D.L. Choi, H.W.K. Lim, H. Rhim, Y.K.H. Kim; Seoul/KR

Purpose
To evaluate the long-term survival results and complications of percutaneous radiofrequency ablation (RFA) for patients with early-stage hepatocellular carcinoma (HCC) as the first-line treatment option and to assess factors that can influence therapeutic efficacy

Material and methods
Between April 1999 and May 2005, 570 patients with 674 HCCs (single HCC < 5 cm in diameter or multiple [up to three] HCCs < 3 cm each) underwent percutaneous RFA as the first-line treatment option in a single institution. We evaluated primary and secondary effectiveness rates, local tumor progression rates (by the Kaplan-Meier method), overall survival rates, and event-free survival rates. We assessed the prognostic values of long-term survival rates in terms of patient age, gender, Child class, serum α-fetoprotein (AFP) level, tumor size, and multiplicity by using Cox proportional hazard models. We also evaluated major and minor complications related to the procedures.

Results
The primary effectiveness rate was 96.7% (652 of 674), and secondary effectiveness rate with 1 year or more follow-up CT was 87.9% (509 of 579). The cumulative rates of the local tumor progression at 1, 2, and 3 years were 8.1%, 10.9%, and 11.8%, respectively. The primary effectiveness rate, secondary effectiveness rate, and local tumor progression rates of very small tumors (< 2 cm) were significantly higher than those of larger tumors (> 2 cm) (P <0.05). The cumulative overall survival rates at 1, 2, 3, 4, and 5 years were 95.2%, 82.9%, 69.5%, 60.8%, and 58.0%, respectively. Patients with Child class A cirrhosis, younger age (< 58 years) or lower AFP level (< 100 µg/L) showed better overall survival rates (P <0.05). The cumulative event-free survival rates at 1, 2, 3, 4, and 5 years were 60.9%, 37.4%, 26.5%, 23.1%, and 21.0%, respectively. Patients with Child class A cirrhosis or younger age showed better event-free survival rates (P <0.05). There were no procedure-related death, 1.9% (per treatment) of major complications, and 4.2% of minor complications.

Conclusion
Percutaneous RFA is considered a reliable treatment for early-stage HCC in terms of therapeutic efficacy and safety. We confirmed that percutaneous RFA could be successfully used as a first-line treatment for early-stage HCCs in a large single-institution series.