Long-term outcome of percutaneous radiofrequency ablation for periportal hepatocellular carcinoma: tumor recurrence or progression, survival and clinical significance

Abstract

Background/aim Recent studies have suggested that periportal location of percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is considered as one of the independent risk factors for local tumor progression (LTP). However, the long-term therapeutic outcomes of percutaneous RFA as the first-line therapy for single periportal HCCand corresponding impacts on tumor recurrence or progression are still unclear. Materials and methods From February 2011 to October 2020, a total of 233 patients with single nodular HCC ≤ 5 cm who underwent RFA ± transarterial chemoembolization (TACE) as first-line therapy was enrolled and analyzed, including 56 patients in the periportal group and 177 patients in the nonperiportal group. The long-term therapeutic outcomes between the two groups were compared, risk factors of tumor recurrence or progression were evaluated. Results The LTP rates at 1, 3, and 5 years were significantly higher in the periportal group than those in the nonperiportal group (15.7, 33.7, and 46.9% vs 6.0, 15.7, and 28.7%, respectively, P = 0.0067). The 1-, 3- and 5-year overall survival (OS) rates in the periportal group were significantly worse than those in the nonperiportal group (81.3, 65.1 and 42.9% vs 99.3, 90.4 and 78.1%, respectively, P<0.0001). In the subgroup of single HCC ≤ 3 cm, patients with periportal HCC showed significantly worse LTP P = 0.0006) and OS (P<0.0001) after RFA than patients with single nonperiportal HCC; The univariate and multivariate analyses revealed that tumor size, periportal HCC and AFP ≥ 400ug/ml were independent prognostic factors for tumor progression after RFA. Furthermore, patients with single periportal HCC had significantly higher risk for IDR(P = 0.0012), PVTT(P<0.0001) and extrahepatic recurrence(P = 0.0010) after RFA than those patients with single nonperiportal HCC. . Conclusion The long-term therapeutic outcomes of RFA as the first-line therapy for single periportal HCC were worse than those for single nonperiportal HCC, an increased higher risk of tumor recurrence or progression after RFA was significantly associated with periportal HCC.

Comparison of radiofrequency ablation and ablative external radiotherapy for the treatment of intrahepatic malignancies: A hybrid meta-analysis

“…Cao et al. 49 reported a major complication rate of 10.7% after RFA for periportal HCCs, which was higher than that of non-periportal controls (5.1%). Kang et al.…”

Liver resection versus microwave ablation for hepatocellular carcinoma in ideal candidates for ablation per Barcelona Clinic Liver Cancer staging: a propensity score matching and inverse probability of treatment weighting analysis

“…This result was confirmed by PSM, IPTW, and multivariate Cox regression analyses. The lower RFS rate in the MWA group might have been caused by several factors, such as the location and size of the tumours 19–21 . Unlike MWA, LRE may achieve adequate tumour excision and excision of its adjacent hepatic parenchyma, which may result in microvascular invasion and micrometastasis 22 .…”

“…tors, such as the location and size of the tumours. [19][20][21] Unlike MWA, LRE may achieve adequate tumour excision and excision of its adjacent hepatic parenchyma, which may result in microvascular invasion and micrometastasis. 22 However, a high risk of postoperative complications is a major concern in patients with abnormal portal pressure or serum bilirubin levels, and patients with these characteristics are excluded from receiving LRE in the BCLC staging system.…”

Radiofrequency ablation with or without transarterial chemoembolization for hepatocellular carcinoma meeting Milan criteria: a focus on tumor progression and recurrence patterns

“…Several factors have been identified as potential predictors of LTP in HCC, including tumor size and location (e.g., perivascular, subcapsular, or subphrenic) ( 8 , 22 , 23 ). Understanding the factors associated with LTP is crucial for guiding treatment decisions and improving patient outcomes.…”