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Intrahepatic distant recurrence after radiofrequency ablation for a single small hepatocellular carcinoma: Risk factors and patterns

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Abstract

Background. The pathogenesis of frequent intrahepatic recurrence of hepatocellular carcinoma (HCC) after surgical resection or local ablation therapy remains uncertain. Risks and patterns of intrahepatic distant recurrence (IDR) of a single, primary HCC lesion after radiofrequency (RF) ablation were examined. Methods. Ninety patients with a single primary HCC lesion of less than 3 cm who had complete RF ablation were enrolled in the study. Risk factors for IDR and the patterns of IDR after RF ablation were analyzed. Results. The median follow-up was 37.4 months. IDR was observed in 44 (48.9%) patients. The cumulative rate of IDR was 10.4%, 52.5%, and 77.0% at 1, 3, and 5 years, respectively. Univariate analysis revealed that a pretreatment serum α-fetoprotein (AFP) level of ≥50 ng/ml (P = 0.0324), a des-γ-carboxy prothrombin (DCP) level of ≥40 mAu/ml (P = 0.006), an ablative margin of <5 mm of the ablation zone (P = 0.0306), and a prothrombin time of <70% (P = 0.0188) were related to IDR. A multivariate stepwise Cox proportional hazards regression model revealed that pretreatment serum AFP and DCP level and the ablative margin were independent risk factors for IDR pretreatment. Serum DCP level ≥ 40 mAu/ml (P = 0.025), local tumor progression (P = 0.011), and ablative margin < 5 mm (P = 0.024) were related to multiple IDR. Conclusions. HCC patients with high serum AFP or DCP before RF ablation should be carefully followed up to monitor any IDR. A suffi cient ablative margin in RF ablation for HCC is required to prevent IDR.

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Authors and Affiliations

  1. Department of Gastroenterology, Kitasato University East Hospital, 2-1-1 Asamizodai, Sagamihara, 228-8520, Japan

    Yusuke Okuwaki, Takahide Nakazawa, Akitaka Shibuya, Koji Ono, Hisashi Hidaka & Katsunori Saigenji

  2. Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo, Japan

    Shigehiro Kokubu

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  1. Yusuke Okuwaki
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  2. Takahide Nakazawa
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  3. Akitaka Shibuya
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  4. Koji Ono
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  5. Hisashi Hidaka
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  6. Masaaki Watanabe
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  7. Shigehiro Kokubu
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  8. Katsunori Saigenji
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Okuwaki, Y., Nakazawa, T., Shibuya, A. et al. Intrahepatic distant recurrence after radiofrequency ablation for a single small hepatocellular carcinoma: Risk factors and patterns. J Gastroenterol 43, 71–78 (2008). https://doi.org/10.1007/s00535-007-2123-z

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  • DOI: https://doi.org/10.1007/s00535-007-2123-z

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