Motivating members' involvement to effectually conduct collaborative software process tailoring.

Contemporary business and software environments are highly competitive and rapidly evolving, resulting in software projects that are highly customized and changeable during development. Therefore, software process tailoring (SPT) is important as software teams conduct SPT to adjust shared development processes and evolve the project to better meet unique and dynamic needs. SPT is a special type of teamwork in which members' active participation and critical input are necessary for understanding and synthesizing various business and technical concerns that may be divergent and conflictual and then jointly identifying an integrated tailoring solution. In this context, this study examines members' decisive and critical involvement in SPT and adopts a motivational perspective to explore how motivation can facilitate SPT performance. Specifically, we use empowerment theory to develop a model to theorize and examine how psychological empowerment (PE) in terms of meaningfulness, autonomy, potency, and impact motivates software teams to efficiently and effectively conduct SPT. The model also considers the power distance (PD) to understand how it functions in team-based critical thinking and decisional processes to energize team members' participative effort. The investigation surveyed 102 software development teams and used partial least squares (PLS) to analyze the data. The results show that PE in terms of the four components has various influences on SPT performance and that PD has nonsignificant moderating effects. This study contributes to the software engineering literature by uncovering the contextual mechanism underlying the relationship between PE and PD in SPT. The limitations and possible extensions of this study are also outlined for future research.

What is the difference in ablation zone of multi-bipolar radiofrequency ablation between liver cirrhosis and normal liver background? - a prospective clinical study.

PURPOSE: To explore the differences in ablation zone between liver cirrhosis and normal liver background and investigate the effect of hepatic blood flow on ablation zone of RFA. METHODS: Between 2017 and 2019, 203 patients who had liver malignancies and underwent percutaneous RFA with Celon bipolar electrodes enrolled into this study. There were 90 patients had liver cirrhosis and 113 patients had normal liver background. They were 63 females and 140 males with average age of 59.0 ± 10.9 years old. Contrast-enhanced CT/MRI was used to evaluate the ablation zone in one month after RFA. The hepatic flow measurements on CDFI and CEUS were performed before RFA. Correlations between ablation zone versus hepatic flow were assessed using multiple linear regression analysis. RESULTS: The average ablation zone in cirrhotic liver was significantly larger than those in normal liver background with 3 cm tip of RF electrodes (length 3.5 ± 0.5 vs 3.1 ± 0.4 cm, p = 0.001; width 2.6 ± 0.3 vs 2.2 ± 0.3 cm, p < 0.001; thickness 2.5 ± 0.3 vs 2.0 ± 0.2 cm, p < 0.001). The similar result was found with three 4 cm tip of RF electrodes (width 3.6 ± 0.5 vs 3.1 ± 0.5 cm, p = 0.019; thickness 3.3 ± 0.5 vs 2.7 ± 0.5 cm, p = 0.002). The multiple linear regression analysis showed arrive time of hepatic vein and portal vein was statistically associated with ablation zone with 3 cm electrodes (p < 0.001, p = 0.001), but explained part of the variance (Adjusted R2=0.294, adjusted R2=0.212). CONCLUSION: The ablation zones of RFA with multi-bipolar electrodes in liver cirrhosis were significantly larger than those in normal liver background, being up to 6 mm in thickness. The hepatic flow parameters partly contributed to the ablation zone.

Long-term outcomes and prognostic analysis of percutaneous radiofrequency ablation in liver metastasis from breast cancer.

