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Radiofrequency ablation of hepatocellular carcinoma as bridge therapy to liver transplantation: A 10‐year intention‐to‐treat analysis
Author(s) -
Lee Min Woo,
Raman Steven S.,
Asvadi Nazanin H.,
Siripongsakun Surachate,
Hicks Robert M.,
Chen Jeffrey,
Worakitsitisatorn Akeag,
McWilliams Justin,
Tong Myron J.,
Finn Richard S.,
Agopian Vatche G.,
Busuttil Ronald W.,
Lu David S.K.
Publication year - 2017
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.29098
Subject(s) - medicine , hepatocellular carcinoma , radiofrequency ablation , liver transplantation , surgery , gastroenterology , population , survival rate , transplantation , oncology , urology , ablation , environmental health
In a long‐term (10‐year) 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 (DSS). From March 2004 to October 2014, RFA was performed as the initial stand‐alone bridge therapy to LT for 121 patients (men/women ratio, 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 10‐year post‐LT and intention‐to‐treat survival rates. Dropout from the waiting list due to tumor progression occurred in 7.4% of patients. HCC recurrence after LT occurred in 5.6% of patients. The post‐LT overall survival (OS) rate at 5 and 10 years was 75.8% and 42.2%, respectively, and the recurrence‐free survival (RFS) rate was 71.1% and 39.6%, respectively. Intention‐to‐treat OS, RFS, and 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 : RFA as a first‐line stand‐alone bridge therapy to LT achieves excellent long‐term overall and tumor‐specific survivals, with a low dropout rate from tumor progression despite long wait list times and a sustained low tumor recurrence rate upon post‐LT follow‐up of up to 10 years. (H epatology 2017;65:1979‐1990)