Abstract

Purpose

To evaluate the feasibility, effectiveness, and treatment outcomes of percutaneous radiofrequency ablation (RFA) in the application of intrahepatic recurrent hepatocellular carcinoma (r-HCC) after liver transplantation (LT).

Methods

From April 2008 to December 2019, a total of 37 patients (34 male and 3 female, mean age: 48.7 ± 10.5 years) with 61 r-HCCs after LT treated by RFA as a first-line option were enrolled. The technical success, recurrence-free survival (RFS), overall survival (OS) and complications were evaluated.

Results

After the first session of RFA, three patients were detected with residual foci. All of them received additional session of RFA and two tumors were successfully ablated. Therefore, the technical success was 97.3% (36/37). During the follow-up period, a total of 7 tumors developed local tumor progression (LTP) after 2.2–10.8 months. The LTP rate was 11.7% for r-HCC in the transplanted liver. The median RFS was 4.8 months (95% confidence interval [CI]: 2.2–7.3 months). The 1-, 3-, and 5-year cumulative OS rates were 68.5%, 40.3%, and 40.3%, respectively. Multivariate analyses revealed that tumor size was the only independent predictor for RFS (hazard ratio [HR] = 2.557, 95% CI, 1.015–6.444; p = .046) and limited extrahepatic metastasis was the only independent prognostic factors of OS after RFA for post-LT r-HCC (HR = 4.031, 95%CI, 1.218–13.339; p = .022). Major complications after RFA occurred in two patients (2/37, 5.4%).

Conclusion

Percutaneous RFA is safe and effective for intrahepatic r-HCC after LT, especially for those without limited extrahepatic metastasis.

中文翻译：

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肝移植后肝内复发性肝细胞癌经皮射频消融的可行性和结果：单中心经验

摘要

目的

为了评估经皮射频消融术（RFA）在肝移植（LT）后肝内复发性肝细胞癌（r-HCC）应用中的可行性，有效性和治疗效果。

方法

从2008年4月至2019年12月，共纳入了37例接受RFA作为一线治疗的LT患者，其中61例r-HCC患者（男34例，女3例，平均年龄：48.7±10.5岁）。评估了技术成功率，无复发生存期（RFS），总生存期（OS）和并发症。

结果

第一次RFA后，发现三名患者有残留病灶。他们都接受了额外的RFA治疗，并且成功消融了两个肿瘤。因此，技术成功率为97.3％（36/37）。在随访期间，总共有7个肿瘤在2.2–10.8个月后出现了局部肿瘤进展（LTP）。r-HCC在移植肝中的LTP率为11.7％。中位RFS为4.8个月（95％置信区间[CI]：2.2–7.3个月）。1年，3年和5年累积OS率分别为68.5％，40.3％和40.3％。多变量分析显示，肿瘤大小是RFS的唯一独立预测因子（危险比[HR] = 2.557，95％CI，1.015–6.444；p = .046），有限的肝外转移是LTA后r-HCC RFA后OS的唯一独立预后因素（HR = 4.031，95％CI，1.218–13.339；p  = .022）。RFA后发生的主要并发症有2例（2 / 37，5.4％）。

结论

经皮RFA对于LT后肝内r-HCC是安全有效的，特别是对于那些无局限性肝外转移的患者。