Influence Factors Of Treatment Outcomes After Percutaneous Radiofrequency Ablation Of Hepatocellular Carcinoma Adja Cent To The Second Hepatic Portal

Objective:To compare the efficacy and complications of ultrasound-guided percutaneous radiofrequency ablation(RFA)in the treatment of hepatocellular carcinoma(HCC)in the second hepatic portal region with those in the non-second hepatic portal,and to explore the risk factors that lead to the failure of percutaneous RFA in the treatment of HCC in the second hepatic portal region and affect the local tumor progression and disease-free survival of patients.Materials and methods:From January 2010 to December 2018,the data of patients with HCC treated by ultrasound-guided percutaneous RFA were collected and analyzed retrospectively.A total of 86 patients with HCC in the second hepatic portal region were included,and86 patients with HCC in the non-second hepatic portal region were randomly selected and matched according to the anatomical location of tumor.The technical success rate,primary technical efficacy rate and complications of radiofrequency ablation were evaluated.Kaplan-Meier analysis was used to estimate the cumulative local tumor progression rate,disease-free survival time and overall survival time of the two groups,and Log-rank test was used to compare the two groups.The best cut-off values of the distance from the edge of the second hepatic portal tumor to the inferior vena cava,technical failure,tumor diameter,local tumor progress and disease-free survival time were determined by the most approximate index in the ROC curve test.Logistic regression analysis was used to evaluate the risk factors leading to technical failure,and Cox regression analysis was used to evaluate the risk factors affecting local tumor progression and disease-free survival time.Results:The technical success rate of the two groups was 91.9% vs.94.2%;P=0.549)and the primary technical efficacy rate(100% vs.97.7%;P=0.477).The cumulative local tumor progression rates in 1-,3-and 5-years in two groups were(11.7%,25.6%,40.4% vs.10.6%,22.0%,36.9%;P=0.761).The 1-,3-,and 5-year disease-free survival times of the two groups were(84.9%,56.1%,7.7% vs.86.0%,50.4%,10.3%;P=0.739).The distance between tumor margin and inferior vena cava([OR],0.577;P=0.011)is an independent risk factor for technical failure of HCC patients in the second hilar region.Tumor diameter([HR],3.596;P<0.001)is an independent risk factor affecting local tumor progression of HCC patients in the second hepatic portal region.Tumor diameter([HR],2.343;P< 0.001),tumor number([HR],2.370;P=0.016)and tumor type([HR],3.957;P<0.001)is an independent risk factor affecting the disease-free survival of HCC patients in the second hepatic portal region.Conclusion:Ultrasound-guided percutaneous RFA is a safe and effective treatment for HCC in the second hepatic portal region.However,the appropriate distance(> 0.5cm)from tumor edge to inferior vena cava should be carefully considered when making ablation plan to avoid technical failure.Patients with appropriate tumor diameter(≤2.5cm)should be selected for ablation to achieve better local tumor control effect.When the oncology features are > 2.5cm in diameter,multiple or recurrent,we should actively strengthen the frequency of reexamination to monitor the risk of high recurrence possibility,and take early intervention measures to prolong the disease-free survival time of HCC patients.