Multimodal Percutaneous Thermal Ablation of Small Hepatocellular Carcinoma: Predictive Factors of Recurrence and Survival in Western Patients

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.

Quantitative dynamic contrast-enhanced ultrasound to predict intrahepatic recurrence of hepatocellular carcinoma after radiofrequency ablation: a cohort study

“…Radiofrequency ablation (RFA) is recommended as one of the locoregional curative treatment methods [2][3][4][5]. The 1-year, 2-year, and 3year recurrence-free survival rates are 60.4%, 46.2%, and 30.3%, respectively [6]. HCC intrahepatic recurrence is an important prognostic factor for overall survival after RFA [7].…”

“…Previous studies have detected a few risk factors for HCC intrahepatic recurrence after RFA, including tumor size, tumor number, serum tumor marker, proximity to a large vessel, insufficient safety margin, subcapsular location, and poor pathologic differentiation of tumor cells [6,[8][9][10][11]. The perfusion of the tumor has been identified as an important factor influencing the energy distribution of thermal ablation [12].…”

MWA Versus RFA in HCC: Superior? Equivalent? Will We Ever Know?

“…Additionally, the imaging guidance modality itself may influence LTP rate. Ultrasound guidance has been shown to reduce the risk of LTP, owing to its realtime ability as compared to CT guidance [5]. This information, too, is not reported in the Bouda et al study.…”

Interventional oncology at the time of COVID-19 pandemic: Problems and solutions

“…Indeed, the use of jet ventilation for percutaneous thermal destruction has been abandoned in the context of COVID-19 [9]. It can be replaced by simple techniques available on any ventilation system such as repeated apnea or low tidal-volume ventilation (i.e., tidal volume between 3 to 4 mL/kg, 320 mL/min minimum; Respiratory rate adjusted to maintain the end tidal carbon dioxide between 35 and 45 mmHg) which can be used to strongly limit liver movements [10].…”

“…According to last EASL recommendations, radiofrequency ablation (RFA) is the standard of care for patients with Barcelona Clinic Liver Cancer staging (BCLC) 0 or A tumors, not suitable for surgery [24]. Therefore, ablation should be favored for small HCCs (i.e., < 3 cm) all the more so as liver ablation is usually a short procedure, with short hospital stay and very few complications [10]. In IR teams used to multi-bipolar RFA, the threshold can be extended up to 5 cm tumors with excellent oncological results [25,26].…”