Differences in Patient Characteristics and Midterm Outcome Between Asian and European Patients Treated with Radiofrequency Ablation for Hepatocellular Carcinoma

• Published in: Cardiovascular and interventional radiology Vol. 39; no. 12; pp. 1708 - 1715
• Main Authors: Burgmans, Mark Christiaan, Too, Chow Wei, Fiocco, Marta, Kerbert, Annarein J. C., Lo, Richard Hoau Gong, Schaapman, Jelte J., van Erkel, Arian R., Coenraad, Minneke J., Tan, Bien Soo
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2016; Springer Nature B.V
• Subjects: ABLATION; Age Factors; Aged; Asian Continental Ancestry Group - statistics & numerical data; Carcinoma, Hepatocellular - epidemiology; Carcinoma, Hepatocellular - surgery; Cardiology; Catheter Ablation - methods; Causality; Clinical Investigation; Comorbidity; COMPARATIVE EVALUATIONS; DEATH; ETIOLOGY; European Continental Ancestry Group - statistics & numerical data; Female; Follow-Up Studies; HAZARDS; HEPATITIS; Hepatitis B - epidemiology; Hepatitis B virus; HEPATOMAS; Humans; Imaging; Incidence; Liver Cirrhosis, Alcoholic - epidemiology; Liver Neoplasms - epidemiology; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - epidemiology; NETHERLANDS; Nuclear Medicine; PATIENTS; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOWAVE RADIATION; Retrospective Studies; SINGAPORE; Treatment Outcome; Ultrasound; Radiofrequency ablation; Recurrence; Hepatocellular carcinoma; European; Asian; Survival
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-016-1462-7

Purpose
The aim of this study was to compare patient characteristics and midterm outcomes after RFA for unresectable Hepatocellular carcinoma (HCC) in Asian and European cohorts.
Materials and Methods
The study was based on retrospective analysis of 279 patients (mean 64.8 ± 12.1 years; 208 males) treated with RFA for de novo HCC in tertiary referral centers in Singapore and the Netherlands, with median follow-up of 28.2 months (quartiles: 13.1–40.5 months). Cumulative incidence of recurrence and death were analyzed using a competing risk model.
Results
Age was higher in the Asian group: 66.5 versus 60.1 years (
p
 < 0.0001). The most common etiology was hepatitis B in the Asian group (48.0 %) and alcohol-induced cirrhosis in Europeans (54.4 %);
p
 < 0.001. Asian patients had less advanced disease: 35.5, 55.0, and 3.0 %, respectively, had BCLC 0, A, and B versus 21.5, 58.2, and 15.2 % in the European group (
p
 = 0.01). The cumulative incidences of recurrence in the Asian group at 1, 2, 3, and 5 years were 37.0, 56.4, 62.3, and 67.7 %, respectively, compared to 32.6, 47.2, 49.7, and 53.4 % in the European group (
p
 = 0.474). At 1, 2, 3, and 5 years, the cumulative incidence rates of death in the Asian group were 2.0, 3.9, 4.9, and 4.9 %, respectively, corresponding to 7.7, 9.2, 14.1, and 21.0 % in the European group (
p
 = 0.155).
Conclusion
Similar short-term treatment outcomes are achieved with RFA in HCC patients in the South-East Asian and Northern-European populations. Midterm recurrence and death rates differ between the groups as a result of differences in baseline patient characteristics and patient selection. Our study provides insight relevant to the design of future international studies.