Features of extrahepatic metastasis after radiofrequency ablation for hepatocellular carcinoma

Abstract

BACKGROUND Extrahepatic metastasis (EHM) of hepatocellular carcinoma (HCC) is associated with poor outcomes. However, the clinical features and risk factors of EHM of HCC after radiofrequency ablation (RFA) remain unclear. AIM To elucidate the characteristics and risk factors of EHM after RFA for HCC. METHODS From January 2008 to December 2017, we retrospectively enrolled 661 patients who underwent RFA as first-line treatment for HCC at 2 tertiary hospitals. The inclusion criteria were age ≥ 18 years, a diagnosis of HCC, and treatment-naivety. Abdominal computed tomography (CT) or magnetic resonance imaging (MRI) and alpha-fetoprotein measurements were routinely performed at 1 mo after RFA and followed-up at intervals of 3-6 mo. Univariate analyses were performed using the chi-squared test or Student’s t -test, and univariate and multivariate analyses were performed via logistic regression, as appropriate. RESULTS EHM was diagnosed in 44 patients (6.7%) during a median follow-up period of 1204 days. The 10-year cumulative rate of HCC recurrence and EHM was 92.7% and 33.7%, respectively. Initial recurrence was most often intrahepatic, and the rate of extrahepatic recurrence at initial recurrence was only 1.2%. The median time to the diagnosis of EHM was 2.68 years, and 68.2% of patients developed EHM within 2 years of the first recurrence, regardless of recurrence-free survival and 75.0% of patients developed EHM within 5 years after first recurrence. EHM was mostly diagnosed via abdominal CT/MRI in 33 (75.0%) and 38 of 44 patients (86.4%) with EHM had either positive abdominal CT scan results or serum AFP level elevation. In multivariate analysis, recurrence-free survival < 2 years, ablation zone/tumor size < 2, and alpha-fetoprotein level > 400 IU/mL were associated with a high EHM risk. CONCLUSION EHM occurs following multiple intrahepatic recurrences after RFA and combined contrast-enhanced abdominal CT and serum AFP were useful for surveillance. Patients especially with high-risk factors require close follow-up for EHM.

Simple parameters predicting extrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma

“…Recent studies have shown that high AFP levels were independent risk factors of HCC invasiveness 27 – 30 . Similarly, our previous study on EHR in RFA for HCC also demonstrated an association between the AFP level and HCC recurrence when the AFP level was > 400 IU/mL, in line with our findings 17 .…”

“…Another study identified IHR as the most common initial site of recurrence, with EHR developing after several treatments for IHR 19 . Uchino et al reported that 82.2% of patients with HCC with EHR presented with IHR, a finding comparable to those of our previous study 17 . Therefore, multiple IHRs may indicate EHR risk in patients with HCC 20 .…”

“…The current results of HCC recurrence and EHR development rates suggested some distinction from our previous study of HCC patients who underwent RFA 17 . In that study, the median times to first HCC recurrence and EHR after RFA were 1.75 and 2.68 years, respectively.…”

Clinical features of extrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma: simple parameters predicting extrahepatic recurrence

“…Another study identi ed IHR as being the most common initial site of recurrence, with EHR developing after several treatments for IHR [21]. Uchino et al reported that 82.2% of HCC patients with EHR presented with IHR, a nding comparable to those of our previous study [19]. Therefore, multiple IHRs can be an indication of EHR risk in patients with HCC [22].…”

“…Current results of HCC recurrence and EHR development rates suggest some distinction from our previous study of HCC patients who underwent RFA [19]. In that study, the median time to rst HCC recurrence and EHR after RFA was 1.75 years and 2.68 years, respectively, with 1-, 3-, 5-, 8-, and 10-year rates of EHR development of 1.0%, 2.9%, 8.1%, 15.7%, and 33.7%, respectively.…”