavinia Patricia Mocan3, Mihaela Sparchez4, Daniel Corneliu Leucuta5, Nadim Al Hajjar2,6

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1) 3rd Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca
2) Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca
3) Department of Pathology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca
4) 2nd Pediatric Clinic, Children’s Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca
5) Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca
6) 3rd Surgical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.274.pro

ABSTRACT
Aims: To report on the long-term impact of tumor and non-tumor related parameters on local recurrence, distant recurrence and survival in patients with naïve or recurrent type hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA).
Methods: We performed 240 RFA sessions on 133 patients with 156 HCC nodules developed on a background of liver cirrhosis and analyzed the outcomes.
Results: Contrast-enhanced ultrasound performed one month after RFA showed complete ablation in 119 out of 133 (89.65%) patients. With a median follow-up of 46 months, 3-, 5- and 7-year survival rates were 61.7%, 35.7%, and 22.6%, respectively. Previous ethanol injection and histological grade were significantly related to local tumor progression. Child-Pugh class, incomplete ablation, histological grade, previous ethanol injection, alpha-fetoprotein level before the treatment, and local recurrence were all significantly related to distant recurrence. Multivariate analysis demonstrated that age, Child-Pugh class, distant recurrence and multiple incomplete ablations were significantly related to survival.
Conclusion: Radiofrequency ablation could be locally curative for HCC, resulting in a survival longer than 7 years. Previous ethanol injection and incomplete ablations were strongly associated with poor outcomes.
Key words: hepatocellular carcinoma – radiofrequency ablation – recurrences – incomplete ablation.
Abbreviations: AFP: alpha fetoprotein; APF: arterio-portal fistula; BCLC: Barcelona clinic liver cancer; CEUS: contrast enhanced ultrasound; CT: computer tomography; HCC: hepatocellular carcinoma; HCV: hepatitis C virus; LTP: local tumor progression; MRI: magnetic resonance imaging; MWA: microwave ablation; OLT: orthotopic liver transplantation, PAT: percutaneous ablation therapy; PEI: percutaneous ethanol injection; RFA: radiofrequency ablation; TACE: transarterial chemoembolization; US: ultrasound.