Upfront multi‐bipolar radiofrequency ablation for HCC in transplant‐eligible cirrhotic patients with salvage transplantation in case of recurrence

Abstract

AbstractIntroductionWe aim to assess the long‐term outcomes of percutaneous multi‐bipolar radiofrequency (mbpRFA) as the first treatment for hepatocellular carcinoma (HCC) in transplant‐eligible cirrhotic patients, followed by salvage transplantation for intrahepatic distant tumour recurrence or liver failure.Materials and MethodsWe included transplant‐eligible patients with cirrhosis and a first diagnosis of HCC within Milan criteria treated by upfront mbp RFA. Transplantability was defined by age <70 years, social support, absence of significant comorbidities, no active alcohol use and no recent extrahepatic cancer. Baseline variables were correlated with outcomes using the Kaplan‐Meier and Cox models.ResultsAmong 435 patients with HCC, 172 were considered as transplantable with HCCs >2 cm (53%), uninodular (87%) and AFP >100 ng/mL (13%). Median overall survival was 87 months, with 75% of patients alive at 3 years, 61% at 5 years and 43% at 10 years. Age (p = .003) and MELD>10 (p = .01) were associated with the risk of death. Recurrence occurred in 118 patients within Milan criteria in 81% of cases. Local recurrence was observed in 24.5% of cases at 10 years and distant recurrence rates were observed in 69% at 10 years. After local recurrence, 69% of patients were still alive at 10 years. At the first tumour recurrence, 75 patients (65%) were considered transplantable. Forty‐one patients underwent transplantation, mainly for distant intrahepatic tumour recurrence. The overall 5‐year survival post‐transplantation was 72%, with a tumour recurrence of 2.4%.ConclusionUpfront multi‐bipolar RFA for a first diagnosis of early HCC on cirrhosis coupled with salvage liver transplantation had a favourable intention‐to‐treat long‐term prognosis, allowing for spare grafts.