Abstract
BackgroundIntrahepatic distant recurrence (IDR) is a significant problem for patients who have undergone radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). The objective of the study was to investigate risk factors and to predict outcomes of recurrent IDR within Milan criteria after complete RFA for primary early-stage HCC.MethodThis retrospective study reviewed 449 patients with intrahepatic distant recurrent HCC after complete RFA for early-stage HCC. After excluding 100 patients who were beyond Milan criteria, with incomplete lab data, or had follow-up less than three months, a total of 349 patient cases were compiled and their baseline characteristics, further treatment modalities after tumor recurrence and survival were analyzed.ResultsAfter a median follow-up of 36.2 months, 92 patients had expired. The majority of patients were male (59.9%) with a median age of 64.3 years (range:38–88). The cumulative 5-year overall survival (OS) rates after treatment for recurrent HCC was 67.2%. On multivariate analysis, end-stage renal disease(Hazard ratio (H.R.) = 2.33, p = 0.021), m-ALBI grade 2a (H.R. = 2.86, p = 0.003) and m-ALBI grades 2b or 3 (H.R. = 2.30, p = 0.009), APRI greater than 1 (H.R. = 1.92, p = 0.036) and 2nd recurrence occurring within 1 year (H.R. = 2.69, p<0.001) were significantly associated with worse survival. The cumulative 5-year 2nd recurrence rate was 87.4%. On multivariate analysis, male gender (H.R. = 1.47, p = 0.01), age greater than 65 years (H.R. = 1.72, p<0.001), an alpha fetoprotein level greater than 20ng/ml (H.R. = 1.41, p = 0.016), surgical treatment for recurrent HCC (H.R. = 0.25, p = 0.007), tumor number greater than 1 (H.R. = 1.35, p = 0.046), and IDR developing within 2 years (H.R. = 1.67, p = 0.001) were prognostic factors for 2nd recurrence.ConclusionOur study suggested that presence of end-stage renal disease, m-ALBI grades 2 and 3, APRI >1 and time to 2nd HCC recurrence were all associated with overall survival while the 2nd HCC recurrence was associated with male gender, age ≥65 years, α-fetoprotein level >20 ng/mL, non-surgical therapy, time to IDR, and tumor number> 1.
Highlights
Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-associated mortality globally and the third most common in Taiwan [1,2,3]
End-stage renal disease(Hazard ratio (H.R.) = 2.33, p = 0.021), modified albumin-bilirubin (m-ALBI) grade 2a (H.R. = 2.86, p = 0.003) and m-ALBI grades 2b or 3 (H.R. = 2.30, p = 0.009), aminotransferase-to-platelet ratio index (APRI) greater than 1 (H.R. = 1.92, p = 0.036) and 2nd recurrence occurring within 1 year (H.R. = 2.69, p
Our study suggested that presence of end-stage renal disease, m-ALBI grades 2 and 3, APRI >1 and time to 2nd hepatocellular carcinoma (HCC) recurrence were all associated with overall survival while the 2nd HCC recurrence was associated with male gender, age 65 years, α-fetoprotein level >20 ng/mL, non-surgical therapy, time to Intrahepatic distant recurrence (IDR), and tumor number> 1
Summary
Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-associated mortality globally and the third most common in Taiwan [1,2,3]. Ultrasonographic surveillance of patients with chronic liver disease provides the opportunity to detect early-stage HCC eligible for curative treatments, such as liver transplantation, tumor resection, and tumor local ablation. Radiofrequency ablation (RFA), an effective local treatment, is recommended in patients with Barcelona Clinic Liver Cancer (BCLC) stages 0 and A HCC who are not fit for surgery [5]. Intrahepatic distant recurrence (IDR) is a significant problem for patients who have undergone radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).
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