Skip to main content
SpringerLink
Log in

RF Ablation Versus Cryoablation for Small Perivascular Hepatocellular Carcinoma: Propensity Score Analyses of Mid-Term Outcomes

  • Clinical Investigation
  • Non-Vascular Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to compare radiofrequency (RF) ablation with cryoablation in patients with perivascular hepatocellular carcinoma (HCC) and evaluate the mid-term outcomes of both therapies.

Materials and Methods

Between January 2015 and April 2018, 111 patients who underwent percutaneous cryoablation (n = 61) or RF ablation (n = 50) for a single perivascular HCC were included. Perivascular HCC was defined as the presence of contacting peritumoral hepatic vessels that were 3 mm or larger in axial diameter. Local tumor progression (LTP) rates were compared by propensity score matching. Procedure-related complications were also assessed.

Results

The median follow-up was 23 months (range 2–45 months). Twenty-five patients were matched in each group. The cumulative LTP rates at 1 and 3 years were 8.3% and 17.3% in the cryoablation group and 8.7% and 26.1% in the RF ablation group, with no significant difference (p = 0.379). Although there were no significant differences between the two groups, vascular thrombosis (16.0% vs. 9.8%, p = 0.493) and hepatic infarction (12.0% vs. 3.3%, p = 0.137) more frequently occurred in the RF ablation group than in the cryoablation group.

Conclusion

In patients with perivascular HCC, cryoablation is an effective alternative treatment compared with RF ablation regarding local tumor control and complications.

Level of Evidence

Level 4 (retrospective case–control study).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

RF:

Radio frequency

HCC:

Hepatocellular carcinoma

BCLC:

Barcelona Clinic Liver Cancer

AIR:

Aggressive intrasegmental recurrence

TACE:

Transarterial chemoembolization

CT:

Computed tomography

MR:

Magnetic resonance

US:

Ultrasound

LTP:

Local tumor progression

CI:

Confidence interval

References

  1. European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236.

    Article  Google Scholar 

  2. Nault JC, Sutter O, Nahon P, Ganne-Carrie N, Seror O. Percutaneous treatment of hepatocellular carcinoma: state of the art and innovations. J Hepatol. 2017;68(4):783–97.

    Article  PubMed  Google Scholar 

  3. Kang TW, Lim HK, Lee MW, et al. Aggressive intrasegmental recurrence of hepatocellular carcinoma after radiofrequency ablation: risk factors and clinical significance. Radiology. 2015;276(1):274–85.

    Article  PubMed  Google Scholar 

  4. Kotoh K, Enjoji M, Arimura E, et al. Scattered and rapid intrahepatic recurrences after radio frequency ablation for hepatocellular carcinoma. World J Gastroenterol. 2005;11(43):6828–32.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kang TW, Lim HK, Cha DI. Aggressive tumor recurrence after radiofrequency ablation for hepatocellular carcinoma. Clin Mol Hepatol. 2017;23(1):95–101.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lu DS, Raman SS, Vodopich DJ, Wang M, Sayre J, Lassman C. Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: assessment of the "heat sink" effect. AJR Am J Roentgenol. 2002;178(1):47–51.

    Article  PubMed  Google Scholar 

  7. Yamada S, Utsunomiya T, Morine Y, et al. Expressions of hypoxia-inducible factor-1 and epithelial cell adhesion molecule are linked with aggressive local recurrence of hepatocellular carcinoma after radiofrequency ablation therapy. Ann Surg Oncol. 2014;21(Suppl 3):S436–S442442.

    Article  PubMed  Google Scholar 

  8. Lee DH, Lee JM, Yoon JH, Kim YJ, Han JK. Thermal injury-induced hepatic parenchymal hypoperfusion: risk of hepatocellular carcinoma recurrence after radiofrequency ablation. Radiology. 2017;282(3):880–91.

    Article  PubMed  Google Scholar 

  9. Song KD. Percutaneous cryoablation for hepatocellular carcinoma. Clin Mol Hepatol. 2016;22(4):509–15.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kim GM, Won JY, Kim MD, et al. Cryoablation of hepatocellular carcinoma with high-risk for percutaneous ablation: safety and efficacy. Cardiovasc Intervent Radiol. 2016;39(10):1447–544.

    Article  PubMed  Google Scholar 

  11. Kim R, Kang TW, Cha DI, et al. Percutaneous cryoablation for perivascular hepatocellular carcinoma: therapeutic efficacy and vascular complications. Eur Radiol. 2019;29(2):654–62.

    Article  PubMed  Google Scholar 

  12. Wang C, Wang H, Yang W, et al. Multicenter randomized controlled trial of percutaneous cryoablation versus radiofrequency ablation in hepatocellular carcinoma. Hepatology. 2015;61(5):1579–90.

    Article  PubMed  Google Scholar 

  13. Huang YZ, Zhou SC, Zhou H, Tong M. Radiofrequency ablation versus cryosurgery ablation for hepatocellular carcinoma: a meta-analysis. Hepatogastroenterology. 2013;60(125):1131–5.

