Factors for early tumor recurrence of single small hepatocellular carcinoma after percutaneous radiofrequency ablation therapy

Abstract

AIM:To evaluate the factors affecting the early tumor recurrence within one year in cirrhotic patients having a single small hepatocellular carcinoma (HCC) after complete tumor necrosis by radiofrequency ablation (RFA) therapy. METHODS:Thirty patients with a single small HCC received RFA therapy by a RFA 2000 generator with LeVeen needle. Tri-phase computerized tomogram was followed every 2 to 3 mo after RFA. The clinical effects and tumor recurrence were recorded. RESULTS:The initial complete tumor necrosis rate was 86.7%. Twenty-two patients were followed for more than one year. The local and overall recurrence rates were 13.6% and 36.4%, 33.3% and 56.2%, 46.6% and 56.2% at 12, 24 and 30 mo, respectively. No major complication or procedure-related mortality was found. The risk factors for early local tumor recurrence within one year were larger tumor size, poor pathologic differentiation of tumor cells and advanced tumor staging. The age of patients with new tumor formation within one year was relatively younger (55.1±8.3 vs 66.7±10.8, P = 0.029). CONCLUSION:Large tumor size, poor pathologic differentiation of tumor cells and advanced tumor staging are the risk factors for early local tumor recurrence within one year, and young age is the positive predictor for new tumor formation within one year.

RFA for Liver Tumors: Does It Really Work?

“…This can be partially explained as a result of the field defect created in a setting of chronic inflammation produced in cirrhotic patients with chronic hepatitis B or C infection. In addition to tumor size, poor pathologic differentiation and tumor stage are two other risk factors for early tumor recurrence after percutaneous RFA of single small lesions [36]. However, most patients who recur locally are able to undergo repeat RFA.…”

“…These lesions can often be treated with a single probe insertion into the center of the tumor bed, especially if an expandable probe is used. Like surgical resection, a 0.5-to 1-cm margin from the tumor edge is considered optimal [36]. Overall survival rates were reported to be as high as 89% and 62% at 1 and 3 years, respectively, in a group of patients undergoing RFA for lesions <3.5 cm [37] (Table 2).…”

“…Tumors >3 cm often require repositioning of the electrode or multiple treatment sessions in order to obtain clear margins. However, even using a more aggressive approach, the efficacy of RFA has been proven to be limited by tumor size [36]. Lesions measuring >5 cm have at best only a 50% chance of being completely ablated [40].…”

Predisposing factors for hepatocellular carcinoma recurrence following initial remission after transcatheter arterial chemoembolization

“…Despite the high complete necrosis rate of RFA, early local or distant tumor recurrence within 1 year may still occur (10). TACE combined with RFA can enhance the advantages of each individual treatment (8) and increase their cooperative effect, demonstrating the potential benefits of a multidisciplinary approach for advanced HCC (11,12).…”

Risk factors for the local recurrence of hepatocellular carcinoma after single-session percutaneous radiofrequency ablation with a single electrode insertion

“…The reported 1-, 2-and 3-year local recurrence rates of HCC after RFA are 1.3-24, 2.4-36.4 and 2.4-46.6%, respectively (6,(8)(9)(10)(11)(12)(13)(14)(15)(16). To achieve better therapeutic effects, it is important to sufficiently control local recurrence after RFA, and the analysis of factors involved in local recurrence is essential.…”