OBJECTIVE: To evaluate the long-term efficacy and prognostic factors of ultrasound-guided percutaneous radiofrequency ablation (RFA) for breast cancer liver metastasis (BCLM). METHODS: Between 2000 and 2015, 69 patients who underwent ultrasound-guided percutaneous RFA for BCLM and had regular follow-up examinations were included. All patients had undergone resection of the primary breast cancer and had received chemotherapy, endocrine therapy or both after surgery. The sample included two males and 67 females with an average age of 50.3 ± 10.0 years (31-76 y). The mean maximum diameter of metastatic lesions in the liver was 2.9 ± 1.4 cm (1.0-6 cm). Thirty-five patients had a single metastasis, while 34 patients had multiple liver metastases (2-5 lesions). Survival results were generated using Kaplan-Meier estimates and a multivariate analysis was performed using the Cox regression model. RESULTS: In total, 92 RFA sessions were performed and 135 BCLM lesions were treated. Major complications occurred in one of the 92 sessions (1.1%). Technical efficacy was achieved in 92.6% of lesions (125/135 lesions). Local tumor progression occurred in 11.6% (8/69) of patients and new intrahepatic metastasis occurred in 55.1% (38/69) of patients. From the time of initial RFA, the median overall survival was 26 months, and the one-, two-, three- and five -year survival rates were 81.8, 50.1, 25.3 and 11.0%, respectively. Based on the multivariate analysis, the following three factors were identified as independent prognostic factors for overall survival: tumor size (p = .017), positive estrogen receptor status (p = .009) and extrahepatic metastatic disease (p = .001). The median progression-free survival was 24 months, and the one-, two-, three- and five -year survival rates after RFA were 77.4, 47.0, 23.7 and 8.5%, respectively. Additionally, the independent prognostic factors for progression-free survival included tumor size (p = .011), ER positivity (p = .001), margin size (p = .017) and extrahepatic metastatic disease (p < .001). CONCLUSION: The results of this study showed that RFA is a safe and locally effective method for the treatment of BCLM, especially in patients with lesions measuring less than 3 cm in diameter, a single liver metastasis, positive estrogen receptor status and no extrahepatic metastases. Also, patients with margin size >10 mm had no local tumor progression.

Percutaneous ablation of the tumor feeding artery for hypervascular hepatocellular carcinoma before tumor ablation.

OBJECTIVE: To evaluate the efficiency and safety of percutaneous ablation of the tumor feeding artery (PAA) before radiofrequency ablation (RFA) for hypervascular hepatocellular carcinoma (HCC) under ultrasound guidance. PATIENTS AND METHODS: In total, 94 patients with hypervascular HCC and tumor feeding artery visible by contrast-enhanced ultrasound were prospectively randomized to receive either PAA combined with RFA (RFA + PAA) or RFA alone. This study was registered at the clinical trials registry website (No. NCT03143140). The mean tumor size was 3.2 ± 0.9 cm (2.0-5.0 cm). The mean follow-up was 23.7 ± 9.7 months (4-44 months). The technical success, local tumor progression and intrahepatic distant recurrence rates were compared. Survival analysis was performed using the Kaplan-Meier method and compared with the log-rank test. RESULTS: The local tumor progression rate was lower for the PAA + RFA group than for the RFA group (8.5% vs 21.3%, p < .082). No significant differences in the technical success and intrahepatic distant recurrence rates were observed between the two groups (97.9% vs 91.5%, p = .203 and 40.4% vs 42.6%, p = .834). The 1- and 3-year local tumor progression-free survival rates were 91.5% and 69.9% vs 68.1% and 52.1% for the PAA + RFA vs RFA groups, respectively (p = .052). The 1- and 3-year overall survival rates were 95.7% and 69.1% vs 89.4% and 66.6% in the PAA + RFA vs RFA groups, respectively (p = .744). The major complication rate was 4.3% in both groups. CONCLUSIONS: PAA appears to be an effective and safe technique for the treatment of hypervascular HCC, with a lower local tumor progression rate than that of conventional RFA.

Long-term outcome of percutaneous radiofrequency ablation in recurrent hepatocellular carcinoma after liver transplantation.

PURPOSE: To investigate the long-term outcome and prognostic factors of radiofrequency ablation (RFA) in recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT). METHODS: From 2004 to 2014, 15 patients with 23 hepatic recurrent HCCs after LT underwent ultrasound-guided percutaneous RFA. There were 14 males and 1 female aged 54.3 ± 9.5 years old (37-78 years old). The average tumour size was 3.3 ± 1.2 cm (1.7-6.0 cm). Seven patients had a single HCC and eight had 2-4 HCCs. Regular follow-up after RFA was performed to assess local response rates and long-term survival rates. Survival results were generated using Kaplan-Meier estimates, and a multivariate analysis was performed using the Cox regression model. RESULTS: The technical success rate was 95.7% (22/23 tumours). The minor complication rate was 7.7% (2/26 sessions), and there were no major complications. The follow-up period was 27.4 ± 18.9 months (12-116 months). The local progression rate and intrahepatic new lesion rate were 13.0% (3/23 tumours) and 53.3% (8/15 patients), respectively. Extrahepatic metastasis was found in four patients (26.7%). The 1-, 3- and 5-year estimated overall survival rates were 71.8%, 35.9% and 26.9%, respectively. Additionally, the multivariate analysis revealed that serum α-fetoprotein (AFP) before RFA, tumour number and extrahepatic metastasis were significantly related to overall survival after RFA. CONCLUSION: Ultrasound-guided percutaneous RFA of recurrent HCC after LT had a high technical success rate and local control. However, RFA cannot decrease the frequency of new tumours or extrahepatic metastasis. The AFP level and tumour number before RFA should be considered to predict the outcome.

