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

Abstract

Multifocality is usually reported as a pejorative factor after percutaneous thermal ablation (PTA) of HCC but little is known in Western series. Recurrence and survival were extracted from a prospective database of all patients who underwent PTA for ≤3 cm HCC. From January 2015 to April 2020, we analyzed 281 patients with unifocal (n = 216), bifocal (n = 46) and trifocal (n = 16) HCC. PTA of bi- and trifocal HCC resulted in a high risk of very early (<6 months) distant recurrence (38.8% and 50%, respectively). Median RFS was 23.3 months (95% CI:18.6–30.4), 7.7 months (95% CI:5.1–11.43, p = 0.002) and 5.2 months (95% CI:3–12.3, p = 0.015), respectively, for uni-, bi- and trifocal HCC groups. In a multivariate analysis, both bifocal (HR = 2.46, p < 0.001) and trifocal (HR = 2.70, p = 0.021) vs. unifocal HCC independently predicted shorter RFS. Median OS in trifocal HCC group was 30.3 months (95 CI:19.3-not reached). Trifocal vs. unifocal HCC independently predicted shorter OS (HR = 3.30, p = 0.008), whereas bifocal vs. unifocal HCC did not (p = 0.27). Naïve patient (HR = 0.42, p = 0.007), AFP > 100 ng/mL (HR = 3.03, p = 0.008), MELD > 9 (HR = 2.84, p = 0.001) and steatotic HCC (HR = 0.12, p = 0.038) were also independent predictors of OS. In conclusion, multifocal HCCs in a Western population have a dramatically increased risk of distant recurrence. OS after PTA of trifocal HCC is significantly below what was expected after a curative treatment.

Comparing Safety and Efficacy of TACE + Apatinib in Combination with a PD-1 Inhibitor versus a Non-triple Therapy for Treating Advanced Primary Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

“…Hence, TACE stands as the standard treatment for intermediate-stage HCC [48][49][50]. However, a number of patients experience early recurrences following TACE [51][52][53]. Scholars have regarded adjuvant therapy post-TACE as a potential strategy to mitigate recurrence [54].…”

Non‐transplantable recurrence after percutaneous thermal ablation of ≤3‐cm HCC: Predictors and implications for treatment allocation

“…During follow-up, the first three occurrences of both local and distant recurrences (according to usual definitions [15,19] ) were recorded. In the case of tumor relapse, the following characteristics of tumor recurrence were collected on follow-up imaging: number of HCC nodules according to EASL criteria, size of the largest nodule, presence of portal vein invasion (PVI) as detected by MRI (from subsegmental to main PVI), and presence of extrahepatic metastasis.…”

PD1 and TIM3 Expression is Associated with Very Early Hepatocellular Carcinoma Recurrence After Percutaneous Thermal Ablation

“…9 Alpha-fetoprotein (AFP) >100 ng/mL and tumor size were found to be predictive factors for IDR, 9 as well as multifocal lesions. 10 During the last decade, immunotherapies, mainly immune checkpoint inhibitors (ICIs), have emerged as promising cancer therapies. 11 While targeting the programmed cell death 1 (PD1) pathway in monotherapy failed to achieve statistically significant improvement in HCC patients, 12 the combination of atezolizumab (anti-PD-L1) and bevacizumab (anti-VEGF) has shown better overall and progression-free survival outcomes than sorafenib in patients with unresectable HCC.…”