HOSPITAL VOLUMES OF PERCUTANEOUS RADIOFREQUENCY ABLATION ASSOCIATED WITH ITS TREATMENT OUTCOMES FOR PATIENTS WITH HEPATOCELLULAR CARCINOMA

ABSTRACT Background Hospital volumes of several major operations were associated with treatment outcomes. The study aims to explore the impact of hospital volumes of radiofrequency ablation (RFA) on the prognosis of patients who received RFA for hepatocellular carcinoma (HCC). Methods We searched for all patients who were diagnosed to have stage I or II HCC from 2004 to 2006 and received RFA as the first-line therapy in a population-based cohort. Clinical parameters and hospitals which provided the service were recorded. Overall survival (OS) and liver cancer-specific survival (CSS) were then compared according to the hospital volumes. The Cox's proportional hazards model was used for multivariate analysis. Results A total of 661 patients received RFA for stage I–II HCC in 28 hospitals. Hospitals were classified as high-volume and low-volume hospitals (first-line RFA for HCC for >10 patients and ≤10 patients per year, respectively). There were 480 (72.6%) patients treated in the high-volume hospitals, and 181 (27.4%) patients treated in the low-volume hospitals. The patient age, gender, tumor sizes and stages were not significantly different between high-volume and low-volume hospitals. Patients treated in high-volume hospitals had significantly longer OS and CSS than patients treated in low-volume hospitals (5-year OS: 58.7 versus 47.2%, P = 0.001; 5-year CSS: 67.1 versus 57.1%, P = 0.009). After adjusting for age, gender, tumor stage and size, hospital level and year of diagnosis, the high volume was still an independent predictor for longer OS (hazard ratio [HR]: 0.57; P  30 per year) was not associated with even better outcome. Conclusions Patients who received first-line RFA for HCC in high-volume hospitals had better survival outcomes.