Preliminary experience with direct percutaneous arterial embolisation combined with radiofrequency ablation for hypervascular HCC.

OBJECTIVE: The purpose of this study was to evaluate the outcomes of a novel technique consisting of ultrasound-guided percutaneous arterial embolisation (PAE) of the tumour-feeding artery before radiofrequency ablation (RFA) for hypervascular hepatocellular carcinoma (HCC). METHODS: Twenty-three HCC patients with hypervascular tumours who were non-TACE candidates were enrolled in the study. The mean size of the tumours was 4.6 ± 1.2 cm (3.2-6.0 cm). PAE was performed using 20-gauge catheter needles under greyscale and colour ultrasound guidance. Regular follow-up was performed to evaluate the outcomes and safety of this novel method. RESULTS: Post-PAE colour Doppler ultrasound revealed an immediate embolising effect in 29 feeding arteries, including 21 arteries that became invisible (72.4%) and 8 arteries that exhibited reduced flow velocity (27.6%). Based on the one-month enhanced CT/MRI, complete necrosis was achieved in 24 of 25 tumours (96.0%). The mean follow-up period was 42.7 ± 9.8 months. Local tumour recurrence was observed in 3 tumours (12.0%), and new intrahepatic tumours developed in 9 patients (39.1%). The probabilities of overall survival at 1, 3, 5 and 10 years were 77.3%, 40.0%, 25.0% and 18.8%, respectively. No major complications occurred in this group. CONCLUSIONS: The PAE method could help effectively to reduce or inhibit the blood supply of HCC. RFA followed by PAE treatment achieved 25.0% 5-year survival with no major complications. As a minimally invasive approach, PAE may provide a novel local therapy for hypervascular HCC patients who are non-TACE candidates.

Clinical application of hepatic wedge ablation for treating liver malignancies of the inferior margin: a new ablation technique.

PURPOSE: To determine the efficacy and safety of percutaneous hepatic wedge ablation in treating hepatic malignancies of the inferior margin. MATERIALS AND METHODS: Seventy-seven patients with hepatic malignancies at the inferior margin underwent percutaneous radiofrequency ablation (RFA). Thirty-two patients underwent hepatic wedge ablation and 45 patients underwent conventional tumour ablation. Comparative analysis of the two groups was performed including gender, age, tumour size, number of ablation cycles, ablation duration and injected hydrodissection volume. The rate of technical success, local tumour progression, intrahepatic distant recurrence, major complications and overall survival were assessed and compared. Survival analysis was analysed using the Kaplan-Meier method. Differences in the survival rates were compared with log-rank test. RESULTS: The mean number of ablation cycles and ablation duration were significantly higher in the hepatic wedge ablation group than conventional tumour ablation (1.6 ± 0.9 vs. 1.2 ± 0.4, p = .042, and 30.2 ± 18.5 vs. 22.5 ± 8.5 min, p = .031, respectively). The local tumour progression rate was significantly lower in hepatic wedge ablation group (0% vs. 17.78%, p = .038) at median follow-up of 21 months. The rate of technical success, intrahepatic distant recurrence, major complications and overall survival did not differ between the two groups. CONCLUSION: Hepatic wedge ablation appears to be a highly effective treatment for hepatic malignancies in the inferior margin and provides a better local control than conventional tumour ablation.

Focal Liver Lesions: Real-time 3-Dimensional Contrast-Enhanced Ultrasonography Compared With 2-Dimensional Contrast-Enhanced Ultrasonography and Magnetic Resonance Imaging.

