Multimodal Percutaneous Thermal Ablation of Small Hepatocellular Carcinoma: Predictive Factors of Recurrence and Survival in Western Patients.

BACKGROUND

To identify the predictive factors of recurrence and survival in an unselected population of Western patients who underwent multimodal percutaneous thermal ablation (PTA) for small Hepatocellular Carcinomas (HCCs).

METHODS

January 2015-June 2019: data on multimodal PTA for <3 cm HCC were extracted from a prospective database. Local tumor progression (LTP), intrahepatic distant recurrence (IDR), time-to-LTP, time-to-IDR, recurrence-free (RFS) and overall (OS) survival were evaluated.

RESULTS

238 patients underwent 317 PTA sessions to treat 412 HCCs. During follow-up (median: 27.1 months), 47.1% patients had IDR and 18.5% died. LTP occurred after 13.3% of PTA. Tumor size (OR = 1.108, < 0.001; hazard ratio (HR) = 1.075, = 0.002) and ultrasound guidance (OR = 0.294, = 0.017; HR = 0.429, = 0.009) independently predicted LTP and time-to-LTP, respectively. Alpha fetoprotein (AFP) > 100 ng/mL (OR = 3.027, = 0.037) and tumor size (OR = 1.06, = 0.001) independently predicted IDR. Multinodular HCC (HR = 2.67, < 0.001), treatment-naïve patient (HR = 0.507, = 0.002) and AFP > 100 ng/mL (HR = 2.767, = 0.014) independently predicted time-to-IDR. RFS was independently predicted by multinodular HCC (HR = 2.144, = 0.001), treatment naivety (HR = 0.546, = 0.004) and AFP > 100 ng/mL (HR = 2.437, = 0.013). The American Society of Anesthesiologists (ASA) score > 2 (HR = 4.273, = 0.011), AFP (HR = 1.002, < 0.001), multinodular HCC (HR = 3.939, = 0.003) and steatotic HCC (HR = 1.81 × 10, < 0.001) independently predicted OS.

CONCLUSIONS

IDR was associated with tumor aggressiveness, suggesting a metastatic mechanism. Besides AFP association with LTP, IDR, RFS and OS, treatment-naïve patients had longer RFS, and multi-nodularity was associated with shorter RFS and OS. Steatotic HCC, identified on pre-treatment MRI, independently predicted longer OS, and needs to be further explored.