Factors Predicting Complete Destruction (CD), Local Tumor Progression (LTP) and Survival after Percutaneous Ablation of Hepatocellular Carcinoma (HCC)

  • Dr Jordan Genov, Clinic of Gastroenterology, University Hospital, Bulgaria
  • Prof Nikola Grigorov, Clinic of Gastroenterology, University Hospital, Bulgaria
  • Dr Rumiana Mitova, Clinic of Gastroenterology, University Hospital, Bulgaria
  • Dr Branimir Golemanov, Clinic of Gastroenterology, University Hospital, Bulgaria
  • Prof Ljudmil Dinkov, Clinic of Gastroenterology, University Hospital, Bulgaria
  • Dr Marin Donov, Clinic of Gastroenterology, University Hospital, Bulgaria

    • Aim: To research on the factors influencing CD, LTP, and survival after ultrasound-guided ablation in patients with HCC.
    Methods: 63 patients (78 HCC, size 1.7-15.0cm) were treated with monopolar RFA, 21 patients (29 HCC, size 2.0-15.0) - with multipolar RFA, and 46 patients (48 HCC, size 3.5-14.5) - with single-session large-volume ethanol injection (Shot-PEI) in a 9-year period. The achieved destruction was assessed using contrast-enhanced CT/US and biopsy. Patients were followed-up for 1-72 months.
    Results: CD was achieved in 67.9% of the lesions after monopolar RFA, in 65.5% after multipolar RFA and in 43.8% after Shot-PEI, depending on the tumor size, location and applied amount of radiofrequency energy. Major complications (MC) were 4.8% after RFA and 13.04% after Shot-PEI. LTP rate per lesion was 17% after monopolar RFA, 10.5% after multipolar RFA, and 42.9% after Shot-PEI, depending on the size and applied RF energy. The achievement of CD of all lesions per patient depended on the size of the largest lesion and BCLC stage, but not on the sex, age, viral infection, Child-Pugh-score and number of lesions. The probability and time to LTP per patient depended only on the size of the largest lesion. Median survival was 58.3 months (95% CI 52.1-64.4). Cumulative 36-month survival was 79%. Factors influencing survival were Child-Pugh-score and completed destruction of all lesions.
    Conclusion: RFA accomplishes local control better than Shot-PEI, with fewer MC. The effectiveness of percutaneous ablation depends on the BCLC stage. Completed destruction of all lesions and Child-Pugh score determine survival.