![]() ![]() The final study population included 94 patients: 55 patients underwent RFA as their sole therapy, 16 underwent HR and 23 had LT.ĭemographic/medical data were collected prospectively via clinical interview and chart analysis, and the data retrospectively analyzed. Of the remaining 185 patients, 69 were lost to follow-up prior to the 5-year mark or were enrolled less than 5 years prior to the time of data analysis and 22 received another therapy (chemoembolization, Yttrium-90 or sorafenib) or no therapy. We excluded 865 patients with multiple tumors or tumors ≥ 3.0 cm. Inclusion criteria were the following: (1) patients with a single tumor ≤ 3.0 cm (2) treatment with HR, RFA, or LT and (3) either minimum follow-up of at least 5 years or death prior to the 5-year mark. Therefore, our goal is to identify characteristics in patients with small HCC (≤ 3.0 cm) that predict comparable long-term survival after HR or RFA versus LT, as these patients may be able to undergo non-transplant therapy and allow allocation of donor livers to those most in need. Smaller tumors have a higher likelihood of being successfully treated by non-transplant therapies. Tumors less than 3.0 cm have been shown to be well-differentiated, contained within the capsule and have better prognosis. Increasing evidence suggests that tumor size is a surrogate marker of tumor biology and surgical outcomes. Prognosis is also affected by the degree of hepatic dysfunction, patient comorbidities, and tumor biology. Direct comparisons of overall survival between HR and RFA are limited by the degree of hepatic dysfunction in the patients who are offered resection versus ablation, but retrospective studies suggest that survival after RFA may not differ significantly from that of HR in certain patient populations. Similarly, radiofrequency ablation (RFA), while not a curative therapy, is a safe and effective alternative to HR in patients who are not surgical candidates. While overall survival (OS) and recurrence-free survival are both higher in patients undergoing LT compared to HR, prior studies have found that resection in patients with a single tumor less than 3.0 cm in size may have comparable survival to those undergoing LT. Prolonged waiting times lead to dropout from the waiting list due to tumor progression exceeding criteria for LT, or death due to liver failure. However, the inadequate number of available donors significantly limits use of LT. LT is viewed as the optimal treatment for HCC as it treats both the tumor and the underlying liver disease. Potential curative therapies for HCC include hepatic resection (HR) and liver transplantation (LT). Advanced stage at diagnosis and poor underlying liver function present major challenges to treatment. Worldwide, there were 782,000 new cases in 2012 and HCC is the second leading cause of cancer-related mortality with 745,000 deaths. Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. Perhaps patients who meet these criteria can safely undergo non-transplant therapy and donor livers can be allocated to patients with a greater need. HR/RFA patients with both MELD < 10 and APRI ≤ 0.5 had 3- and 5-year OS of 77.3% and 72.7%.Ĭonclusion: Patients with MELD < 10 and APRI ≤ 0.5 who undergo HR/RFA have survival approaching LT. The strongest predictors of survival after HR/RFA were MELD < 10 and APRI ≤ 0.5 (OR 4.25, 95% CI 1.63-11.08). Results: LT patients had 3- and 5-year OS of 82.6% and 73.9% compared to HR/RFA patients with 3- and 5-year OS of 40.8% and 33.8%. Overall survival (OS) and odds-ratios (OR) for survival after HR/RFA were calculated for MELD score, platelet count, creatinine, albumin, AST/platelet ratio index (APRI), international normalized ratio, and bilirubin. Methods: In a database of 1,050 HCC patients, the authors identified those with single HCC ≤ 3.0 cm, who underwent hepatic resection (HR, n = 16), radiofrequency ablation (RFA, n = 55), or LT ( n = 23) with 5-year follow-up. The authors sought to identify characteristics that predicted long-term survival after non-transplant therapies in patients with small HCC. Aim: Liver transplantation (LT) is the most effective treatment for long-term survival from hepatocellular carcinoma (HCC) however, insufficient donors limit therapy.
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