Page 32 - Read Online

RFA therapy is now widely indicated in patients with small etiological background of liver disease was HCV infection for
HCC in which the survival rates were similar to surgical all patients as other etiology of liver disease were excluded
[5]
resection. [6] from this study. Exclusion criteria for our study were as
following: maximum diameter of HCC > 4 cm, number of
Hepatocellular carcinoma has a high rate of recurrence HCC nodules > 3, previous history of treatment of HCC,
after curative resection or local ablation therapy, reaching follow-up observation for less than 6 months after RFA
approximately 80% within 5 years. [7-9] The recurrence of HCC therapy and cirrhotic patient by other than CHC.
and patient survival are associated with the number of HCC
nodules and their sizes. [10,11] Hepatic reserve function at the All patients were divided according to glycemic state to
time of HCC therapy is another factor that is associated the following three groups: Group I included 37 controlled
with the recurrence of HCC and patient survival. Antiviral type 2 diabetic patients, with adequate maintenance of
[12]
therapy targeting HCV [13,14] or HBV has been shown to blood glucose, with 52 HCC nodules; Group II included
[15]
decrease HCC recurrence, and improve hepatic reserve 25 uncontrolled type 2 diabetic patients with inadequate
function and survival. maintenance of blood glucose, with 43 HCC nodules; and
Group III included 45 euglycemic patients with 64 HCC
There is a strong association between diabetes mellitus and nodules. The Child-Pugh classification grade was either
increased cancer risk in liver, the key organ involved in the A (n = 50) or B (n = 57). The number of HCC nodules was
metabolic derangements typical of diabetes. Metabolic 1 in 61 patients, 2 in 40 patients, and 3 in 6 patients. The
[16]
factors, such as obesity and diabetes, are closely linked to maximum diameter of HCC nodules was 3.11 ± 0.53 cm.
the etiology of nonalcoholic steatohepatitis, which is also
considered a cause of HCC. If these metabolic factors are Inadequate maintenance of blood glucose was defined as
[17]
related to the recurrence of HCC, therapeutic intervention an average value of casual blood glucose ≥ 200 mg/dL. The
targeting these factors may lead to prevention of frequent level of hemoglobin A1c (HbA1c) was not used in the present
recurrence of HCC and improved patient survival. study because the lifespan of erythrocytes is shortened due to
hypersplenism in patients with chronic hepatitis or cirrhosis,
The impact of diabetes on the recurrence of HCC, after leading to lower HbA1c levels relative to the blood glucose
treatment, has been discussed, but with conflicting results. [18-21] level. Diagnosis of type 2 diabetes was made according to
[22]
In our study, the possible impacts of hyperglycemia on the the American Diabetes Association criteria of a fasting blood
recurrence of HCC in chronic hepatitis C (CHC) patients after glucose level ≥ 126 mg/dL and/or HbA1c level ≥ 6.5. Obesity
[23]
curative RFA were analyzed and we found that inadequate was defined as a body mass index > 25 kg/m according to
2
maintenance of blood glucose was related to the high rate the definition of the Japan Society for the Study of Obesity. [24]
of HCC recurrence.
After initial treatment of HCC by RFA, the ablated area
METHODS was confirmed by triphasic computed tomography (CT) or
dynamic magnetic resonance imaging (MRI) within 1-week.
This study was conducted retrospectively on 107 patients If the ablated area was not sufficient, then RFA therapy was
with 159 hepatic focal lesions. The patients were curatively repeated until the HCC nodule was completely ablated.
treated by RFA therapy from January 2010 to June 2013.
There were 70 males and 37 females with mean age Diagnosis of HCC was based on abdominal ultrasonography,
50.4 ± 9.4 years. triphasic CT, dynamic MRI and alpha-fetoprotein (AFP).
Classical HCC was diagnosed for tumors showing vascular
An informed consent was taken from all participants. All the enhancement with washout on at least two types of
records were confidential. The results of this research were diagnostic imaging. Tumor biopsy was used to diagnose
used only for scientific purpose. Any unexpected risks that tumors with non-classical imaging findings.
appeared during the course of the research were cleared with
the participants and the clinical committee on time. For surveillance of HCC recurrence after curative therapy with
RFA, patients were evaluated by abdominal ultrasonography,
We selected the patients for this study according to contrast-enhanced triphasic CT, or contrast-enhanced
the following inclusion criteria: maximum diameter of dynamic MRI every 3 months.
HCC ≤ 4 cm, number of HCC nodules ≤ 3, no previous
history of treatment of HCC and follow-up observation for at Recurrence of HCC was diagnosed based on reappearance
least 6 months and up to 36 months after RFA therapy. The of arterial enhancement in the ablated lesions or new focal

Hepatoma Research | Volume 1 | Issue 1 | April 15, 2015 25