Abstract
ObjectivesThermal ablation (TA) is an established treatment for early HCC. There is a lack of data on the efficacy of repeated TA for recurrent HCC, resulting in uncertainty whether good oncologic outcomes can be obtained without performing orthotopic liver transplantation (OLTx). This study analyses outcomes after TA, with a special focus on repeat TA for recurrent HCC, either as a stand-alone therapy, or in relationship with OLTx.MethodsData from a prospectively registered database on interventions for HCC in a tertiary hepatobiliary centre was completed with follow-up until December 2020. Outcomes studied were rate of recurrence after primary TA and after its repeat interventions, the occurrence of untreatable recurrence, OS and DSS after primary and repeat TA, and complications after TA. In cohorts matched for confounders, OSS and DSS were compared after TA with and without the intention to perform OLTx.ResultsAfter TA, 100 patients (56·8%) developed recurrent HCC, of whom 76 (76·0%) underwent up to four repeat interventions. During follow-up, 76·7% of patients never developed a recurrence unamenable to repeat TA or OLTx. OS was comparable after primary TA and repeat TA. In matched cohorts, OS and DSS were comparable after TA with and without the intention to perform OLTx.ConclusionsWe found TA to be an effective and repeatable therapy for primary and recurrent HCC. Most recurrences can be treated with curative intent. There are patients who do well with TA alone without ever undergoing OLTx.Key Points• Recurrent HCC after primary TA can often be treated effectively with repeat TA. Survival after repeat TA is comparable to primary TA.• In matched cohorts, outcomes after TA with and without subsequent waitlisting for OLTx are comparable.• There are patients who do well for many years with primary and repeat TA alone; some despite multiple recurrences.
Highlights
Hepatocellular carcinoma (HCC) is a major cause of global morbidity and mortality [1], with an rising incidence in the Western world due to an increasing prevalence of steatohepatitis [2]
In order to compare survival without bias from tumour stage, age or comorbidity, we analysed patients who had been waitlisted for OLTx at any time after primary Thermal ablation (TA) (“intention-to-performOLTx”), and compared them to a cohort of patients matched for age (< 70 years), tumour size and number and comorbidity (ASA < 3; no severe cardiopulmonary comorbidity), who upon revision of charts by a liver transplant surgeon would have been eligible for OLTx from a medical point of view, but who were never waitlisted due to other reasons (“eligible, non-waitlisted”)
We found TA to be a reliable, repeatable treatment modality for HCC
Summary
Hepatocellular carcinoma (HCC) is a major cause of global morbidity and mortality [1], with an rising incidence in the Western world due to an increasing prevalence of steatohepatitis [2]. Staged according to the BCLC classification, only very early (single tumour, < 2 cm) and early HCC (up to three tumours, < 3 cm each) are generally considered curable [3]. Curative treatment options include thermal ablation (TA, which includes microwave ablation and radiofrequency ablation), hepatic resection (HR), and orthotopic liver transplantation (OLTx) [4]. The latter is generally considered to yield the best recurrence-free survival [5], but is limited by a scarcity in available donor organs, and considerable procedural morbidity and mortality [6]. Liver-sparing treatment modalities are plagued by higher rates of tumour recurrence [3]. Initial therapy is with either HR or TA, after which some patients may eventually undergo OLTx [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
