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

Abstract

AIM:To analyze the risk factors of hepatocellular carcinoma (HCC) recurrence after radiofrequency ablation (RFA) treatment with HCV-associated hepatitis. METHODS:Twenty-six patients with HCV-associated HCC who were followed-up for more than 12 mo were selected for this study. Risk factors for distant intrahepatic recurrences of HCC were evaluated for patients in whom complete coagulation was achieved without recurrence in the same subsegment as the primary nodule. Twelve clinical and tumoral factors were examined: Age, gender, nodule diameter, number of primary HCC nodule, Child-Pugh classification, serum platelet, serum albumin, serum AST, post RFA AST, serum ALT, post RFA ALT, post RFA treatment. RESULTS:Distant recurrences of HCC in remnant liver after RFA were observed in 14 cases and in the number of primary HCC nodules (P = 0.047), and the serum platelets (P = 0.030), the clear difference came out by the recurrence group and the non-recurrence group. The cumulative recurrence rates after 1 and 2 years were 30.8% and 86.8%, respectively for primary multinodular HCC, and 15.4% and 29.5% respectively, for primary uninodular HCC. In addition the 1-year recurrence rates for patients with serum albumin more than 3.4 g/dL and less than 3.4 g/dL were 23.1% for both, but the 2-years recurrence rates were 89.0% and 23.1%, respectively. The number of primary HCC nodules (relative risk, 6.970; P = 0.016) were found to be a statistically significant predictor for poor distant intrahepatic recurrence by univariate analysis. CONCLUSION:Patients who have multiple HCC nodules, low serum platelets and low serum albumin accompanied by HCV infection, should be carefully followed because of the high incidence of new HCC lesions in the remnant liver, even if coagulation RFA is complete.

Incidence of new foci of hepatocellular carcinoma after radiofrequency ablation: role of multidetector CT

“…segments VIII, VII and VI, no segments were spared. These findings are consistent with the literature, which indicates a high rate of intrahepatic HCC recurrence at sites other than that of the RFA, with percentages ranging from 40.6% to 53% [2,6,14,15]. In this respect, there is evidence that recurrence in a different hepatic segment, associated with the presence of distant metastases, has a significant negative influence on overall survival; hence, constant monitoring and aggressive treatment may be indicated in patients with intrahepatic recurrence in a different segment in order to optimise the benefits of RFA [6,7].…”

“…Nello studio di Zytoon et al [18], ad esempio, non è stato rilevato alcun significativo fattore di rischio. Di contro, nello studio di Yamanaka et al [15] si è giunti alla conclusione che i pazienti che hanno più noduli di HCC, bassi livelli sierici di piastrine o di albumina, associati ad infezione da virus dell'epatite C dovrebbero essere seguiti attentamente a causa dell'elevata incidenza di nuove lesioni di HCC nel resto del fegato, anche dopo necrosi coagulativa almost half of the first group. As a consequence, and in view of the high rate of new HCC foci reported by Lencioni et al over longer follow-up periods (as high as 81% at 5 years), a longer follow-up period might have led to detection of new nodules in this group of patients [12].…”

“…A study by Zytoon et al, for example, found no significant risk factor [18]. Conversely, Yamanaka et al reached the conclusion that patients with a greater number of HCC nodules, low serum platelet or albumin levels and associated C virus infection should undergo close monitoring because of the high incidence of new HCC lesions in the rest of the liver, even after complete post-RFA coagulative necrosis [15]. Kim et al reported that elevated serum alpha-fetoprotein was the only risk factor for intrahepatic distant recurrence [14].…”

“…a At 18-month computed tomography after radiofrequency ablation, a roundish hyperattenuating mass of 2.1 cm is appreciable in segments VI-VII during the arterial phase (arrow); b during the portal-venous phase, the lesion shows a clearcut washout with a peripheral hyperattenuating rim (arrow). [2,6,14,15]. A tale proposito, vi è evidenza che la recidiva in un ditor found to correlated significantly with the development of new HCC nodules was proximity to the hepatic capsule (p<0.018) ( Table 5).…”

Preclinical and post-treatment changes in the HCC-associated serum proteome

“…Another possibility is that SELDI detects changes in the liver that precede HCC. It is noteworthy that HCV patients with cirrhosis and HCC are at a very high risk of new primary HCC when they are not cured of their HCV infection (Yamanaka et al, 2005). Thus, the proteomic changes could be the hallmark of premalignant lesions that persist after the ablation of the first malignant tumour.…”