Risk factors for recurrence beyond Milan criteria after radiofrequency ablation in transplantable small hepatocellular carcinoma

Abstract

This study aims to determine the risk factors of recurrence beyond Milan criteria in patients with transplantable early hepatocellular carcinoma (HCC) after the first Radiofrequency ablation (RFA). 95 patients with newly diagnosed transplantable small HCC with single ≤ 3 cm were analyzed retrospectively. During the 39-month median follow-up period, 12 (21.8%) patients with HCC < 2 cm and 22 (56.4%) patients with HCC ≥ 2 cm relapsed beyond Milan criteria (p = 0.001). The 1and 3-year recurrence rates beyond Milan criteria were 6.3% and 14.7% in HCC < 2 cm group, compared with 24.1% and 55.6% in HCC ≥ 2 cm group(p < 0.0001).HCC ≥ 2 cm, red blood cell distribution width-to-lymphocyte ratio (RLR) ≥ 18.3, alphafetoprotein (AFP) > 15 ng/ml and early recurrence after RFA were independent predictors of recurrence exceeding Milan criteria. For patients with transplantable early single small HCC whose tumor diameter ≥ 2cm and have higher RLR and AFP levels before first RFA and early recurrence after RFA (recurrence within 2 years), close follow-up and early liver transplantation should be initiated to obtain the best survival benefit.

Red blood cell distribution width derivatives in alcohol-related liver cirrhosis and metabolic-associated fatty liver disease

“…RDW was even proposed as a prognostic marker in the course of hepatocellular carcinoma[ 26 , 27 ]. What is more, recently a higher level of RLR has been explored as a potential marker of its recurrence[ 28 ]. In our ALC group, RPR correlated positively with MELD score and the diagnostic accuracy of both: RDW and RPR turned out to be high (AUC = 0.912 and AUC = 0.965, respectively).…”

Frontline resection or liver transplantation in patients with single‐nodule hepatocellular carcinoma

“…Although complete radiological response after ablation could be achieved in the vast majority of patients, tumour recurrence rates are as high as 70% 3 . Liver resection could be considered more appropriate than local ablation for nodules larger than 2 cm or in smaller nodules if there is no contraindication for an eventual LT, but still, HCC recurrence may occur in 50%–70% 3,4 . Adjuvant therapies could decrease this risk in the future but their efficacy needs to be confirmed 5 .…”

“…3 Liver resection could be considered more appropriate than local ablationfornoduleslargerthan2 cmorinsmallernodulesifthere isnocontraindicationforaneventualLT,butstill,HCCrecurrence may occur in 50%-70%. 3,4 Adjuvant therapies could decrease this riskinthefuturebuttheirefficacyneedstobeconfirmed. 5 Incontrast,LTisassociatedwithreducedHCCrecurrencerates(around 10% in single-nodule HCC under Milan) and 5-year survival rates around80%.…”