[Long-term efficacy of radiofrequency ablation in 446 patients with hepatocellular carcinoma]

To investigate the efficacy of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) according to standardized treatment strategy and individualized protocol.

A total of 468 patients of HCC underwent ultrasound/Contrast-enhanced ultrasound guided RF ablation in our department according to individualized protocol for large tumors, hypervascular tumors and tumors located adjacent to important structures in our study, of which 22 HCCs having undergone palliative RF ablation were excluded because of huge size, diffusive multiple tumors or adjacent structures invasion. The remaining 446 HCCs (680 sessions) were included and followed-up regularly to assess treatment efficiency. Of the 446 patients, 367 were male and 79 were female. 828 lesions underwent RFA. The mean size of tumors was (3.6±1.4)cm. Regular follow-up was conducted for 3-119 months. In this study, long-term outcome of various refractory tumors were also investigated.

The overall ablation success rate was 97%(803/828) 1 month after RFA. The recurrent rate was 7.2% (60/828). Base on Kaplan-Meier method, the 1-, 3- and 5-year overall survival rates after RF ablation were 85.3%, 61.3% and 47.0%, respectively. The ablation success rate of tumors larger than 3.5 cm was 90.8% (275/303). The 5-year survival rates of patients who had HCC for 3.1-5 cm and >5 cm were 45.1% and 35.9%, respectively. In this study, there were 40.3% (334/828) tumors located adjacent to important structures. The ablation success rates of these tumors located adjacent to gallbladder, diaphragm, bowel and major vessels were 93.5% (58/62), 92.5% (123/133), 92.4% (61/66) and 93.2% (68/73), respectively. The incidence of major complications was 3.1% (21/680), which included 5 intraperitoneal hemorrhages, 4 biliary injuries, 2 hemopleural effusions, 3 bowel perforations and 7 needle tract seedings. Treatment-related death occurred in 1 case of bowel perforation.

In RF ablation of refractory HCC, application of standardized treatment strategy and individualized protocol plays important roles in improving ablation success rate and minimizing potential complications. It could extend the indications of RF ablation for HCC in China.