Multiple-Electrode Switching-Based Radiofrequency Ablation vs. Conventional Radiofrequency Ablation for Single Early-Stage Hepatocellular Carcinoma Ranging From 2 to 5 Cm

Purpose: To retrospectively compare the treatment outcome of multiple-electrode switching-based radiofrequency ablation (switching RFA) and the conventional RFA for early-stage hepatocellular carcinoma (HCC). Methods: A total of 122 patients with single early-stage HCC ranging from 2.1 to 5.0 cm received ultrasonography-guided percutaneous RFA as the first-line treatment. Seventy-one patients underwent switching RFA, and 51 underwent conventional RFA. Tumor response, major complication, local tumor progression (LTP), and overall survival (OS) were compared between the two groups. Log-rank tests and Cox regression models were used for univariate and multivariate analyses to identify predictors of LTP and OS. Results: The rate of initial local complete response rates were 100% (71/71) in the switching RFA group and 98.0% (50/51) in the conventional RFA group (P > 0.05). No major complication occurred in the switching RFA group, whereas two in the conventional RFA group. After a median follow-up period of 45.9 months (range, 9.8–60.0 months), the rates of LTP in the switching RFA and conventional RFA groups were 19.7% (14/71) and 41.2% (21/51), respectively. The cumulative LTP rates at 1, 3, and 5 years were 11.3, 20.5, and 20.5% for switching RFA and 17.6, 38.7, and 46.7% for conventional RFA, respectively (p < 0.001). Switching RFA was an independent factor associated with a lower LTP rate (p = 0.022). Five-year OS rates were 75.8% after switching RFA vs. 66.2% after conventional RFA (p = 0.363). Extrahepatic recurrence was a significant prognostic factor for OS in multivariable analysis. Conclusion: Compared with conventional RFA, switching RFA provides a high local tumor control for single early-stage HCC. An ongoing randomized trial might help to clarify the role of this approach for the treatment of HCC.