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Hepatology. 2017 Feb 7. doi: 10.1002/hep.29098. [Epub ahead of print]

Radiofrequency Ablation of Hepatocellular Carcinoma as Bridge Therapy to Liver Transplantation: A Ten Year Intention-to-treat Analysis.

Author information

  • 1Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095.
  • 2Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine.
  • 3Department of Radiology, Chulabhorn Hospital, Bangkok, Thailand.
  • 4Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA.
  • 5Department of Medicine, Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California.
  • 6Department of Surgery, Dumont-UCLA Transplant and Liver Cancer Centers, Los Angeles, CA.

Abstract

In a long-term (10 years) study of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) as bridging therapy in patients listed for orthotopic liver transplantation (LT), we evaluated the impact of RFA on waiting list dropout rate, post-LT tumor recurrence, and long-term intention to treat, disease-specific survival. From March 2004 to October 2014, RFA was performed as the initial stand-alone bridge therapy to LT for 121 patients (male:female = 83:38; mean age, 60.0 years) with 156 de-novo HCCs (mean size: 2.4 cm). Follow-up period from initial RFA ranged from 1.3 to 128.0 months (median: 42.9 months). We assessed the overall and tumor specific waiting list dropout rates, post-LT tumor recurrence, and the 10-year post-LT and intention-to-treat survival rates. Drop out from the waiting list due to tumor progression occurred in 7.4% of patients. HCC recurrence after LT occurred in 5.6% of patients. Post-LT overall survival (OS) and recurrence-free survival (RFS) rates at 5 and 10 years were 75.8% and 42.2%, and 71.1% and 39.6% respectively. Intention-to-treat OS, RFS, and disease-specific survival (DSS) rates for the entire study population at 5 and 10 years were 63.5% and 41.2%, 60.8% and 37.7%, and 89.5% and 89.5%, respectively.

CONCLUSION:

In the largest and longest intention-to-treat study to date of HCC treated by RFA as first line stand-alone bridge therapy to LT, long term overall and tumor specific survivals were excellent, with low dropout rate from tumor progression despite long wait list times, and sustained low tumor recurrence rate upon follow up post LT up to 10 years. This article is protected by copyright. All rights reserved.

KEYWORDS:

Dropout; Hepatocellular carcinoma; Liver transplantation; Radiofrequency ablation; Ten-year survival

PMID:
28170115
DOI:
10.1002/hep.29098
[PubMed - as supplied by publisher]
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