OBJECTIVES: This study sought to evaluate the application of real-time 3-dimensional (3D) contrast-enhanced ultrasonography (US) to diagnose focal liver lesions and to compare these results with those from 2-dimensional (2D) contrast-enhanced US and contrast-enhanced magnetic resonance imaging (MRI). METHODS: Patients with focal liver lesions were examined by 2D contrast-enhanced US, 3D contrast-enhanced US, and contrast-enhanced MRI for lesion characterization, and biopsies and comprehensive clinical diagnoses served as reference standards. The sensitivity, specificity, area under the receiver operating characteristic curve, and intermodality agreement were assessed. The number of contrast agent injections and lesions observed per injection were calculated for 3D and 2D contrast-enhanced US. The number and display quality of the feeding arteries observed with 3D and 2D contrast-enhanced US were assessed. RESULTS: A total of 117 patients with 151 focal liver lesions were enrolled, including 67 cases of hepatocellular carcinoma, 51 cases of liver metastasis, and 33 cases of benign liver lesions. No significant differences were found among the modalities. The sensitivity values for 3D contrast-enhanced US, 2D contrast-enhanced US, and contrast-enhanced MRI were 96%, 95%, and 93%, respectively; the specificity values were 87%, 84%, and 89%; and the area under the receiver operating characteristic curve values were 0.92, 0.90, and 0.92. The intermodality agreement was excellent (κ > 0.77). Fewer contrast agent injections were needed, and more lesions and feeding arteries were more clearly displayed on 3D than 2D contrast-enhanced US (P < .001). CONCLUSIONS: Real-time 3D contrast-enhanced US is useful for diagnosing focal liver lesions and for observing feeding arteries with fewer contrast agent injections.

Does Thermosensitive Liposomal Vinorelbine Improve End-Point Survival after Percutaneous Radiofrequency Ablation of Liver Tumors in a Mouse Model?

Purpose To investigate the role of thermosensitive liposome-encapsulated vinorelbine (Thermo-Vin) in combined radiofrequency (RF) ablation of liver tumors. Materials and Methods Approval from the institutional animal care and use committee was obtained before this study. First, the anticancer efficacy of Thermo-Vin was assessed in vitro (H22 cells) for 72 hours at 37°C or 42°C. Next, 203 H22 liver adenocarcinomas were implanted in 191 mice for in vivo study. Tumors were randomized into seven groups: (a) no treatment, (b) treatment with RF ablation alone, (c) treatment with RF ablation followed by free vinorelbine (Free-Vin) at 30 minutes, (d) treatment with RF ablation followed by empty liposomes (Empty-Lip+RF), (e) treatment with RF ablation followed by Thermo-Vin (5 mg/kg), (f) treatment with RF ablation followed by Thermo-Vin (10 mg/kg), and (g) treatment with RF ablation followed by Thermo-Vin (20 mg/kg). Tumor destruction areas and pathologic changes were compared for different groups at 24 and 72 hours after treatment. Kaplan-Meier analysis was used to compare end-point survival (tumor < 30 mm in diameter). Additionally, the effect of initial tumor size on long-term outcome was analyzed. Results In vitro, both Free-Vin and Thermo-Vin dramatically inhibited H22 cell viability at 24 hours. Likewise, in vivo, 10 mg/kg Thermo-Vin+RF ablation increased tumor destruction compared with RF ablation (P = .001). Intratumoral vinorelbine accumulation with Thermo-Vin+RF increased 15-fold compared with Free-Vin alone. Thermo-Vin substantially increased apoptosis at the coagulation margin and suppressed cellular proliferation in the residual tumor (P < .001). The Thermo-Vin+RF study arm also had better survival than the arm treated with RF ablation alone (mean, 37.6 days ± 20.1 vs 23.4 days ± 5.0; P = .001), the arm treated with Free-Vin+RF (23.3 days ± 1.2, P = .002), or the arm treated with Empty-Lip+RF (20.8 days ± 0.4, P < .001) in animals with medium-sized (10-12-mm) tumors. No significant difference in end-point survival was noted in the treatment arms with large or small tumors. Conclusion Thermo-Vin can effectively increase tumor destruction and improve animal survival. End-point survival is most affected in animals with medium-sized tumors, suggesting that combination therapy should be tailored to tumor size and the expected volume of ablation of the device used. (©) RSNA, 2016 Online supplemental material is available for this article.

The influence of early adoption of nonenhanced computed tomography on management of patients with pyogenic liver abscess.

