Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2015; 21(17): 5287-5294
Published online May 7, 2015. doi: 10.3748/wjg.v21.i17.5287
Radiofrequency ablation for single hepatocellular carcinoma 3 cm or less as first-line treatment
Jun Gao, Shao-Hong Wang, Xue-Mei Ding, Wen-Bing Sun, Xiao-Long Li, Zong-Hai Xin, Chun-Min Ning, Shi-Gang Guo
Jun Gao, Shao-Hong Wang, Xue-Mei Ding, Wen-Bing Sun, Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
Xiao-Long Li, Department of General Surgery, Affiliated Hospital of Chifeng University, Chifeng 024000, Inner Mongolia Autonomous Region, China
Zong-Hai Xin, Department of General Surgery, Zhanhua People’s Hospital, Zhanhua 256800, Shandong Province, China
Chun-Min Ning, Shi-Gang Guo, Department of General Surgery, Chaoyang Central Hospital, Chaoyang 122000, Liaoning Province, China
Author contributions: Gao J and Sun WB designed the research, analyzed and interpreted the data, and drafted the manuscript; Wang SH, Ding XM, Li XL, Xin ZH, Ning CM and Guo SG performed the study, analyzed the data and helped draft the manuscript; all authors read and approved the final manuscript.
Supported by Dr. Jieping Wu Medical Foundation, Nos. 320675007131 and 32067501207; Clinical-Basic Medicine Cooperation Fund of Capital Medical University, No. 1300171711; and Program for Medical Key Discipline of Shijingshan District, No. 20130001.
Ethics approval: The study was reviewed and approved by the four Institutional Review Boards of the four institutions according to the standards of the Declaration of Helsinki.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors have no conflicts of interest to declare.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wen-Bing Sun, MD, Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, No. 5 Jingyuan Street, Beijing 100043, China. cyhswb@qq.com
Telephone: +86-10-51718372 Fax: +86-10-51718017
Received: October 30, 2014
Peer-review started: October 30, 2014
First decision: November 26, 2014
Revised: December 9, 2014
Accepted: January 30, 2015
Article in press: January 30, 2015
Published online: May 7, 2015
Abstract

AIM: To evaluate long-term outcomes of radiofrequency (RF) ablation as first-line therapy for single hepatocellular carcinoma (HCC) ≤ 3 cm and to determine survival and prognostic factors.

METHODS: We included all 184 patients who underwent RF ablation as a first-line treatment for single HCC ≤ 3 cm between April 2005 and December 2013. According to the criteria of Livraghi, the 184 patients were divided into two groups: those suitable for surgical resection (84 cases) and those unsuitable for surgical resection (100 cases). The primary endpoints were the overall survival (OS) rate and safety; the secondary endpoints were primary technique effectiveness and recurrence rate.

RESULTS: There were 19 (10.3%) cases of ablation related minor complications. The complete tumor ablation rate after one RF session was 97.8% (180/184). The rate of local tumor progression, extrahepatic metastases and intrahepatic distant recurrence were 4.9% (9/184), 9.8% (18/184) and 37.5% (69/184), respectively. In the 184 patients, the 1-, 3-, and 5-year OS rates were 99.5%, 81.0%, and 62.5%, respectively. The 1-, 3-, and 5-year OS rates were 100%, 86.9%, and 71.4%, respectively, in those suitable for surgical resection and 99.0%, 76.0%, and 55.0%, respectively, in those unsuitable for surgical resection (P = 0.021). On univariate and multivariate analyses, poorer OS was associated with Child-Pugh B class and portal hypertension (P < 0.05).

CONCLUSION: RF ablation is a safe and effective treatment for single HCC ≤ 3 cm. The OS rate of patients suitable for surgical resection was similar to those reported in surgical series.

Keywords: Hepatocellular carcinoma, Radiofrequency ablation, Therapeutic efficacy, Safety, Survival

Core tip: The argument against the role of radiofrequency (RF) ablation as a first treatment option for patients with small hepatocellular carcinoma (HCC) is represented by the lack of adequate evidence proving that its effectiveness is comparable to that of surgical resection (SR). The study provides evidence that RF ablation is a safe and effective first-line treatment for single HCC 3 cm or less, even when SR is possible. Furthermore, we also induced the systemic technical measures to promote the efficacy of RF ablation for HCC from the surgeon’s perspective.