Thermal ablation for hepatocellular carcinoma: a large-scale analysis of long-term outcome and prognostic factors
Introduction
Primary liver cancer, especially hepatocellular carcinoma (HCC), is the fifth most frequent type of malignant tumour.1, 2 HCC has a high incidence rate, with approximately 500,000–1,000,000 cases each year globally and is also the third most lethal type of cancer.1, 2 Image-guided local thermal ablation, especially radiofrequency ablation (RFA) and microwave ablation (MWA), represents the third most effective radical treatment method for HCC after liver transplantation and surgical resection.3, 4 Liver transplantation may be considered the best option as it removes both the cancer and the underlying diseased liver, but lack of liver grafts is a major limitation. Surgical resection allows a 5-year survival rate of approximately 50% and is often considered as the first-line treatment, especially when liver function is acceptable. Globally, only 10–20% of patients are eligible to undergo transplantation or resection.5, 6 Thermal ablation is increasingly considered as a possible first-line treatment, even outside the classical contraindications of surgery, such as major liver dysfunction, co-morbidities, or patient refusal3, 7; however, although thermal ablation for treating HCC has achieved significant results, its long-term outcome has been variously appreciated.8, 9, 10 In particular, few studies have covered a 10-year outcome.11 The aim of the present study was to investigate the long-term outcome and prognostic factors when treating hepatocellular carcinoma (HCC) with thermal ablation, based on the retrospective analysis of a large series of patients followed for up to 10 years.
Section snippets
Patients
From October 2001 to May 2013, a total of 1,210 patients with malignant liver tumours received local thermal ablation therapy at Tianjin Third Central Hospital, China. Among the patients, 1,121 cases were diagnosed as having HCC, and 846 cases meeting the inclusion criteria were enrolled in the present study. Diagnosis of HCC included needle biopsy-based histopathological diagnosis and/or radiological diagnosis: 638 (75.4%) cases were diagnosed at histopathology and 208 (24.6%) were diagnosed
Basic clinical characteristics of patients
Patients were predominantly males with cirrhosis (87.5%) of viral origin (related to hepatitis B virus [HBV] in 77%). Six hundred and ninety-five patients were Child–Pugh Class A. One hundred and ninety-seven patients received RFA, and 649 patients underwent MWA. The numbers of patients who underwent one to seven ablation sessions were 604, 171, 56, 9, 3, 1, and 2, respectively, with a mean of 1.4 ± 0.76 sessions per case. Complete ablation was obtained in 97.1% of the cases (1204/1240; Table 2
Discussion
HCC accounts for >80% of patients with primary liver cancer. Most HCC patients develop from pre-existing cirrhosis, mainly attributable to alcoholic cirrhosis or hepatitis B or C virus infection.14 The 5-year survival rate for HCC is <5% in all patients. More than 30% of patients are diagnosed at early stages and surgical resection or liver transplantation have long been considered as the first options.15 In the last two decades, thermal ablation has been increasingly applied to HCC, with
Acknowledgements
This work was supported by grant from Tianjin Health Industry Key Research Project (no. 13KG111).
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