    PubMed  Google Scholar 

  14. Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria—a 10-year update. Radiology. 2014;273(1):241–60.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lee S, Kang TW, Cha DI, et al. Radiofrequency ablation vs. surgery for perivascular hepatocellular carcinoma: propensity score analyses of long-term outcomes. J Hepatol. 2018;69(1):70–8.

    Article  PubMed  Google Scholar 

  16. Kim YS, Lim HK, Rhim H, et al. Ten-year outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: analysis of prognostic factors. J Hepatol. 2013;58(1):89–97.

    Article  PubMed  Google Scholar 

  17. Song KD, Lee MW, Rhim H, et al. Aggressive intrasegmental recurrence of hepatocellular carcinoma after combined transarterial chemoembolization and radiofrequency ablation. AJR Am J Roentgenol. 2016;207(5):1122–7.

    Article  PubMed  Google Scholar 

  18. Sinn DH, Choi GS, Park HC, et al. Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients. PLoS ONE. 2019;14(1):e0210730.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Choe J, Kim KW, Kim YI, et al. Feasibility of a low-power radiofrequency ablation protocol to delay steam popping. J Vasc Interv Radiol. 2016;27(2):268–74.

    Article  PubMed  Google Scholar 

  20. Song KD, Lee MW, Rhim H, et al. Percutaneous US/MRI fusion-guided radiofrequency ablation for recurrent subcentimeter hepatocellular carcinoma: technical feasibility and therapeutic outcomes. Radiology. 2018;288(3):878–86.

    Article  PubMed  Google Scholar 

  21. Lu DS, Raman SS, Limanond P, et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol. 2003;14(10):1267–74.

    Article  PubMed  Google Scholar 

  22. Kang TW, Lim HK, Lee MW, Kim YS, Choi D, Rhim H. Perivascular versus nonperivascular small HCC treated with percutaneous RF ablation: retrospective comparison of long-term therapeutic outcomes. Radiology. 2014;270(3):888–99.

    Article  PubMed  Google Scholar 

  23. Min JH, Lim HK, Lim S, et al. Radiofrequency ablation of very-early-stage hepatocellular carcinoma inconspicuous on fusion imaging with B-mode US: value of fusion imaging with contrast-enhanced US. Clin Mol Hepatol. 2014;20(1):61–70.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kang TW, Lim HK, Lee MW, Kim YS, Choi D, Rhim H. First-line radiofrequency ablation with or without artificial ascites for hepatocellular carcinomas in a subcapsular location: local control rate and risk of peritoneal seeding at long-term follow-up. Clin Radiol. 2013;68(12):e641–e651.

    Article  CAS  PubMed  Google Scholar 

  25. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol. 2017;40(8):1141–6.

    Article  CAS  PubMed  Google Scholar 

  26. Kang TW, Lim HK, Cha DI. Percutaneous ablation for perivascular hepatocellular carcinoma: refining the current status based on emerging evidence and future perspectives. World J Gastroenterol. 2018;24(47):5331–7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Nicoli N, Casaril A, Abu Hilal M, et al. A case of rapid intrahepatic dissemination of hepatocellular carcinoma after radiofrequency thermal ablation. Am J Surg. 2004;188(2):165–7.

    Article  PubMed  Google Scholar 

  28. Choi BI, Lee KH, Han JK, Lee JM. Hepatic arterioportal shunts: dynamic CT and MR features. Kor J Radiol. 2002;3(1):1–15.

    Article  Google Scholar 

  29. Song KD, Lim HK, Rhim H, et al. Repeated hepatic resection versus radiofrequency ablation for recurrent hepatocellular carcinoma after hepatic resection: a propensity score matching study. Radiology. 2015;275(2):599–608.

    Article  PubMed  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    So Yeon Cha, Tae Wook Kang, Ji Hye Min, Kyoung Doo Song, Min Woo Lee, Hyunchul Rhim & Hyo Keun Lim

  2. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Dong Hyun Sinn

  3. Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea

    Min Su Park

  4. Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Hyo Keun Lim

Authors
  1. So Yeon Cha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tae Wook Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ji Hye Min
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyoung Doo Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Min Woo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyunchul Rhim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hyo Keun Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dong Hyun Sinn
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Min Su Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors have participated in all three of the following: substantial contributions to conception and design, acquisition of data, or analysis, and interpretation of data, drafted the article or revised it critically for important intellectual content, and approved the final version of the manuscript.

Corresponding author

Correspondence to Tae Wook Kang.

Ethics declarations

Conflict of interest

The authors declare that no conflicts of interest are associated with this publication. The authors declare that there are no potential conflicts (financial, professional, or personal) associated with this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cha, S.Y., Kang, T.W., Min, J.H. et al. RF Ablation Versus Cryoablation for Small Perivascular Hepatocellular Carcinoma: Propensity Score Analyses of Mid-Term Outcomes. Cardiovasc Intervent Radiol 43, 434–444 (2020). https://doi.org/10.1007/s00270-019-02394-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-019-02394-4

Keywords

Search

Navigation