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Outcomes of Radiofrequency Ablation as First-Line Therapy for Hepatocellular Carcinoma less than 3 cm in Potentially Transplantable Patients

Doyle, Adam; Gorgen, Andre; Muaddi, Hala; Aravinthan, Aloysious D.; Issachar, Assaf; Mironov, Oleg; Zhang, Wei; Kachura, John; Beecroft, Robert; Cleary, Sean P.; Ghanekar, Anand; Greig, Paul D.; McGilvray, Ian D; Selzner, Markus; Cattral, Mark S.; Grant, David R.; Lilly, Leslie B.; Selzner, Nazia; Renner, Eberhard L.; Sherman, Morris; Sapisochin, Gonzalo

Outcomes of Radiofrequency Ablation as First-Line Therapy for Hepatocellular Carcinoma less than 3 cm in Potentially Transplantable Patients Thumbnail


Authors

Adam Doyle

Andre Gorgen

Hala Muaddi

Assaf Issachar

Oleg Mironov

Wei Zhang

John Kachura

Robert Beecroft

Sean P. Cleary

Anand Ghanekar

Paul D. Greig

Ian D McGilvray

Markus Selzner

Mark S. Cattral

David R. Grant

Leslie B. Lilly

Nazia Selzner

Eberhard L. Renner

Morris Sherman

Gonzalo Sapisochin



Abstract

© 2019 European Association for the Study of the Liver Background & Aims: Radiofrequency ablation (RFA) is an effective treatment for single hepatocellular carcinoma (HCC) ≤3 cm. Disease recurrence is common, and in some patients will occur outside transplant criteria. We aimed to assess the incidence and risk factors for recurrence beyond Milan criteria in potentially transplantable patients treated with RFA as first-line therapy. Methods: We performed a retrospective cohort study of potentially transplantable patients with new diagnoses of unifocal HCC ≤3 cm that underwent RFA as first-line therapy between 2000-2015. We defined potentially transplantable patients as those aged 2 cm). Competing risks Cox regression was used to identify predictors of recurrence beyond Milan criteria. Results: We included 301 patients (167 HCC ≤2 cm and 134 HCC >2 cm). Recurrence beyond Milan criteria occurred in 36 (21.6%) and 47 (35.1%) patients in the HCC ≤2 cm and the HCC >2 cm groups, respectively (p = 0.01). The 1-, 3- and 5-year actuarial survival rates after RFA were 98.2%, 86.2% and 79.0% in the HCC ≤2 cm group vs. 93.3%, 77.6% and 70.9% in the HCC >2 cm group (p = 0.01). Tumor size >2 cm (hazard ratio 1.94; 95% CI 1.25–3.02) and alpha-fetoprotein levels at the time of ablation (100–1,000 ng/ml: hazard ratio 2.05; 95% CI 1.10–3.83) were found to be predictors of post-RFA recurrence outside Milan criteria. Conclusion: RFA for single HCC ≤3 cm provides excellent short- to medium-term survival. However, we identified patients at higher risk of recurrence beyond Milan criteria. For these patients, liver transplantation should be considered immediately after the first HCC recurrence following RFA. Lay summary: Radiofrequency ablation and liver transplantation are treatment options for early stages of hepatocellular carcinoma (HCC). After ablation some patients will experience recurrence or metastatic spread of the initial tumor or may develop new tumors within the liver. Despite close follow-up, these recurrences can progress rapidly and exceed transplant criteria, preventing the patient from receiving a transplant. We identified that patients with HCC >2 cm and higher serum alpha-fetoprotein are at greater risk of recurrence beyond the transplant criteria. These data suggest that liver transplantation should be considered immediately after the first HCC recurrence for these patients.

Citation

Doyle, A., Gorgen, A., Muaddi, H., Aravinthan, A. D., Issachar, A., Mironov, O., …Sapisochin, G. (2019). Outcomes of Radiofrequency Ablation as First-Line Therapy for Hepatocellular Carcinoma less than 3 cm in Potentially Transplantable Patients. Journal of Hepatology, 70(5), 866-873. https://doi.org/10.1016/j.jhep.2018.12.027

Journal Article Type Article
Acceptance Date Dec 24, 2018
Online Publication Date Jan 5, 2019
Publication Date Jan 5, 2019
Deposit Date Jan 18, 2019
Publicly Available Date Jan 18, 2019
Journal Journal of Hepatology
Print ISSN 0168-8278
Electronic ISSN 1600-0641
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 70
Issue 5
Pages 866-873
DOI https://doi.org/10.1016/j.jhep.2018.12.027
Keywords Hepatology
Public URL https://nottingham-repository.worktribe.com/output/1481490
Publisher URL https://www.sciencedirect.com/science/article/pii/S0168827819300017

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