Published online May 7, 2015. doi: 10.3748/wjg.v21.i17.5287
Peer-review started: October 30, 2014
First decision: November 26, 2014
Revised: December 9, 2014
Accepted: January 30, 2015
Article in press: January 30, 2015
Published online: May 7, 2015
Processing time: 195 Days and 10.6 Hours
AIM: To evaluate long-term outcomes of radiofrequency (RF) ablation as first-line therapy for single hepatocellular carcinoma (HCC) ≤ 3 cm and to determine survival and prognostic factors.
METHODS: We included all 184 patients who underwent RF ablation as a first-line treatment for single HCC ≤ 3 cm between April 2005 and December 2013. According to the criteria of Livraghi, the 184 patients were divided into two groups: those suitable for surgical resection (84 cases) and those unsuitable for surgical resection (100 cases). The primary endpoints were the overall survival (OS) rate and safety; the secondary endpoints were primary technique effectiveness and recurrence rate.
RESULTS: There were 19 (10.3%) cases of ablation related minor complications. The complete tumor ablation rate after one RF session was 97.8% (180/184). The rate of local tumor progression, extrahepatic metastases and intrahepatic distant recurrence were 4.9% (9/184), 9.8% (18/184) and 37.5% (69/184), respectively. In the 184 patients, the 1-, 3-, and 5-year OS rates were 99.5%, 81.0%, and 62.5%, respectively. The 1-, 3-, and 5-year OS rates were 100%, 86.9%, and 71.4%, respectively, in those suitable for surgical resection and 99.0%, 76.0%, and 55.0%, respectively, in those unsuitable for surgical resection (P = 0.021). On univariate and multivariate analyses, poorer OS was associated with Child-Pugh B class and portal hypertension (P < 0.05).
CONCLUSION: RF ablation is a safe and effective treatment for single HCC ≤ 3 cm. The OS rate of patients suitable for surgical resection was similar to those reported in surgical series.
Core tip: The argument against the role of radiofrequency (RF) ablation as a first treatment option for patients with small hepatocellular carcinoma (HCC) is represented by the lack of adequate evidence proving that its effectiveness is comparable to that of surgical resection (SR). The study provides evidence that RF ablation is a safe and effective first-line treatment for single HCC 3 cm or less, even when SR is possible. Furthermore, we also induced the systemic technical measures to promote the efficacy of RF ablation for HCC from the surgeon’s perspective.