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Percutaneous Radiofrequency Ablation of Hepatocellular Carcinoma: Effect of Histologic Grade on Therapeutic Results

Seong Hyun Kim1, Hyo K. Lim1, Dongil Choi1, Won Jae Lee1, Seung Hoon Kim1, Min Ju Kim1, Chan Kyo Kim1, Yong Hwan Jeon1, Jong Mee Lee1 and Hyunchul Rhim1

1 All authors: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, South Korea.


Figure 1
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  		Fig. 1A —54-year-old man with Edmondson-Steiner grade I hepatocellular carcinoma (HCC) who had local tumor progression after radiofrequency ablation. Contrast-enhanced CT scan obtained during arterial phase before radiofrequency ablation shows 2.7-cm HCC (arrows) in liver segment VI.

 

Figure 2
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  		Fig. 1B —54-year-old man with Edmondson-Steiner grade I hepatocellular carcinoma (HCC) who had local tumor progression after radiofrequency ablation. Contrast-enhanced CT scan obtained during arterial phase 5 months after radiofrequency ablation shows no evidence of local tumor progression in radiofrequency ablation zone (arrows), with atrophy of hepatic parenchyma distal to ablation zone.

 

Figure 3
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  		Fig. 1C —54-year-old man with Edmondson-Steiner grade I hepatocellular carcinoma (HCC) who had local tumor progression after radiofrequency ablation. Contrast-enhanced CT scan obtained during arterial phase 7 months after radiofrequency ablation shows local tumor progression (arrows) in peripheral margin of radiofrequency ablation zone (asterisk).

 

Figure 4
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  		Fig. 2A —46-year-old-woman with Edmondson-Steiner grade II hepatocellular carcinoma (HCC) who had delayed local tumor progression after radiofrequency ablation. Contrast-enhanced CT scan obtained during arterial phase 3 months after radiofrequency ablation for 2.5-cm HCC in liver segment VII shows radiofrequency ablation zone (arrows) with no local tumor progression.

 

Figure 5
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  		Fig. 2B —46-year-old-woman with Edmondson-Steiner grade II hepatocellular carcinoma (HCC) who had delayed local tumor progression after radiofrequency ablation. Contrast-enhanced CT scan obtained during arterial phase 19 months after radiofrequency ablation shows decrease in size of radiofrequency ablation zone (arrows) with no local tumor progression.

 

Figure 6
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  		Fig. 2C —46-year-old-woman with Edmondson-Steiner grade II hepatocellular carcinoma (HCC) who had delayed local tumor progression after radiofrequency ablation. Contrast-enhanced CT scan obtained during arterial phase 26 months after radiofrequency ablation shows local tumor progression (arrow) in margin of radiofrequency ablation zone (asterisk).

 

Figure 7
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  		Fig. 3A —45-year-old-man with Edmondson-Steiner grade III hepatocellular carcinoma (HCC) who had delayed local tumor progression after radiofrequency ablation. Contrast-enhanced CT scan obtained during arterial phase before radiofrequency ablation shows 3.2-cm HCC tumor (arrows) in liver segment II.

 

Figure 8
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  		Fig. 3B —45-year-old-man with Edmondson-Steiner grade III hepatocellular carcinoma (HCC) who had delayed local tumor progression after radiofrequency ablation. Contrast-enhanced CT scan obtained during arterial phase 23 months after radiofrequency ablation shows small, enhancing nodule (arrow) in margin of radiofrequency ablation zone (asterisk), with substantial decrease in size of zone.

 

Figure 9
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  		Fig. 3C —45-year-old-man with Edmondson-Steiner grade III hepatocellular carcinoma (HCC) who had delayed local tumor progression after radiofrequency ablation. Contrast-enhanced CT scan obtained during arterial phase 26 months after radiofrequency ablation shows growth of enhancing nodule (arrow) and new enhancing nodule (arrowhead) in margin of radiofrequency ablation zone (asterisk).

 

Figure 10
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  		Fig. 4 —Curves indicate cumulative survival in three groups with different histologic grades after radiofrequency ablation. Cumulative survival rates at 1, 3, and 5 years were 97%, 79%, and 71%, respectively, for group 1; 92%, 56%, and 44%, respectively, for group 2; and 100%, 57%, and 43%, respectively, for group 3. Three- and 5-year cumulative survival rates in group 1 were higher than those of groups with higher histologic grades, but no statistically significant difference was found for cumulative survival rates between groups (p > 0.05). Number of patients followed up at 1, 3, and 5 years was 35, 14, and one, respectively, in group 1; 46, 23, and seven, respectively, in group 2; and seven, four, and two, respectively in group 3.

 

Figure 11
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  		Fig. 5 —Curves indicate cancer-free survival in three groups with different histologic grades after radiofrequency ablation. Cancer-free survival rates at 1, 2, 3, and 4 years were 74%, 44%, 39%, and 39%, respectively, for group 1; 53%, 23%, 13%, and 10%, respectively, for group 2; and 57%, 29%, 14%, and 0%, respectively, for group 3. Four-year cancer-free survival rate showed a trend to decrease with increasing histologic grade of hepatocellular carcinoma (p < 0.05 for groups 1 vs 2; p > 0.05 for groups 1 vs 3 and groups 2 vs 3 by Bonferroni correction). Number of patients followed up at 1, 2, 3, and 4 years was 25, 10, four, and two, respectively, in group 1; 24, seven, four, and two, respectively, in group 2; and four, two, one, and one, respectively, in group 3.

 

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