Korean Journal of Radiology

  • 제22권12호
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  • Pages.1974-1984
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  • 2021
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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No-Touch vs. Conventional Radiofrequency Ablation Using Twin Internally Cooled Wet Electrodes for Small Hepatocellular Carcinomas: A Randomized Prospective Comparative Study

  • Yun Seok Suh (Department of Radiology, Seoul National University Hospital) ;
  • Jae Won Choi (Department of Radiology, Seoul National University Hospital) ;
  • Jeong Hee Yoon (Department of Radiology, Seoul National University Hospital) ;
  • Dong Ho Lee (Department of Radiology, Seoul National University Hospital) ;
  • Yoon Jun Kim (Department of Internal Medicine, Seoul National University Hospital) ;
  • Jeong Hoon Lee (Department of Internal Medicine, Seoul National University Hospital) ;
  • Su Jong Yu (Department of Internal Medicine, Seoul National University Hospital) ;
  • Eun Ju Cho (Department of Internal Medicine, Seoul National University Hospital) ;
  • Jung Hwan Yoon (Department of Internal Medicine, Seoul National University Hospital) ;
  • Jeong Min Lee (Department of Radiology, Seoul National University Hospital)
  • 투고 : 2021.01.29
  • 심사 : 2021.07.13
  • 발행 : 2021.12.01
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초록

Objective: This study aimed to compare the efficacy between no-touch (NT) radiofrequency ablation (RFA) and conventional RFA using twin internally cooled wet (TICW) electrodes in the bipolar mode for the treatment of small hepatocellular carcinomas (HCC). Materials and Methods: In this single-center, two-arm, parallel-group, prospective randomized controlled study, we performed a 1:1 random allocation of eligible patients with HCCs to receive NT-RFA or conventional RFA between October 2016 and September 2018. The primary endpoint was the cumulative local tumor progression (LTP) rate after RFA. Secondary endpoints included technical conversion rates of NT-RFA, intrahepatic distance recurrence, extrahepatic metastasis, technical parameters, technical efficacy, and rates of complications. Cumulative LTP rates were analyzed using Kaplan-Meier analysis and the Cox proportional hazard regression model. Considering conversion cases from NT-RFA to conventional RFA, intention-to-treat and as-treated analyses were performed. Results: Enrolled patients were randomly assigned to the NT-RFA group (37 patients with 38 HCCs) or the conventional RFA group (36 patients with 38 HCCs). Among the NT-RFA group patients, conversion to conventional RFA occurred in four patients (10.8%, 4/37). According to intention-to-treat analysis, both 1- and 3-year cumulative LTP rates were 5.6%, in the NT-RFA group, and they were 11.8% and 21.3%, respectively, in the conventional RFA group (p = 0.073, log-rank). In the as-treated analysis, LTP rates at 1 year and 3 years were 0% and 0%, respectively, in the NT-RFA group sand 15.6% and 24.5%, respectively, in the conventional RFA group (p = 0.004, log-rank). In as-treated analysis using multivariable Cox regression analysis, RFA type was the only significant predictive factor for LTP (hazard ratio = 0.061 with conventional RFA as the reference, 95% confidence interval = 0.000-0.497; p = 0.004). There were no significant differences in the procedure characteristics between the two groups. No procedure-related deaths or major complications were observed. Conclusion: NT-RFA using TICW electrodes in bipolar mode demonstrated significantly lower cumulative LTP rates than conventional RFA for small HCCs, which warrants a larger study for further confirmation.

키워드

과제정보

We thank Chris Woo, BA for his English editing.

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