Abstract: Objective:To investigate the clinical effect and prognostic factors of intraoperative radiofrequency ablation (RFA) in treatment of hepatocellular carcinoma (HCC) with severe cirrhosis.
Methods:The retrospective casecontrol study was conducted. The clinicopathological data of 188 HCC patients with severe cirrhosis who were admitted to the Zhongshan Hospital of Fudan University between January 2009 and December 2013 were collected. According to intraoperative exploration, tumor condition and liver cirrhosis situations, partial hepatectomy combined with intraoperative RFA or single RFA was selected. Observation indicators: (1) operation situations: operation time, volume of intraoperative blood loss, blood transfusion, hepatic inflow occlusion, number of tumors of surgical resection and number of tumors removed by RFA; (2) postoperative recovery situations: postoperative complications and duration of postoperative hospital stay; (3) followup; (4) factors analysis affecting tumorfree survival. Followup using outpatient examination and telephone interview was performed to detect tumor damage and survival of patients up to March 2016. Measurement data with normal distribution were represented as ±s. The survival rate was calculated by the KaplanMeier method. The univariate analysis was done by the the Logrank test, and multivariate analysis was done using the COX regression model.
Results: (1) Operation situations: all the 188 HCC patients underwent successful operations, including 74 undergoing partial hepatectomy with intraoperative RFA and 114 undergoing single RFA. Of 188 patients, 11 were combined with cholecystectomy, 6 with right adrenalectomy and 1 with subtotal gastrectomy, without perioperative death. Operation time and volume of intraoperative blood loss in 188 patients were (2.3±1.4)hours and (64±4)mL，without blood transfusion and hepatic inflow occlusion. Numbers of patients with 1 tumor of surgical resection and with 2 tumors of surgical resection and total number of tumors of surgical resection were 61, 13, 87 in 74 patients undergoing partial hepatectomy with intraoperative RFA. Numbers of patients with 1, 2, 3 and 4 tumors removed by RFA and total number of tumors of RFA were 123, 58, 6, 1 and 261 in 114 patients undergoing single RFA. (2) Postoperative recovery situations: of 188 patients, 19 with severe complications were improved by symptomatic treatments, including 7 with massive pleural effusion, 5 with massive intraabdominal effusion, 3 with intraabdominal bleeding, 3 with severe local infection and 1 with massive pleural and intraabdominal effusion. Duration of postoperative hospital stay was (7.61±0.20)days. (3) Followup: 182 of 188 patients were followed up for 21-85 months, with a median time of 41 months. Patients received enhanced rescans of magnetic resonance imaging (MRI) at 1 month postoperatively, 174 had complete tumor damage, with a tumor damage rate of 92.55%(174/188). During the followup, 46 patients died. The overall median survival time, 1, 2, 3year overall survival rates, median tumorfree survival time and 1, 2, 3year tumorfree survival rates were 38 months, 99%, 96%, 86%, 31 months, 92%, 77% and 41%, respectively. (4) Factors analysis affecting tumorfree survival: results of univariate analysis showed that preoperative alphafetoprotein (AFP), number of tumors and surgical procedures were relative factors affecting tumorfree survival of HCC patients with severe cirrhosis (χ2=5.623, 4.744, 7.293, P<0.05). Results of multivariate analysis showed that preoperative AFP >20 μg/L and partial hepatectomy with intraoperative RFA were independent risk factors affecting tumorfree survival of HCC patients with severe cirrhosis after open RFA (RR=1.523, 1.615, 95% confidence interval: 1.056-2.198, 1.006-2.594, P<0.05).
Conclusions:Intraoperative RFA is safe and feasible in treatment of HCC with severe cirrhosis, with advantages of less postoperative complications and rapid recovery, and it can provide better longterm survival for patients. Preoperative AFP＞20 μg/L and partial hepatectomy with intraoperative RFA are independent risk factors affecting tumorfree survival of HCC patients with severe cirrhosis after open RFA.