Risk factors for recurrence beyond Milan criteria after radiofrequency ablation in transplantable small hepatocellular carcinoma.

This study aimed to determine the risk factors of recurrence beyond Milan criteria in patients with transplantable early hepatocellular carcinoma (HCC) after the first Radiofrequency ablation (RFA). 95 patients with newly diagnosed transplantable small HCC with single ≤3 cm lesions were analyzed retrospectively. During the 39-month median follow-up period, 12 (21.8%) patients with HCC < 2 cm and 22 (56.4%) patients with HCC ≥ 2 cm relapsed beyond Milan criteria (p = 0.001). The 1- and 3-year recurrence rates beyond Milan criteria were 6.3% and 14.7% in the HCC <2 cm group, compared with 24.1% and 55.6% in HCC ≥2 cm group (p < 0.0001). HCC ≥2 cm, red blood cell distribution width-to-lymphocyte ratio (RLR) ≥ 18.3, alpha-fetoprotein (AFP) >15 ng/ml and early recurrence after RFA were independent predictors of recurrence exceeding Milan criteria. Close follow-up and early liver transplantation should be initiated to obtain the best survival benefit for patients with transplantable early single small HCC with a tumor diameter ≥2 cm and higher RLR and AFP levels before the first RFA and early recurrence after RFA (recurrence within 2 years).