Non‐transplantable recurrence after percutaneous thermal ablation of ≤3‐cm HCC: Predictors and implications for treatment allocation

• Published in: Hepatology communications 2022-10, Vol.6 (10), p.2975-2987
• Main Authors: Gozzo, Cecilia, Hermida, Margaux, Herrero, Astrid, Panaro, Fabrizio, Cassinotto, Christophe, Mohamad, Azhar Meerun, Assenat, Eric, Guillot, Chloé, Allimant, Carole, Schembri, Valentina, Basile, Antonio, Dharancy, Sébastien, Ursic‐Bedoya, José, Guiu, Boris
• Format: Article
• Language: English
• Subjects: Ablation; alpha-Fetoproteins; Carcinoma, Hepatocellular - surgery; Comorbidity; Diabetes; Humans; Life Sciences; Liver cancer; Liver cirrhosis; Liver diseases; Liver Neoplasms - surgery; Magnetic resonance imaging; Metastasis; Neoplasm Recurrence, Local - epidemiology; Patients; Retrospective Studies; Success; Transplants & implants; Variables
• ISSN: 2471-254X; 2471-254X
• DOI: 10.1002/hep4.2063

Percutaneous thermal ablation (PTA), resection, and liver transplantation are the standard curative options for hepatocellular carcinoma (HCC). Liver transplantation yields the best long‐term outcomes but is limited by graft shortage. Thus, patients with ≤3‐cm HCC are primarily treated by PTA even though recurrence is frequent and may occur outside transplant criteria. Data on non‐transplantable recurrence (NTR) following PTA are lacking, however. We therefore investigated the incidence and predictors of NTR among 213 potentially transplantable patients (cirrhosis, 93%; Child‐Pugh A, 98.6%; alcohol‐related disease, 62%) with ≤3‐cm HCC(s) treated by PTA, to stratify them according to their NTR risk and to improve treatment allocation. During follow‐up (median: 41.2 months), NTR occurred in 18.3% (alpha‐fetoprotein [AFP] model) and 23% (Milan) patients. NTR prediction with competing‐risk analysis and internal validation revealed AFP > 100 ng/ml (subdistribution hazard ratio: 7.28; p