Multi-Organ Transplant Program, Toronto General Hospital, University of Toronto, Toronto, Canada; Department of Gastroenterology and Hepatology, Royal Perth Hospital, Australia.
Multi-Organ Transplant Program, Toronto General Hospital, University of Toronto, Toronto, Canada.
J Hepatol. 2019 May;70(5):866-873. doi: 10.1016/j.jhep.2018.12.027. Epub 2019 Jan 5.
BACKGROUND & AIMS: Radiofrequency ablation (RFA) is an effective treatment for single hepatocellular carcinoma (HCC) ≤3 cm. Disease recurrence is common, and in some patients will occur outside transplant criteria. We aimed to assess the incidence and risk factors for recurrence beyond Milan criteria in potentially transplantable patients treated with RFA as first-line therapy.
We performed a retrospective cohort study of potentially transplantable patients with new diagnoses of unifocal HCC ≤3 cm that underwent RFA as first-line therapy between 2000-2015. We defined potentially transplantable patients as those aged <70 years without any comorbidities that would preclude transplant surgery. Incidence of recurrence beyond Milan criteria was compared across 2 groups according to HCC diameter at the time of ablation: (HCC ≤2 cm vs. HCC >2 cm). Competing risks Cox regression was used to identify predictors of recurrence beyond Milan criteria.
We included 301 patients (167 HCC ≤2 cm and 134 HCC >2 cm). Recurrence beyond Milan criteria occurred in 36 (21.6%) and 47 (35.1%) patients in the HCC ≤2 cm and the HCC >2 cm groups, respectively (p = 0.01). The 1-, 3- and 5-year actuarial survival rates after RFA were 98.2%, 86.2% and 79.0% in the HCC ≤2 cm group vs. 93.3%, 77.6% and 70.9% in the HCC >2 cm group (p = 0.01). Tumor size >2 cm (hazard ratio 1.94; 95%CI 1.25-3.02) and alpha-fetoprotein levels at the time of ablation (100-1,000 ng/ml: hazard ratio 2.05; 95%CI 1.10-3.83) were found to be predictors of post-RFA recurrence outside Milan criteria.
RFA for single HCC ≤3 cm provides excellent short- to medium-term survival. However, we identified patients at higher risk of recurrence beyond Milan criteria. For these patients, liver transplantation should be considered immediately after the first HCC recurrence following RFA.
Radiofrequency ablation and liver transplantation are treatment options for early stages of hepatocellular carcinoma (HCC). After ablation some patients will experience recurrence or metastatic spread of the initial tumor or may develop new tumors within the liver. Despite close follow-up, these recurrences can progress rapidly and exceed transplant criteria, preventing the patient from receiving a transplant. We identified that patients with HCC >2 cm and higher serum alpha-fetoprotein are at greater risk of recurrence beyond the transplant criteria. These data suggest that liver transplantation should be considered immediately after the first HCC recurrence for these patients.
射频消融（RFA）是治疗单个直径≤3cm 的肝细胞癌（HCC）的有效方法。疾病复发很常见，在某些患者中，即使符合米兰标准，也会发生复发。本研究旨在评估在符合米兰标准的移植候选患者中，接受 RFA 作为一线治疗后，超出米兰标准的复发的发生率和危险因素。
我们对 2000 年至 2015 年间接受 RFA 作为一线治疗的新诊断为单发 HCC≤3cm 的符合米兰标准的移植候选患者进行了回顾性队列研究。我们将符合米兰标准的移植候选者定义为年龄<70 岁且无任何会影响移植手术的合并症的患者。根据消融时 HCC 的直径，将复发超出米兰标准的发生率在 2 组之间进行比较：（HCC≤2cm 与 HCC>2cm）。采用竞争风险 Cox 回归分析确定超出米兰标准的复发的预测因素。
我们纳入了 301 名患者（HCC≤2cm 组 167 例，HCC>2cm 组 134 例）。HCC≤2cm 组和 HCC>2cm 组中分别有 36 例（21.6%）和 47 例（35.1%）患者出现超出米兰标准的复发（p=0.01）。HCC≤2cm 组和 HCC>2cm 组的 RFA 后 1、3 和 5 年的无复发生存率分别为 98.2%、86.2%和 79.0%，77.6%和 70.9%（p=0.01）。肿瘤大小>2cm（风险比 1.94；95%CI 1.25-3.02）和消融时甲胎蛋白水平（100-1000ng/ml：风险比 2.05；95%CI 1.10-3.83）被发现是超出米兰标准后 RFA 复发的预测因素。
RFA 治疗单个 HCC≤3cm 可提供优异的短期至中期生存率。然而，我们发现存在更高超出米兰标准的复发风险的患者。对于这些患者，RFA 后首次 HCC 复发时应立即考虑肝移植。
非专业翻译，仅供参考。
