Survival after radiofrequency ablation and salvage transplantation in patients with hepatocellular carcinoma and Child-Pugh A cirrhosis

详细信息    查看全文

• 作者：Gisè ; le N’ ; Kontchou¹ ; Mounir Aout² ; Alexis Laurent³ ; Pierre Nahon¹ ; Nathalie Ganne-Carrié ; ¹ ; Vé ; ronique Grando¹ ; Iman Baghad¹ ; Dominique Roulot¹ ; Jean Claude Trinchet¹ ; Nicolas Sellier⁴ ; Daniel Cherqui³ ; Eric Vicaut² ; Michel Beaugrand¹ ; Olivier Seror⁴ ;   ; ^{olivier.seror@jvr.aphp.fr}
• 关键词：Primary liver cancer ; Hepatoma ; Percutaneous ablation ; Liver graft ; Recurrence
• 刊名：Journal of Hepatology
• 出版年：2012
• 出版时间：January 2012
• 年：2012
• 卷：56
• 期：1
• 页码：160-166
• 全文大小：600 K

文摘

Background & Aims

In patients with hepatocellular carcinoma (HCC) within the Milan criteria, liver transplantation (LT) may be the best therapeutic option. However, the shortage of grafts, leads to attempt liver resection (LR) or radiofrequency ablation (RFA) as a first-line treatment for patients with Child-Pugh A cirrhosis.

Methods

We report results, obtained between 2000 and 2007 from a single center, involving 67 patients (mean age: 57 years) eligible for LT, who were treated with RFA, followed by LT if there was recurrence or liver failure.

Results

Eighty three tumors were treated (mean size: 29 ¡À 9 mm; 16 binodular forms). RFA achieved complete ablation in 96 % of nodules. No mortality occurred. During a post-RFA median follow-up of 48 months, 38 patients experienced recurrence, corresponding to a 5-year recurrence rate of 58 % . Of these, 14 patients did not receive a transplant because they fell outside the Milan criteria, 21 were transplanted, and 3 were treated by RFA after refusing LT. Binodularity (95 % CI HR = 2, 1.0?.0; p = 0.049) was the unique risk factor for recurrence. By the study¡¯s end-point, 24 patients had undergone LT (21 for HCC recurrence and three for liver failure). No HCC recurrence occurred after LT. Among the 43 non-transplant patients, 12 died due to HCC progression, and 27 were alive without detectable viable tumor. The probability rates for 5-year overall and tumor-free survival were 74 % and 69 % , respectively.

Conclusions

First line RFA followed by salvage LT allows survival figures that are at least as good as a first-line LT, while limiting the number of grafts.