Follow-up schedule for initial recurrent hepatocellular carcinoma after ablation based on risk classification

Abstract

Background: To date, no standard follow-up guidelines exist regarding patients receiving ablation for initial recurrent hepatocellular carcinoma (HCC). We aimed to explore whether intensive follow-up could benefit these patients. Methods: We reviewed the clinical data of patients who received complete ablation for initial HCC recurrence after curative treatments in our institution from January 2005 to June 2017. Risk factors for second recurrence of HCC were identified by univariate and multivariate analyses. Patients were classified into low-and high-risk groups according to the outcome of the classification and regression model. The patients were further categorized into short-(< 3 months) and long-interval (3-6 months) follow-up subgroups based on their surveillance in the first 2 years after complete ablation for initial recurrence. The Kaplan-Meier method with log-rank test was performed to compare the overall survival (OS) based on follow-up intervals in each risk group. We also validated our results by stratifying patients into subgroups with different numbers of risk factors and comparing the OS between patients with different follow-up intervals. Results: A total of 361 patients were enrolled. The risk factors for secondary recurrence included the Barcelona Clinic Liver Cancer (BCLC) stage at initial recurrence and first recurrence-free survival after curative treatments for primary HCC (p < 0.001 and p = 0.002). Two risk groups (low and high) were identified. In both the low-and highrisk groups, the OS of patients was not associated with intervals of follow-up (p = 0.29 and 0.49). No significant difference was found in the rates of BCLC 0/A stage, tumor location or curative treatments for the second recurrence by different follow-up intervals in each risk group (p = 0.34 and 0.87; p = 0.69 and 0.97). The same tendency was found in subgroups with 0/1/2 risk factors for secondary recurrence during validation. Conclusion: The long-interval follow-up did not compromise the survival of patients with complete ablation for initial recurrent HCC.

Cost-Effectiveness Analysis of Follow-Up Schedule for Hepatocellular Carcinoma after Radiofrequency Ablation

“…Liu et al [ 37 ] found that the overall survival of the short-interval group (<4 months) was better than that of the long-interval group (4–6 months) for HCC patients with multiple tumors less than 3 cm or a solitary tumor between 3 and 5 cm following curative thermal ablation. In contrast, the intensive interval for follow-up visits has not been shown to prolong overall survival as reported in two recent studies [ 38 , 39 ]. However, costs of follow-up were not taken into account in these prior studies.…”

Multiparametric liver MRI for predicting early recurrence of hepatocellular carcinoma after microwave ablation

“…LTP is considered related to the microscopic spread of residual tumor cells beyond the ablation margin and the local environment of a tumor (e.g., contact with blood vessels). In contrast, intrahepatic and extrahepatic metastases tend to depend on the aggressiveness and biological behavior of each tumor itself [ 23 – 25 ]. This fact explains the low sensitivity of MAM in predicting overall early recurrence.…”

Treatment of hepatitis C virus infection in patients with hepatocellular carcinoma: Truth or dare?

“…However, more than half of the recurrences developed within 1 year and up to one third within 6 months 25 . Data appear to be similar for thermal ablation 26 . Per current guidelines, the recommended follow‐up regimen consists in contrast‐enhanced sectional imaging every 3 months for the first year 27,28 .…”

“…Given that no data is currently available with regards to the best timing for HCV treatment, a sensitive approach would be to start the DAAs regimen when the certainty for cancer control is maximal, and this moment appears to be in the 3–6 months range. Moreover, while choosing the optimum starting point, one might take into account previously described risk factors for recurrence, such as BCLC stage (0 vs A), tumor size, location, and the extent of vascular invasion in the resection specimen for patients who benefited from surgery 26 …”