Hepatogastroenterology Department, Caen University Hospital, Avenue de la Côte de Nacre, Caen, France.
Radiology Department, Hospices Civils de Lyon, Lyon, France.
Liver Int. 2022 Apr;42(4):905-917. doi: 10.1111/liv.15129. Epub 2022 Jan 5.
BACKGROUND & AIMS: Long-term outcomes after percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD) have been poorly studied. We aim to determine the outcomes after multibipolar RFA in these patients compared to other aetiologies as well as the prognostic impact of metabolic syndrome (MS).
Patients who underwent multibipolar RFA as the first treatment for HCC within Milan criteria (2008-2018) were enrolled in this multicentre retrospective cohort from four tertiary centres in France. The association of MS and NAFLD with adverse events and outcomes after percutaneous RFA were assessed using Kaplan Meier method, log-rank test and uni/multivariate analysis with the Cox models.
Among 520 patients, 390 patients (75%) had at least one component of MS including obesity (30%) and 95% had cirrhosis. Sixty-two patients (12.6%) had NAFLD-HCC, 225 (45.5%) had alcohol-related-HCC, 36 (7.3%) had HBV-HCC and 171 (34.6%) had HCV-HCC. Patients with NAFLD-HCC were significantly older (median age 72.6 years, P < .001), more obese (median BMI 30.3 kg/m , P < .001) and had more components of MS. Patients with NAFLD-HCC achieved a median overall survival (OS) of 79 months (1-year, 3-year and 5-year OS of 90%, 71% and 59%). There were no differences in morbidity, tumour recurrence and OS among patients with NAFLD-HCC vs other aetiologies as well as no prognostic impact of metabolic components.
Percutaneous multibipolar RFA is an efficient treatment in HCC patients with NAFLD or metabolic syndrome and achieved similar long-term oncological outcomes compared to other aetiologies.
非酒精性脂肪性肝病（NAFLD）患者经皮射频消融（RFA）治疗肝细胞癌（HCC）的长期疗效研究甚少。本研究旨在比较多极 RFA 治疗此类患者与其他病因患者的疗效，并分析代谢综合征（MS）对预后的影响。
本多中心回顾性队列研究纳入了 2008 年至 2018 年期间在法国四家三级中心接受多极 RFA 作为米兰标准内 HCC 一线治疗的患者。采用 Kaplan-Meier 法、Log-rank 检验及单因素/多因素 Cox 回归分析评估 MS 和 NAFLD 与经皮 RFA 后不良事件和结局的相关性。
520 例患者中，390 例（75%）至少存在一项 MS 组分，包括肥胖（30%）和肝硬化（95%）。62 例（12.6%）患者为 NAFLD-HCC，225 例（45.5%）为酒精相关性 HCC，36 例（7.3%）为 HBV-HCC，171 例（34.6%）为 HCV-HCC。NAFLD-HCC 患者的年龄显著更大（中位年龄 72.6 岁，P<0.001）、更肥胖（中位 BMI 30.3kg/m2，P<0.001），且 MS 组分更多。NAFLD-HCC 患者的中位总生存（OS）为 79 个月（1 年、3 年和 5 年 OS 率分别为 90%、71%和 59%）。与其他病因患者相比，NAFLD-HCC 患者的发病率、肿瘤复发和 OS 无差异，MS 组分对预后也无影响。
经皮多极 RFA 是治疗 HCC 合并 NAFLD 或 MS 患者的有效方法，与其他病因患者相比，长期肿瘤学疗效相当。