Background and Aim: A pyogenic liver abscess (PLA) is an infectious disease with high in-hospital mortality. It has no specific symptoms and is difficult to be diagnosed early in the emergency department. Ultrasound is commonly used to detect PLA lesions of PLA, but its sensitivity can be affected by lesion size, location, and clinician experience. Therefore, early diagnosis and prompt treatment (especially abscess drainage) are crucial for better patient outcomes and should be prioritized by clinical physicians. Methods: We conducted a retrospective study to compare the effect of early and late (i.e., receiving CT scanning within 48 h and >48 h after admission) adoption of nonenhanced computed tomography (CT) scanning regarding the hospitalization days and interval between admission and drainage of patients with PLA. Results: This study included 76 hospitalized patients with PLA in the Department of Digestive Disease of Xiamen Chang Gung Hospital in China who underwent CT examinations from 2014 to 2021. We conducted CT scans on 56 patients within 48 h of admission and on 20 patients more than 48 h after admission. The early CT group had a significantly shorter hospitalization length compared with the late CT group (15.0 days vs. 20.5 days; P = 0.035). Besides, the median time to initiate drainage after admission was also significantly shorter in the early CT group than in the late CT group (1.0 days vs. 4.5 days; P < 0.001). Conclusion: Early CT scanning within 48 h of admission may aid in early PLA diagnosis and benefit disease recovery, as revealed by our findings.

Intestinal fatty acid-binding protein is a biomarker for diagnosis of biliary tract infection.

BACKGROUND AND AIM: Biliary tract infection (BTI) is an inflammatory disease and commonly associated with bacteremia. Delays in diagnosis or treatment of BTI cause high morbidity and mortality. However, an early diagnosis depends on appropriate clinical investigations. Appropriate biomarkers are urgently needed to improve the BTI diagnostic rate. We hypothesized that intestinal fatty acid-binding protein (I-FABP) might be a potential biomarker for BTI diagnosis. METHODS: We examined data from subjects aged ≥18 years diagnosed with BTI, including cholangitis and cholecystitis, whose blood samples were adequate for I-FABP and zonulin assessment. We also collected blood samples from healthy volunteers as the control group. We excluded subjects in both groups who received steroids, antibiotics, or probiotics within 1 month before hospital admission (BTI cohort) or participation in this research (controls). The main study endpoint was to compare the diagnostic ability of I-FABP to detect BTI in comparison with high-sensitivity C-reactive protein (hs-CRP) and zonulin. RESULTS: The study collected the data of 51 patients with BTI and 35 healthy subjects. The receiver operating characteristic (ROC) area under the curve (AUC) for I-FABP was 0.884 (95% confidence interval [CI]: 0.814-0.954), numerically higher than that for hs-CRP (0.880; 0.785-0.976) and zonulin (0.570; 0.444-0.697). We estimated that the optimal cutoff value of I-FABP was 2.1 ng/mL (sensitivity: 0.804; specificity: 0.829) for the diagnosis of BTI. CONCLUSIONS: In summary, this study suggests that I-FABP may be a potential alternative biomarker to hs-CRP for diagnosing BTI. Further research should verify the use of I-FABP as a marker for BTI diagnosis, but also for other inflammatory diseases.

Thermosensitive liposomal doxorubicin plus radiofrequency ablation increased tumor destruction and improved survival in patients with medium and large hepatocellular carcinoma: A randomized, double-blinded, dummy-controlled clinical trial in a single center.

BACKGROUND: Lyso-thermosensitive liposomal doxorubicin (LTLD, ThermoDox) consists of doxorubicin encapsulated contained within a heat-sensitive liposome. AIMS AND OBJECTIVES: We sought to evaluate whether the use of combined radiofrequency ablation (RFA) and LTLD would result in larger coagulation volume and longer overall survival (OS) compared with the use of RFA alone in patients with 3-7 cm unresectable hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Between 2010 and 2012, 22 HCC patients were randomly assigned to one of two treatments in our center: (1) ultrasound-guided percutaneous RFA plus intravenous (IV) infusion of LTLD (combination, n = 11) or (2) RFA plus IV dummy (RFA, n = 11). Four patients withdrew from the study, and the remaining 18 patients entered the final analysis. There were 14 male and 4 female patients with an average age of 61.1 ± 9.3 years (range: 40-73 years). The average tumor size was 4.2 ± 1.0 cm (range: 3.1-6.1 cm). One-month enhanced computed tomography was used to evaluate the ablation efficacy and coagulation volume after RFA. Regular follow-up after RFA was performed to assess toxicity, local response rates, and OS rates. RESULTS: A major complication (empyema) occurred in one case in the combination group. Combination treatment region did not induce any additional toxicity beyond doxorubicin. The primary ablation success rate was 93.3% (14/15 tumors) in the combination group and 77.8% (7/9 tumors) in the RFA group (P = 0.308). The difference in coagulation volume between pre- and post-RFA in the combination group was significantly larger than that of the RFA group (105.7 ± 73.8 cm 3 vs. 37.3 ± 8.5 cm 3, P = 0.013). The follow-up period ranged from 11 to 80 months (average: 49.1 ± 24.8 months). The local progression rate was 6.7% (1/15 tumors) in the combination group and 22.2% (2/9 tumors) in the RFA group. The mean OS for the combination group was 68.5 ± 7.2 months, which was significantly greater compared with the RFA group (46.0 ± 10.6 months, P = 0.045). CONCLUSIONS: RFA with heat target delivery chemotherapy facilitated better tumor coagulation necrosis without additional toxicity. This combined treatment may improve the clinical efficacy of RFA or free doxorubicin and prolong survival in patients with medium to large HCC.

