Radiofrequency ablation for recurrent hepatocellular carcinoma: 10-year outcomes of local tumor progression vs intrahepatic distant recurrence.

OBJECTIVES

To compare the long-term outcome of radiofrequency ablation (RFA) for local tumor progression (LTP) vs intrahepatic distant recurrence (IDR) in recurrent hepatocellular carcinoma (rHCC), including cases with repeated LTP.

MATERIALS AND METHODS

From 2010 to 2022, 1326 rHCC patients treated with curative-intent RFA were identified. Propensity score matching (PSM) was used to balance the bias between the LTP group and the IDR group. Overall survival (OS) and progression-free survival (PFS), were compared between groups using log-rank tests and Cox proportional hazards models.

RESULTS

A total of 584 patients were finally enrolled (125 LTPs, 459 IDRs), with a median follow-up of 5.8 years. After PSM, 218 patients (109 patients in each group) were selected. The median OS was comparable between LTP and IDR (70.3 months vs 93.1 months, p = 0.974). However, PFS was significantly worse in the LTP group (13.8 months vs 20.9 months, p = 0.028). LTP incidence was higher in the LTP group (42.2% vs 12.8%, p < 0.001). Multiple recurrences, early recurrence (≤ 1 year), and ≥ 3 LTP episodes were independent risk factors for OS. The median OS decreased with increasing LTP episodes (0: 99.3 months; 1: 86.9 months; 2: 88.9 months; ≥ 3: 44.9 months, p = 0.031).

CONCLUSIONS

RFA demonstrated effective control of LTP in rHCC, with comparable OS but worse PFS compared with IDR, primarily due to the higher risk of LTP. RFA may not be the first choice for those with ≥ 3 LTP episodes.

CRITICAL RELEVANCE STATEMENT

LTP of hepatocellular carcinoma shows higher recurrence than IDR after RFA, requiring close follow-up. Three or more repeat LTPs significantly worsen prognosis, suggesting the need for alternative treatment strategies.

KEY POINTS

Long-term outcomes of RFA for LTP vs IDR of hepatocellular carcinoma remain unclear. LTP has worse PFS; ≥ 3 repeat LTP significantly worsens OS. LTP tends to recur after RFA, requiring close follow-up; ≥ 3 repeat LTPs need alternative local treatment.