| ObjectiveTo observe and analyze the outcomes and complications of ultrasound-guided percutaneous radiofrequency ablation (RFA) applied to hepatocellular carcinoma (HCC) located in high-risk sites, to assess the safety and efficacy of RFA treatment for liver cancer in high-risk sites, and to explore strategies to improve the effects of HCC in high-risk locations treated by RFA.MethodsDuring June 2009 and June 2014,301 patients, who were diagnosed as hepatocellular carcinoma by surgery or biopsy,were performed percutaneous RFA with single internally cooled electrodes. Based on imaging studies 98 patients with lesions abutting extrahepatic organs (such as the gastrointestinal tract), primary or secondary vessels, bile ducts, the inferior vena cava or hepatic vein, the gallbladder wall(<5mm), liver surface(<lcm),diaphragm, pericardium were defined as high-risk group,and the remaining 203 patients with tumors located in other parts of the liver were low-risk group as control. There were no significant difference between the two groups in patient’s gender, age, preoperative AFP level, HBV-DNA load, liver function, tumor stage,size and number.In high-risk group,65 patients, according to the tumor location,were treated with combined RFA and TACE, PEI, artificial pleural effusion,artificial ascites,or assisted laparoscopic RFA. After a month, complete or partial ablation was examined by contrast-enhanced ultrasound, enhanced CT or MRI. Complications were observed with Clavien-Dindo classification method.All cases were followed up for 3-63 Month postoperatively. The chi-square test was used to compare morbidity and complete ablation (CA)rate. Overall survival(OS) and progression-free survival(PFS) were analyzed by Kaplan-Meier method, and compared with the Log-Rank test.ResultsA total os 412 nodules (135 in high-risk group,277 in low-risk group) were treated with percutaneous ultrasound-guided RFA. The overall complication rate was 23.3%(23.5% vs 23.2%).According to Clavien-Dindo classification of surgical complications, complications in grade Ⅰ-Ⅱ(medication available) in two groups were 17.3% and 20.7%,in grade Ⅲ/Ⅵ (invasive methods required,such as surgical, interventional,telescopic techniques) were 5.1% and 2.5%. One case V grade complications (lead to death) occurred in high-risk group.The overall mortality was 0.3%. There were no statistical difference in complication morbidity and mortality.Postoperatively,the overall CA rate was 93%(280 cases in 301).The complete ablation rate of high-risk group was significantly lower than low-risk group (88.8%vs 95.1%, P<0.05). However,the CA rate of the 67 patients in high-risk group underwent combined RFA therapy, was 92.5%.There were no significant difference (P> 0.05) compared to low-risk group.The cumulative 1-,3-and 5-year OS rate of high-risk group was significantly lower than low-risk group(92.1%、58.2%、23.6 vs 96.3%、 73.4%、34.7%,P<0.05).The cumulative 1-,3-and 5-year PFS rate of high-risk group was also significantly lower than low-risk group(61.8%、48.2%、 29.7%vs82.2%、65.2%、36.8%,P<0.05).However 1-,3-and 5-year OS rate and PFS rate of patients treated with combined RFA therapy were 93.4%,65.6%, 37.5% and 72.9%,66.8%,35.5%,respectively, which was no significant difference (P> 0.05) compared to low-risk groups.Conclusions1. Percutaneous RFA for HCC in high-risk sites is a safe procedure without major complications complication rate similar to security implementation.2. Percutaneous RFA for HCC in high-risk sites is less effective in terms of local tumor control and long-term survival. It still needs to be further explored and improved.3.According to the exact location of the tumor, RFA combined with PEI, TACE, artificial pleural effusion, artificial ascites, laparoscopic approach may increase the complete ablation rate and prolong long-term survival of HCC in high-risk sites. |
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