Ten-year survival of hepatocellular carcinoma patients undergoing radiofrequency ablation as a first-line treatment.

AIM: To investigate the long-term survival and prognostic factors in hepatocellular carcinoma (HCC) patients undergoing radiofrequency ablation (RFA) as a first-line treatment. METHODS: From 2000 to 2013, 316 consecutive patients with 404 HCC (1.0-5.0 cm; mean: 3.2 ± 1.1 cm) underwent ultrasonography-guided percutaneous RFA as a first-line treatment. There were 250 males and 66 females with an average age of 60.1 ± 10.8 years (24-87 years). Patients were followed for 1 year to > 10 years after RFA (234, 181, 136, and 71 for 3, 5, 7, and 10 years, respectively). Overall local response rates and long-term survival rates were assessed. Survival results were generated using Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model. RESULTS: In total, 548 RFA sessions were performed and major complications occurred in 10 sessions (1.8%). Local tumor progression and/or new tumor development were observed in 43.3% (132/305) of the patients during the follow-up period. Overall 5- and 10-year survival rates were 49.7% and 28.4%, respectively. Based on multivariate analysis, three factors were identified as independent prognostic factors for overall survival: Child-Pugh classification (HR = 4.054, P < 0.001), portal vein hypertension (HR = 2.743, P = 0.002), and tumor number (HR = 2.693, P = 0.003). The local progression-free 5- and 10-year survival rates were 42.7% and 19.5%. In addition to the Child-Pugh classification and the number of tumors, the number of RFA sessions (HR = 1.550, P = 0.002) was associated with local progression-free survival. CONCLUSION: RFA can achieve acceptable outcomes for HCC patients as a first-line treatment, especially for patients with Child-Pugh class A, patients with a single tumor and patients without portal vein hypertension.

Radiofrequency ablation of hepatocellular carcinoma in difficult locations: Strategies and long-term outcomes.

AIM: To investigate the treatment strategies and long-term outcomes of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in difficult locations and to compare the results with non-difficult HCC. METHODS: From 2004 to 2012, a total of 470 HCC patients underwent ultrasound-guided percutaneous RFA. Among these HCC patients, 382 with tumors located ≤ 5 mm from a major vessel/bile duct (n = 87), from peripheral important structures (n = 232) or from the liver capsule (n = 63) were regarded as difficult cases. There were 331 male patients and 51 female patients, with an average age of 55.3 ± 10.1 years old. A total of 235 and 147 patients had Child-Pugh class A and class B liver function, respectively. The average tumor size was 3.4 ± 1.2 cm. Individual treatment strategies were developed to treat these difficult cases. During the same period, 88 HCC patients with tumors that were not in difficult locations served as the control group. In the control group, 74 patients were male, and 14 patients were female, with an average age of 57.4 ± 11.8 years old. Of these, 62 patients and 26 patients had Child-Pugh class A and class B liver function, respectively. Regular follow-up after RFA was performed to assess treatment efficacy. Survival results were generated from Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model. RESULTS: Early tumor necrosis rate in the difficult group was similar to that in the control group (97.6% vs 94.3%, P = 0.080). The complication rate in the difficult group was significantly higher than that in the control group (4.9% vs 0.8%, P = 0.041). The follow-up period ranged from 6 to 116 mo, with an average of 28 ± 22.4 mo. Local progression rate in the difficult group was significantly higher than that in the control group (12.7% vs 7.1%, P = 0.046). However, the 1-, 3-, 5-, and 7-year overall survival rates in the difficult group were not significantly different from those in the control group (84.3%, 54.4%, 41.2%, and 29.9% vs 92.5%, 60.3%, 43.2%, and 32.8%, respectively, P = 0.371). Additionally, a multivariate analysis revealed that tumor location was not a significant risk factor for survival. CONCLUSION: There was no significant difference in long-term overall survival between the two groups even though the local progression rate was higher in the difficult group.