Frequency,Risk Factors and Survival Associated with an Intrasubsegmental Recurrence after Radiofrequency Ablation for Hepatocellular Carcinoma |
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| Authors: | Ryosuke Tateishi Shuichiro Shiina Masaaki Akahane Jiro Sato Yuji Kondo Ryota Masuzaki Hayato Nakagawa Yoshinari Asaoka Tadashi Goto Kuni Otomo Masao Omata Haruhiko Yoshida Kazuhiko Koike |
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| Institution: | 1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.; 2. Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.; 3. Yamanashi Prefectural Hospital Organization, Tokyo, Japan.; Icahn School of Medicine at Mount Sinai, United States of America, |
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| Abstract: | BackgroundIn the treatment of hepatocellular carcinoma (HCC), hepatic resection has the advantage over radiofrequency ablation (RFA) in terms of systematic removal of a hepatic segment.MethodsWe enrolled 303 consecutive patients of a single naïve HCC that had been treated by RFA at The University of Tokyo Hospital from 1999 to 2004. Recurrence was categorized as either intra- or extra-subsegmental as according to the Couinaud''s segment of the original nodule. To assess the relationship between the subsegments of the original and recurrent nodules, we calculated the kappa coefficient. We assessed the risk factors for intra- and extra-subsegmental recurrence independently using univariate and multivariate Cox proportional hazard regression. We also assessed the impact of the mode of recurrence on the survival outcome.ResultsDuring the follow-up period, 201 patients in our cohort showed tumor recurrence distributed in a total of 340 subsegments. Recurrence was categorized as exclusively intra-subsegmental, exclusively extra-subsegmental, and simultaneously intra- and extra-subsegmental in 40 (20%), 110 (55%), and 51 (25%) patients, respectively. The kappa coefficient was measured at 0.135 (95% CI, 0.079–0.190; P<0.001). Multivariate analysis revealed that of the tumor size, AFP value and platelet count were all risk factors for both intra- and extra-subsegmental recurrence. Of the patients in whom recurrent HCC was found to be exclusively intra-subsegmental, extra-subsegmental, and simultaneously intra- and extra-subsegmental, 37 (92.5%), 99 (90.8%) and 42 (82.3%), respectively, were treated using RFA. The survival outcomes after recurrence were similar between patients with an exclusively intra- or extra-subsegmental recurrence.ConclusionsThe effectiveness of systematic subsegmentectomy may be limited in the patients with both HCC and chronic liver disease who frequently undergo multi-focal tumor recurrence. |
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