Percutaneous RFA for HCC leads to frequent recurrences, high survival rates

Kim YS. J Hepatol. 2012;doi:10.1016/j.jhep.2012.09.020.

October 12, 2012

Patients with hepatocellular carcinomas treated with percutaneous radiofrequency ablation experienced frequent tumor recurrences but had high 10-year survival rates in a recent study.

Researchers evaluated data from 1,305 patients who underwent percutaneous radiofrequency ablation (RFA) for 1,502 hepatocellular carcinomas between April 1999 and April 2011, with a median follow-up of 33.4 months.

RFA was successful within one session in 94.8% of cases and complete ablation occurred in 1,482 tumors during initial treatments, indicating an effectiveness rate of 98.7%. The tumor progression rate was 9.7% at 1 year, 27% at 5 years and 36.9% at 10 years. Risk for tumor progression was associated with larger tumor size (B=0.584, P=.001) via multivariate analysis.

Among 1,283 participants who survived longer than 30 days after complete treatment, recurrence occurred in 795 cases, with one to 17 incidents per patient. Intrahepatic distant recurrence occurred in 54.8% of patients during follow-up, with a cumulative rate of 24.4% at 1 year, 73.1% at 5 years and 88.5% at 10 years and a 59.7% survival rate (mean recurrence-free survival time=43.6 months). Extrahepatic recurrence occurred in 12.6% of patients, with a cumulative rate of 2.7% at 1 year, 19.1% at 5 years and 38.2% at 10 years and a survival rate of 32.3% (mean recurrence-free survival time=113.3 months).

There were 407 deaths; causes included HCC progression (333 patients), hepatic failure or complications related to cirrhosis (39 patients) or other systemic or organ complications (35 patients). Mean overall survival time was 82.9 months after RFA, with cumulative survival rates of 95.5% at 1 year, 59.7% at 5 years and 32.3% at 10 years. Investigators observed associations between poor survival and Child-Turcotte-Pugh class B (B=–1.054, P<.001), advanced age (B=0.043, P=.01), extrahepatic recurrence (B=0.971, P=.007) and not having received antiviral therapy during follow-up (B=–0.699, P=.034).

“Ten-year survival outcomes after percutaneous radiofrequency ablation as a first-line therapeutic option of hepatocellular carcinoma are excellent and comparable to those of surgery, even though tumor recurrences are relatively frequent,” the researchers concluded. “Aggressive antiviral therapy after radiofrequency ablation appears to prolong survival of the patients if the underlying liver disease is related to hepatitis viral infection.”

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