Upfront multi-bipolar radiofrequency ablation for HCC in transplant-eligible cirrhotic patients with salvage transplantation in case of recurrence

Liver Int. 2024 Jun;44(6):1464-1473. doi: 10.1111/liv.15900. Epub 2024 Apr 6.

Abstract

Introduction: We aim to assess the long-term outcomes of percutaneous multi-bipolar radiofrequency (mbpRFA) as the first treatment for hepatocellular carcinoma (HCC) in transplant-eligible cirrhotic patients, followed by salvage transplantation for intrahepatic distant tumour recurrence or liver failure.

Materials and methods: We included transplant-eligible patients with cirrhosis and a first diagnosis of HCC within Milan criteria treated by upfront mbp RFA. Transplantability was defined by age <70 years, social support, absence of significant comorbidities, no active alcohol use and no recent extrahepatic cancer. Baseline variables were correlated with outcomes using the Kaplan-Meier and Cox models.

Results: Among 435 patients with HCC, 172 were considered as transplantable with HCCs >2 cm (53%), uninodular (87%) and AFP >100 ng/mL (13%). Median overall survival was 87 months, with 75% of patients alive at 3 years, 61% at 5 years and 43% at 10 years. Age (p = .003) and MELD>10 (p = .01) were associated with the risk of death. Recurrence occurred in 118 patients within Milan criteria in 81% of cases. Local recurrence was observed in 24.5% of cases at 10 years and distant recurrence rates were observed in 69% at 10 years. After local recurrence, 69% of patients were still alive at 10 years. At the first tumour recurrence, 75 patients (65%) were considered transplantable. Forty-one patients underwent transplantation, mainly for distant intrahepatic tumour recurrence. The overall 5-year survival post-transplantation was 72%, with a tumour recurrence of 2.4%.

Conclusion: Upfront multi-bipolar RFA for a first diagnosis of early HCC on cirrhosis coupled with salvage liver transplantation had a favourable intention-to-treat long-term prognosis, allowing for spare grafts.

Keywords: hepatocellular carcinoma; percutaneous ablation; radiofrequency; salvage transplantation.

MeSH terms

  • Aged
  • Carcinoma, Hepatocellular* / mortality
  • Carcinoma, Hepatocellular* / surgery
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Liver Cirrhosis* / complications
  • Liver Cirrhosis* / surgery
  • Liver Neoplasms* / mortality
  • Liver Neoplasms* / surgery
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local*
  • Proportional Hazards Models
  • Radiofrequency Ablation* / methods
  • Retrospective Studies
  • Salvage Therapy* / methods
  • Treatment Outcome