Local recurrence of hepatocellular carcinoma in the tumor blood drainage area following radiofrequency ablation

Hirooka,Masashi; Ochi,Hironori; Koizumi,Yohei; Tokumoto,Yoshio; Hiraoka,Atsushi; Kumagi,Teru; Abe,Masanori; Tanaka,Hiroaki; Hiasa,Yoichi

doi:10.3892/mco.2013.229

Local recurrence of hepatocellular carcinoma in the tumor blood drainage area following radiofrequency ablation

Authors:
- Masashi Hirooka
- Hironori Ochi
- Yohei Koizumi
- Yoshio Tokumoto
- Atsushi Hiraoka
- Teru Kumagi
- Masanori Abe
- Hiroaki Tanaka
- Yoichi Hiasa
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Affiliations: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime 791‑0295, Japan, Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Ehime 790‑0024, Japan, Department of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime 791‑0295, Japan
Published online on: December 20, 2013 https://doi.org/10.3892/mco.2013.229
Pages: 182-186

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Abstract

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. HCC is generally considered to spread via the bloodstream and local recurrence often occurs in the blood drainage area determined by computed tomography during hepatic arteriography (CTHA), despite complete ablation of the primary nodule. This study was conducted in order to prospectively assess the rate of local recurrence in the blood drainage area depicted by delayed‑phase CTHA. The participants comprised 364 consecutive patients (260 men and 104 women; mean age, 67.4±8.6 years), enrolled between April, 2002 and December, 2011. The participants were divided into two groups, according to whether the ablation area covered the entire blood drainage area as defined by delayed‑phase CTHA (group A) or not (group B). Local tumor progression was compared between the two groups. The median time to recurrence was significantly shorter for group B (434 days) compared to that for group A (1,474 days; P=0.0037). The cumulative local recurrence rates for group A were 0, 0 and 1.5% at 1, 3 and 5 years postoperatively, respectively, whereas the recurrence rates for group B were 3.8, 17.0 and 22.8% at 1, 3 and 5 years, respectively (P<0.0001). In conclusion, the safety margin for radiofrequency ablation should be defined as the blood drainage area and ablation should aim at acquiring adequate safety margins.

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1	Mazzaferro V, Regalia E, Doci R, et al: Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 334:693–699. 1996. View Article : Google Scholar : PubMed/NCBI
2	Arii S, Yamaoka Y, Futagawa S, et al: Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan. Hepatology. 32:1224–1229. 2000. View Article : Google Scholar : PubMed/NCBI
3	Ikai I, Itai Y, Okita K, et al: Report of the 15th follow-up survey of primary liver cancer. Hepatol Res. 28:21–29. 2004. View Article : Google Scholar : PubMed/NCBI
4	Shiina S, Teratani T, Obi S, Hamamura K, Koike Y and Omata M: Percutaneous ethanol injection therapy for liver tumors. Eur J Ultrasound. 13:95–106. 2001. View Article : Google Scholar : PubMed/NCBI
5	Shiina S, Teratani T, Obi S, et al: A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology. 129:122–130. 2005. View Article : Google Scholar : PubMed/NCBI
6	Uehara T, Hirooka M, Ishida K, et al: Percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinoma with artificially induced pleural effusion and ascites. J Gastroenterol. 42:306–311. 2007. View Article : Google Scholar
7	Hirooka M, Iuchi H, Kumagi T, et al: Virtual sonographic radiofrequency ablation of hepatocellular carcinoma visualized on CT but not on conventional sonography. AJR Am J Roentgenol. 186(Suppl 5): S255–S260. 2006. View Article : Google Scholar
8	Takayasu K, Arii S, Ikai I, et al: Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology. 131:461–469. 2006. View Article : Google Scholar : PubMed/NCBI
9	Tateishi R, Shiina S, Teratani T, et al: Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer. 103:1201–1209. 2005.PubMed/NCBI
10	Hiraoka A, Horiike N, Yamashita Y, et al: Efficacy of radiofrequency ablation therapy compared to surgical resection in 164 patients in Japan with single hepatocellular carcinoma smaller than 3 cm, along with report of complications. Hepatogastroenterology. 55:2171–2174. 2008.
11	Kim YS, Rhim H, Cho OK, Koh BH and Kim Y: Intrahepatic recurrence after percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of the pattern and risk factors. Eur J Radiol. 59:432–441. 2006. View Article : Google Scholar
12	Choi D, Lim HK, Rhim H, et al: Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long-term results and prognostic factors in a large single-institution series. Eur Radiol. 17:684–692. 2007. View Article : Google Scholar
13	Hori T, Nagata K, Hasuike S, et al: Risk factors for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation. J Gastroenterol. 38:977–981. 2003. View Article : Google Scholar : PubMed/NCBI
14	Kim SH, Lim HK, Choi D, et al: Percutaneous radiofrequency ablation of hepatocellular carcinoma: effect of histologic grade on therapeutic results. AJR Am J Roentgenol. 186(Suppl 5): S327–S333. 2006. View Article : Google Scholar : PubMed/NCBI
15	Komorizono Y, Oketani M, Sako K, et al: Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session, single application of percutaneous radiofrequency ablation. Cancer. 97:1253–1262. 2003. View Article : Google Scholar
16	Lencioni R, Cioni D, Crocetti L, et al: Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology. 234:961–967. 2005. View Article : Google Scholar : PubMed/NCBI
17	Livraghi T, Meloni F, Di Stasi M, et al: Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology. 47:82–89. 2008. View Article : Google Scholar
18	Nakazawa T, Kokubu S, Shibuya A, et al: Radiofrequency ablation of hepatocellular carcinoma: correlation between local tumor progression after ablation and ablative margin. AJR Am J Roentgenol. 188:480–488. 2007. View Article : Google Scholar
19	Okusaka T, Okada S, Ueno H, et al: Satellite lesions in patients with small hepatocellular carcinoma with reference to clinicopathologic features. Cancer. 95:1931–1937. 2002. View Article : Google Scholar : PubMed/NCBI
20	Sakon M, Nagano H, Nakamori S, et al: Intrahepatic recurrences of hepatocellular carcinoma after hepatectomy: analysis based on tumor hemodynamics. Arch Surg. 137:94–99. 2002. View Article : Google Scholar : PubMed/NCBI
21	Hirooka M, Kisaka Y, Uehara T, et al: Efficacy of laparoscopic radiofrequency ablation for hepatocellular carcinoma compared to percutaneous radiofrequency ablation with artificial ascites. Dig Endosc. 21:82–86. 2009. View Article : Google Scholar
22	Kitao A, Zen Y, Matsui O, Gabata T and Nakanuma Y: Hepatocarcinogenesis: multistep changes of drainage vessels at CT during arterial portography and hepatic arteriography - radiologic-pathologic correlation. Radiology. 252:605–614. 2009. View Article : Google Scholar
23	Kim YS, Lee WJ, Rhim H, Lim HK, Choi D and Lee JY: The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (>2 and <5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. AJR Am J Roentgenol. 195:758–765. 2010.
24	Nakashima Y, Nakashima O, Tanaka M, Okuda K, Nakashima M and Kojiro M: Portal vein invasion and intrahepatic micrometastasis in small hepatocellular carcinoma by gross type. Hepatol Res. 26:142–147. 2003. View Article : Google Scholar : PubMed/NCBI
25	Kudo M: Local ablation therapy for hepatocellular carcinoma: current status and future perspectives. J Gastroenterol. 39:205–214. 2004. View Article : Google Scholar : PubMed/NCBI