Abstract
Background: To identify the predictive factors of recurrence and survival in an unselected population of Western patients who underwent multimodal percutaneous thermal ablation (PTA) for small Hepatocellular Carcinomas (HCCs). Methods: January 2015–June 2019: data on multimodal PTA for <3 cm HCC were extracted from a prospective database. Local tumor progression (LTP), intrahepatic distant recurrence (IDR), time-to-LTP, time-to-IDR, recurrence-free (RFS) and overall (OS) survival were evaluated. Results: 238 patients underwent 317 PTA sessions to treat 412 HCCs. During follow-up (median: 27.1 months), 47.1% patients had IDR and 18.5% died. LTP occurred after 13.3% of PTA. Tumor size (OR = 1.108, p < 0.001; hazard ratio (HR) = 1.075, p = 0.002) and ultrasound guidance (OR = 0.294, p = 0.017; HR = 0.429, p = 0.009) independently predicted LTP and time-to-LTP, respectively. Alpha fetoprotein (AFP) > 100 ng/mL (OR = 3.027, p = 0.037) and tumor size (OR = 1.06, p = 0.001) independently predicted IDR. Multinodular HCC (HR = 2.67, p < 0.001), treatment-naïve patient (HR = 0.507, p = 0.002) and AFP > 100 ng/mL (HR = 2.767, p = 0.014) independently predicted time-to-IDR. RFS was independently predicted by multinodular HCC (HR = 2.144, p = 0.001), treatment naivety (HR = 0.546, p = 0.004) and AFP > 100 ng/mL (HR = 2.437, p = 0.013). The American Society of Anesthesiologists (ASA) score > 2 (HR = 4.273, p = 0.011), AFP (HR = 1.002, p < 0.001), multinodular HCC (HR = 3.939, p = 0.003) and steatotic HCC (HR = 1.81 × 10-16, p < 0.001) independently predicted OS. Conclusions: IDR was associated with tumor aggressiveness, suggesting a metastatic mechanism. Besides AFP association with LTP, IDR, RFS and OS, treatment-naïve patients had longer RFS, and multi-nodularity was associated with shorter RFS and OS. Steatotic HCC, identified on pre-treatment MRI, independently predicted longer OS, and needs to be further explored.
Highlights
Hepatocellular Carcinoma (HCC) is the fifth most common cancer, and the third leading cause of death from cancer worldwide [1].Percutaneous thermal ablation (PTA) is a validated treatment option for very early and early stageHepatocellular Carcinomas (HCCs), together with surgical resection and liver transplantation [2]
This retrospective analysis was performed using data prospectively collected in a database of patients who underwent percutaneous thermal ablation (PTA) for Hepatocellular Carcinoma (HCC) at our institution
We found that variables reflecting tumor aggressiveness were the only independent predictors of intrahepatic distant recurrence (IDR) occurrence: alpha fetoprotein (AFP) >100 ng/mL (3-fold increased risk of IDR) and tumor size (IDR risk increased by 6% per mm of tumor diameter increase)
Summary
HCC is the fifth most common cancer, and the third leading cause of death from cancer worldwide [1].Percutaneous thermal ablation (PTA) is a validated treatment option for very early and early stageHCC, together with surgical resection and liver transplantation [2]. PTA is frequently not performed in the case of high-risk HCC location (liver dome, subcapsular, near a large vessel or an adjacent organ) [12]. All of these technical issues could lead to considerable selection bias in the routine practice, explaining the choice of palliative treatments in many cases. Few data are available on the outcomes of multimodal PTA in unselected populations of patients with small HCC. To identify the predictive factors of recurrence and survival in an unselected population of Western patients who underwent multimodal percutaneous thermal ablation (PTA) for small Hepatocellular Carcinomas (HCCs).
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