Predicting outcomes for recurrent hepatocellular carcinoma within Milan criteria after complete radiofrequency ablation

Abstract

Background Intrahepatic 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. Method This 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. Results After 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. Conclusion Our 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.

Assessment of Prognostic Value of Aspartate Aminotransferase-to-Platelet Ratio Index in Patients With Hepatocellular Carcinoma: Meta-Analysis of 28 Cohort Studies

“…In addition to predicting the prognosis of patients with HCC throughout the follow-up period, Liu et al found that the APRI levels could be an independent risk factor for early recurrence <1 year in the background of cirrhosis/fibrosis, and the study conducted by Allenson et al showed that a high APRI level was associated with OS <30 days (30,45). Furthermore, Chen et al found that a high APRI level predicted a higher risk of second recurrence (34). These findings can broaden the prediction range of APRI.…”

Uni-, Bi- or Trifocal Hepatocellular Carcinoma in Western Patients: Recurrence and Survival after Percutaneous Thermal Ablation

“…Most cohorts [ 5 , 10 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ] reporting on PTA for early-stage HCC come from Asia, where viral cirrhosis represents around 80% of liver disease, by contrast with the Western population, whose cirrhosis is mainly due to alcohol (57% of alcohol-induced liver disease, 25% of viral cirrhosis and 15% of NASH in our series). Higher mortality and recurrence rates are observed in patients with alcohol-related HCC, compared to viral etiology [ 22 ].…”

Treatment for Hepatocellular Carcinoma in South Asia

“…Transplantation, ablation, and surgical resection are curative treatments with an overall 5-year survival varying between 60 and 75%. 1,3 While 5-year HCC recurrence rate following liver transplantation is less than 15%, it exceed 70% (60-85%) 7 in patients with ablation and surgical resection. 1,3 Surgical resection have been claimed to have an edge over ablation due to lessor recurrence rate in some studies, but a metaanalysis and systematic review comparing RFA and resection reported similar over-all 5-year survival rate of $80% and RFA is relatively less expensive.…”

“…Therefore, in cases where SR is not a suitable treatment, ablative measures are preferred. 1,3,7 Treatment of choice in HCC occurring in the noncirrhotic liver and in very early suitable HCC is resection as is depicted in BCLC staging in figure. 1,3 However, early or very early HCC can be detected by instituting surveillance of high-risk patients by using regular screening techniques like abdominal ultrasonography with alfa-fetoprotein (AFP), as recommended in various guidelines on HCC, at every 6 months.…”