Risk factors for distant recurrence of hepatocellular carcinoma in the liver after complete coagulation by microwave or radiofrequency ablation

Abstract

BACKGROUND In patients with hepatocellular carcinoma (HCC), recurrences in the distant liver often are observed after curative treatment. Microwave coagulation therapy (MCT) and radiofrequency ablation (RFA) have been developed as less invasive alternatives than surgical resection for small HCCs. In the current study, risk factors for distant recurrence of HCC were analyzed in patients in whom complete coagulation was achieved. METHODS Ninety‐two patients with HCCs < 3 cm in greatest dimension were treated by MCT or RFA percutaneously or laparoscopically. Eighty‐four patients in whom complete coagulation was achieved without recurrence in the same subsegment as the primary nodule were included in this study. Distant recurrences were observed in 22 patients. Fifteen possible risk factors for a distant recurrence were analyzed. RESULTS When comparing the patients with a recurrence of HCC nodules in the remnant liver to those without recurrence, the authors observed a statistically significant difference only in serum α‐fetoprotein. The distant recurrence‐free survival was analyzed by the Kaplan–Meier method. A statistically significant difference was observed in hepatitis C virus (HCV) infection as an etiopathic agent of underlying liver diseases (P < 0.005) and in the number of the primary HCC nodules (P < 0.05, log‐rank test). A multivariate stepwise Cox hazard model revealed that HCV infection and the number of primary HCC nodules were statistically independent risk factors. CONCLUSIONS Patients who had more than two HCC nodules accompanied by HCV infection had a high incidence of recurrence of HCC in the remnant liver, even when coagulation by microwave or ablation by radiofrequency was complete. Cancer 2001;91:949–56. © 2001 American Cancer Society.

Risk factors for the recurrence of hepatocellular carcinoma after radiofrequency ablation of hepatocellular carcinoma in patients with hepatitis C

“…RFA is successful for achieving a one-session treatment for patients with small HCC using RFA with CT assistance, and RFA with CT assistance is effective for the treatment of patients with small HCC [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . One of the advantages of RFA is that it can be repeatedly performed, can be combined with TACE, and can also be used according to the features of the disease and the response [7] .…”

“…Patients who have more than two HCC nodules accompanied by HCV infection should be carefully followed because of a high incidence of new HCC lesions in the remnant liver, even if coagulation by microwave or ablation by radiofrequency is complete [11] . Our observations are consistent with these reports, and it is reasonable to argue that there may be multicentric occurrence of HCC in the remnant liver at the same frequency as that for HCV-associated cirrhosis.…”

Clinical significance of tumor markers in detection of recurrent hepatocellular carcinoma after radiofrequency ablation

“…Despite good control of treated lesions, new tumors frequently occur in the different regions of the liver. Previous studies have reported intra-hepatic distant recurrence rates of 18.7-22.5%, 62.1-67% and 81-81.7% at 1, 3 and 5 years, respectively, after percutaneous ethanol injection therapy (PEIT) (31-33), 38 and 60% at 1 and 2 years, respectively, after RFA (34), and 18 and 52% at 1 and 2 years, respectively, after RFA or microwave coagulation therapy (35). In the present subjects, distant recurrence occurred in 8.3, 19.3 and 66.3% at 1, 3 and 5 years, respectively, after the combination of TACE and RFA; these rates were comparable to those reported previously (31)(32)(33)(34)(35).…”

Prevention of intrahepatic metastasis of liver cancer by suicide gene therapy and chemokine ligand 2/monocyte chemoattractant protein‐1 delivery in mice

“…Primary liver cancer is the fifth most common neoplasm in the world and the third most common cause of cancer-related deaths [1,2]. Despite the development of novel modalities for treatment of hepatocellular carcinoma (HCC), including transcatheter arterial embolization, percutaneous ablation, surgical resection and liver transplantation, the prognosis of patients with HCC still remains relatively poor.…”

“…Despite the development of novel modalities for treatment of hepatocellular carcinoma (HCC), including transcatheter arterial embolization, percutaneous ablation, surgical resection and liver transplantation, the prognosis of patients with HCC still remains relatively poor. One of the major factors responsible for these unsatisfactory outcomes is the high frequency of intrahepatic recurrence after curative treatment [1,2]. Intrahepatic recurrence is due to two mechanisms; intrahepatic metastasis (IM) originating from the primary cancer, and a second primary cancer arising from multicentric carcinogenesis (MC).…”