Risk factors for distant
recurrence of hepatocellular carcinoma in the liver after complete coagulation
by microwave or radiofrequency ablation
Izumi N, Asahina Y, Noguchi O, Uchihara M, Kanazawa N, Itakura J, Himeno Y,
Miyake S, Sakai T, Enomoto N
Division of Gastroenterology and Hepatology, Musashino Red-Cross Hospital, Tokyo,
Japan.
Background: In patients with hepatocellular carcinoma (HCC), recurrences in the distant liver often are observed after curative treatment. Microwave coagulation therapy (MCT) and radiofrequency ablation (RFA) have been developed as less invasive alternatives than surgical resection for small HCCs. In the current study, risk factors for distant recurrence of HCC were analyzed in patients in whom complete coagulation was achieved.
Methods: Ninety-two
patients with HCCs < 3 cm in greatest dimension were
treated by MCT or RFA percutaneously or laparoscopically. Eighty-four patients
in whom complete coagulation was achieved without recurrence in the same subsegment
as the primary nodule were included in this study. Distant recurrences were
observed in 22 patients. Fifteen possible risk factors for a distant recurrence
were analyzed.
Results: When comparing
the patients with a recurrence of HCC nodules in the remnant liver to those
without recurrence, the authors observed a statistically significant difference
only
in serum alpha-fetoprotein. The distant recurrence-free survival was analyzed
by the Kaplan-Meier method. A statistically significant difference was observed
in hepatitis C
virus (HCV) infection as an etiopathic agent of underlying liver diseases (P
< 0.005) and in the number of the primary HCC nodules (P < 0.05, log-rank
test). A multivariate stepwise Cox hazard model revealed that HCV infection
and the number of primary HCC nodules were statistically independent risk factors.
Conclusions: Patients who had more than two HCC nodules accompanied by HCV infection had a high incidence of recurrence of HCC in the remnant liver, even when coagulation by microwave or ablation by radiofrequency was complete
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