J Gastrointestin Liver Dis, December 2018 Vol. 27 No 4: 399-407 1) 3 rd Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 2) Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 3) Department of Pathology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca 4) 2 nd Pediatric Clinic, Children’s Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 5) Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 6) 3 rd Surgical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania Address for correspondence: Dr. Tudor Mocan Institute of Gastroenterology and Hepatology, Croitorilor Str.19-21, 400162 Cluj-Napoca Romania mocan_tudor@yahoo.com Received: 03.07.2018 Accepted: 26.11.2018 Prognostic Factors afer Percutaneous Radiofrequency Ablation in the Treatment of Hepatocellular Carcinoma. Impact of Incomplete Ablation on Recurrence and Overall Survival Rates Zeno Sparchez 1,2 , Tudor Mocan 1,2 , Pompilia Radu 2 , Lavinia Patricia Mocan 3 , Mihaela Sparchez 4 , Daniel Corneliu Leucuta 5 , Nadim Al Hajjar 2,6 INTRODUCTION Hepatocellular carcinoma (HCC) is a common malignancy worldwide, with its incidence increasing due to the dissemination of hepatitis B and C virus infection [1]. Cirrhotic patients in particular, have the highest risk of developing HCC. According to the European Association for the Study of Liver diseases (EASL), they should be monitored every 6 months with ultrasound. Surveillance can lead to the diagnosis of HCC at early stages, when the tumor may be treated with a curative intent. ABSTRACT Aims: To report on the long-term impact of tumor and non-tumor related parameters on local recurrence, distant recurrence and survival in patients with naïve or recurrent type hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA). Methods: We performed 240 RFA sessions on 133 patients with 156 HCC nodules developed on a background of liver cirrhosis and analyzed the outcomes. Results: Contrast-enhanced ultrasound performed one month afer RFA showed complete ablation in 119 out of 133 (89.65%) patients. With a median follow-up of 46 months, 3-, 5- and 7-year survival rates were 61.7%, 35.7%, and 22.6%, respectively. Previous ethanol injection and histological grade were signifcantly related to local tumor progression. Child-Pugh class, incomplete ablation, histological grade, previous ethanol injection, alpha-fetoprotein level before the treatment, and local recurrence were all signifcantly related to distant recurrence. Multivariate analysis demonstrated that age, Child-Pugh class, distant recurrence and multiple incomplete ablations were signifcantly related to survival. Conclusion: Radiofrequency ablation could be locally curative for HCC, resulting in a survival longer than 7 years. Previous ethanol injection and incomplete ablations were strongly associated with poor outcomes. Key words: hepatocellular carcinoma - radiofrequency ablation - recurrences - incomplete ablation. Abbreviations: AFP: alpha fetoprotein; APF: arterio-portal fstula; BCLC: Barcelona clinic liver cancer; CEUS: contrast enhanced ultrasound; CT: computer tomography; HCC: hepatocellular carcinoma; HCV: hepatitis C virus; LTP: local tumor progression; MRI: magnetic resonance imaging; MWA: microwave ablation; OLT: orthotopic liver transplantation, PAT: percutaneous ablation therapy; PEI: percutaneous ethanol injection; RFA: radiofrequency ablation; TACE: transarterial chemoembolization; US: ultrasound. DOI: http://dx.doi.org/10.15403/jgld.2014.1121.274.pro Among the curative treatment modalities, surgical resection, liver transplantation, or percutaneous ablation therapies (PATs) have all proven their efcacy [2]. Unfortunately, only 20% of HCC patients are candidates for surgical resection and the reported rate of recurrence is high even afer curative resection [3]. By far, the best treatment modality is liver transplantation. However, the waiting time for orthotopic liver transplantation (OLT) is more than 1 year in Europe [4]. Among various PATs, radiofrequency ablation (RFA) is currently the most used [5, 6]. However, in developing countries percutaneous ethanol injection (PEI) was extensively used even afer RFA was widely available, especially in lesions smaller than 2 cm [7, 8]. Until now, several studies that have evaluated tumor or non-tumor related parameters as prognostic factors for local or distant recurrence are controversial [9–11]. Anyway, there is scarce data about tumor or non-tumor related parameters as prognostic factors for long- term survival [12]. Afer gaining more and more experience ORIGINAL PAPER