Comparison of no-touch multi-bipolar vs. monopolar radiofrequency ablation for small HCC

Background & Aims: The primary aim of this study was to compare the rate of global radiofrequency ablation (RFA) failure between monopolar RFA (MonoRFA) vs. no-touch multi-bipolar RFA (NTmbpRFA) for small hepatocellular carcinoma (HCC) <= 5 cm in cirrhotic patients. Methods: A total of 362 cirrhotic patients were included retrospectively across four French centres (181 per treatment group). Global RFA failure (primary RFA failure or local tumour progression) was analysed using the Kaplan-Meier method after coarsened exact matching. Cox regression models were used to identify factors associated with global RFA failure and overall survival (OS). Results: Patients were well matched according to tumour size (<= 30/>30 mm); tumour number (one/several); tumour location (subcapsular and near large vessel); serum AFP (<10; 10-100; >100 ng/ml); Child-Pugh score (A/B) and platelet count (= 100 G/L), p = 1 for all. One case of perioperative mortality was observed in the NTmbpRFA group and the rate of major complications was 7.2% in both groups (p = 1). The cumulative rates of global RFA failure at 1, 3 and 5 years were respectively 13.3%, 31% and 36.7% for MonoRFA vs. 0.02%, 7.9% and 9.2% for NTmbpRFA, p < 0.001. Monopolar RFA, tumour size >30 mm and HCC near large vessel were independent factors associated with global RFA failure. Five-year OS was 37.2% following MonoRFA vs. 46.4% following NTmbpRFA p = 0.378. Conclusions: This large multicentre case-matched study showed that NTmbpRFA provided better primary RFA success and sustained local tumour response without increasing severe complications rates, for HCC <= 5 cm. Lay summary: Using no-touch multi-bipolar radiofrequency ablation for hepatocellular carcinoma <5 cm provide a better sustained local tumour control compared to monopolar radiofrequency ablation. (C) 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.