Radiofrequency ablation: technical and clinical long-term outcomes for single hepatocellular carcinoma up to 30 mm

Western guidelines consider radiofrequency ablation (RF) as the standard treatment for 'very early' and 'early' hepatocellular carcinoma (HCC) in nonsurgical cirrhotic patients. RF has also been proposed as the first-line therapy for 'surgical' candidates with a single nodule of 20 mm or less. The aim of this monocentric cohort study was to evaluate the technical and clinical outcomes of RF in the treatment of cirrhotic patients with a single HCC of 30 mm or less.

We included all 209 consecutive patients treated between January 2001 and June 2011. The primary endpoints were the overall survival (OS) rate and safety; the secondary endpoints were primary technique effectiveness, local tumor progression, and the disease-free survival rate.

The 5-year OS rate of the entire sample was 44.3% (95% confidence interval: 36.7-55.8); Child-Pugh class B was the worst negative prognostic factor (hazard ratio: 2.06; P=0.008). A subgroup of 70 Child-Pugh class A patients suitable for surgical resection according to current Western operability criteria showed a 5-year OS rate of 60.6%. Treatment-related mortality and morbidity rates were 0 and 3.4%, respectively. Primary technique effectiveness rate was 95.2% after one to three RF sessions. The 5-year cumulative incidence of local tumor progression was 21.5 and 32.5% for nodules ≤20 and 21-30 mm, respectively. The 5-year disease-free survival rate (comprehensive of any kind of tumor progression or death) was 17.8% (95% confidence interval: 11.1-25.8).

RF is an effective and very safe therapy for HCC up to 30 mm; in 'surgical' cirrhotic patients, the OS rate was similar to those reported in surgical series, although the local recurrence rate was higher.