Muñoz-Martínez Sergio, Sapena Victor, García-Criado Ángeles, Darnell Anna, Forner Alejandro, Belmonte Ernest, Sanduzzi-Zamparelli Marco, Rimola Jordi, Soler Alexandre, Llarch Neus, Iserte Gemma, Mauro Ezequiel, Ayuso Carmen, Rios Jose, Bruix Jordi, Vilana Ramon, Reig María
Barcelona Clinic Liver Cancer (BCLC) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain.
Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain.
Cancers (Basel). 2023 Jun 21;15(13):3269. doi: 10.3390/cancers15133269.
Ablation is a first-line treatment for Barcelona Clinic Liver Cancer (BCLC)-0/A hepatocellular carcinoma (HCC). However, there are scarce data about patients' outcomes after recurrence. The present study evaluates the impact of patient and tumor characteristics at baseline and at recurrence on the Clinical Decision-Making process.
We evaluated BCLC-0/A patients treated with percutaneous ablation from January 2010 to November 2018. Clinical and radiological data such as age, tumor location at ablation, pattern of recurrence/progression, and comorbidities during follow-up were registered. Tumor location was divided into 'suboptimal' vs. 'optimal' locations for ablation. The Clinical Decision-Making was based on tumor burden, liver dysfunction, or comorbidities. The statistical analysis included the time-to-recurrence/progression, censoring at time of death, date of last follow-up or liver transplantation, and time-to-event was estimated by the Kaplan-Meier method and Cox regression models to evaluate the risk of an event of death and change of treatment strategy.
A total of 225 patients [39.1% BCLC-0 and 60.9% BCLC-A] were included, 190 had unifocal HCC and 82.6% were ≤3 cm. The complete response rate and median overall survival were 96% and 60.7 months. The HCC nodules number (Hazard Ratio-HR 3.1), Child-Pugh (HR 2.4), and Albumin-Bilirubin score (HR 3.2) were associated with increased risk of death during follow-up. HCC in 'suboptimal location' presented a shorter time to recurrence. When comorbidities prevented further loco-regional or systemic treatment, the risk of death was significantly increased (HR 2.0, = 0.0369) in comparison to those who received treatment.
These results expose the impact of non-liver comorbidities when considering treatment for recurrence after ablation in the real-world setting and in research trials. Ultimately, we identified an orphan population for which effective interventions are needed.
消融是巴塞罗那临床肝癌（BCLC）-0/A期肝细胞癌（HCC）的一线治疗方法。然而，关于复发后患者预后的数据很少。本研究评估基线和复发时患者及肿瘤特征对临床决策过程的影响。
我们评估了2010年1月至2018年11月接受经皮消融治疗的BCLC-0/A期患者。记录临床和放射学数据，如年龄、消融时肿瘤位置、复发/进展模式以及随访期间的合并症。肿瘤位置分为消融的“非最佳”位置与“最佳”位置。临床决策基于肿瘤负荷、肝功能不全或合并症。统计分析包括复发/进展时间、死亡时、最后随访或肝移植时的截尾，事件发生时间采用Kaplan-Meier方法和Cox回归模型估计，以评估死亡事件和治疗策略改变的风险。
共纳入225例患者[BCLC-0期占39.1%，BCLC-A期占60.9%]，190例为单发性HCC，82.6%的肿瘤直径≤3 cm。完全缓解率和中位总生存期分别为96%和60.7个月。HCC结节数量（风险比-HR 3.1）、Child-Pugh评分（HR 2.4）和白蛋白-胆红素评分（HR 3.2）与随访期间死亡风险增加相关。“非最佳位置”的HCC复发时间较短。当合并症妨碍进一步的局部区域或全身治疗时，与接受治疗的患者相比，死亡风险显著增加（HR 2.0，P = 0.0369）。
这些结果揭示了在现实世界环境和研究试验中，考虑消融后复发治疗时非肝脏合并症的影响。最终，我们确定了一个需要有效干预的特殊人群。
