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

• Published in: Cancer Vol. 91; no. 5; pp. 949 - 956
• Main Authors: Izumi, Namiki, Asahina, Yasuhiro, Noguchi, Osamu, Uchihara, Masakatsu, Kanazawa, Nobuhiko, Itakura, Jun, Himeno, Yoshiro, Miyake, Shozo, Sakai, Takahiro, Enomoto, Nobuyuki
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 01.03.2001; Wiley-Liss
• Subjects: Aged; Biological and medical sciences; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Catheter Ablation; Diseases of the digestive system; Female; Hepatitis C - complications; hepatitis C virus; hepatocellular carcinoma; Humans; Laparoscopy; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Male; Medical sciences; microwave coagulation; Microwaves - therapeutic use; Middle Aged; Neoplasm Recurrence, Local; Radio Waves; radiofrequency ablation; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); recurrence of HCC; Risk Factors; Human; Relapse; Coagulation; Microwave; Instrumentation therapy; Hepatic disease; Hepatocellular carcinoma; Malignant tumor; Radiofrequency; Ablation; Infection; Etiology; Viral disease; Risk factor; Digestive diseases; Viral hepatitis C
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(20010301)91:5<949::AID-CNCR1084>3.0.CO;2-H

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 distant recurrence of hepatocellular carcinoma (HCC) in the liver after complete coagulation by microwave or radiofrequency ablation were investigated by multivariate analysis. Hepatitis C virus (HCV) infection and the number of primary HCC nodules were statistically independent. Patients who had more than two HCC nodules and HCV infection had a high incidence of recurrence of HCC in the remnant liver, even when coagulation by microwave or radiofrequency ablation was complete.