Predicting outcomes for recurrent hepatocellular carcinoma within Milan criteria after complete radiofrequency ablation

Hsin Yeh Chen; Sheng Nan Lu; Chao Hung Hung; Jing Houng Wang; Chien Hung Chen; Yi Hao Yen; Yuan Hung Kuo; Kwong Ming Kee

doi:10.1371/journal.pone.0242113

Predicting outcomes for recurrent hepatocellular carcinoma within Milan criteria after complete radiofrequency ablation

Hsin Yeh Chen
, Sheng Nan Lu
, Chao Hung Hung
, Jing Houng Wang
, Chien Hung Chen
, Yi Hao Yen
, Yuan Hung Kuo
, Kwong Ming Kee^*

^*Corresponding author for this work

School of Medicine

Chang Gung University

Research output: Contribution to journal › Journal Article › peer-review

20 Scopus citations

Abstract

Background Intrahepatic distant recurrence (IDR) is a significant problem for patients who have undergone radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). The objective of the study was to investigate risk factors and to predict outcomes of recurrent IDR within Milan criteria after complete RFA for primary early-stage HCC. Method This retrospective study reviewed 449 patients with intrahepatic distant recurrent HCC after complete RFA for early-stage HCC. After excluding 100 patients who were beyond Milan criteria, with incomplete lab data, or had follow-up less than three months, a total of 349 patient cases were compiled and their baseline characteristics, further treatment modalities after tumor recurrence and survival were analyzed. Results After a median follow-up of 36.2 months, 92 patients had expired. The majority of patients were male (59.9%) with a median age of 64.3 years (range:38–88). The cumulative 5-year overall survival (OS) rates after treatment for recurrent HCC was 67.2%. On multivariate analysis, end-stage renal disease(Hazard ratio (H.R.) = 2.33, p = 0.021), m-ALBI grade 2a (H.R. = 2.86, p = 0.003) and m-ALBI grades 2b or 3 (H.R. = 2.30, p = 0.009), APRI greater than 1 (H.R. = 1.92, p = 0.036) and 2^nd recurrence occurring within 1 year (H.R. = 2.69, p<0.001) were significantly associated with worse survival. The cumulative 5-year 2^nd recurrence rate was 87.4%. On multivariate analysis, male gender (H.R. = 1.47, p = 0.01), age greater than 65 years (H.R. = 1.72, p<0.001), an alpha fetoprotein level greater than 20ng/ ml (H.R. = 1.41, p = 0.016), surgical treatment for recurrent HCC (H.R. = 0.25, p = 0.007), tumor number greater than 1 (H.R. = 1.35, p = 0.046), and IDR developing within 2 years (H. R. = 1.67, p = 0.001) were prognostic factors for 2^nd recurrence. Conclusion Our study suggested that presence of end-stage renal disease, m-ALBI grades 2 and 3, APRI >1 and time to 2^nd HCC recurrence were all associated with overall survival while the 2^nd HCC recurrence was associated with male gender, age ≥65 years, α-fetoprotein level >20 ng/mL, non-surgical therapy, time to IDR, and tumor number> 1.

Original language	English
Article number	e0242113
Journal	PLoS ONE
Volume	15
Issue number	11 November
DOIs	https://doi.org/10.1371/journal.pone.0242113
State	Published - 11 2020

Bibliographical note

Publisher Copyright:
© 2020 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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SDG 3 Good Health and Well-being

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10.1371/journal.pone.0242113

Cite this

@article{5b54f95a32ea4057aae6b33f54aa76af,

title = "Predicting outcomes for recurrent hepatocellular carcinoma within Milan criteria after complete radiofrequency ablation",

abstract = "Background Intrahepatic distant recurrence (IDR) is a significant problem for patients who have undergone radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). The objective of the study was to investigate risk factors and to predict outcomes of recurrent IDR within Milan criteria after complete RFA for primary early-stage HCC. Method This retrospective study reviewed 449 patients with intrahepatic distant recurrent HCC after complete RFA for early-stage HCC. After excluding 100 patients who were beyond Milan criteria, with incomplete lab data, or had follow-up less than three months, a total of 349 patient cases were compiled and their baseline characteristics, further treatment modalities after tumor recurrence and survival were analyzed. Results After a median follow-up of 36.2 months, 92 patients had expired. The majority of patients were male (59.9\%) with a median age of 64.3 years (range:38–88). The cumulative 5-year overall survival (OS) rates after treatment for recurrent HCC was 67.2\%. On multivariate analysis, end-stage renal disease(Hazard ratio (H.R.) = 2.33, p = 0.021), m-ALBI grade 2a (H.R. = 2.86, p = 0.003) and m-ALBI grades 2b or 3 (H.R. = 2.30, p = 0.009), APRI greater than 1 (H.R. = 1.92, p = 0.036) and 2nd recurrence occurring within 1 year (H.R. = 2.69, p<0.001) were significantly associated with worse survival. The cumulative 5-year 2nd recurrence rate was 87.4\%. On multivariate analysis, male gender (H.R. = 1.47, p = 0.01), age greater than 65 years (H.R. = 1.72, p<0.001), an alpha fetoprotein level greater than 20ng/ ml (H.R. = 1.41, p = 0.016), surgical treatment for recurrent HCC (H.R. = 0.25, p = 0.007), tumor number greater than 1 (H.R. = 1.35, p = 0.046), and IDR developing within 2 years (H. R. = 1.67, p = 0.001) were prognostic factors for 2nd recurrence. Conclusion Our study suggested that presence of end-stage renal disease, m-ALBI grades 2 and 3, APRI >1 and time to 2nd HCC recurrence were all associated with overall survival while the 2nd HCC recurrence was associated with male gender, age ≥65 years, α-fetoprotein level >20 ng/mL, non-surgical therapy, time to IDR, and tumor number> 1.",

author = "Chen, \{Hsin Yeh\} and Lu, \{Sheng Nan\} and Hung, \{Chao Hung\} and Wang, \{Jing Houng\} and Chen, \{Chien Hung\} and Yen, \{Yi Hao\} and Kuo, \{Yuan Hung\} and Kee, \{Kwong Ming\}",

note = "Publisher Copyright: {\textcopyright} 2020 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2020",

month = nov,

doi = "10.1371/journal.pone.0242113",

language = "英语",

volume = "15",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "11 November",

}

TY - JOUR

T1 - Predicting outcomes for recurrent hepatocellular carcinoma within Milan criteria after complete radiofrequency ablation

AU - Chen, Hsin Yeh

AU - Lu, Sheng Nan

AU - Hung, Chao Hung

AU - Wang, Jing Houng

AU - Chen, Chien Hung

AU - Yen, Yi Hao

AU - Kuo, Yuan Hung

AU - Kee, Kwong Ming

N1 - Publisher Copyright: © 2020 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2020/11

Y1 - 2020/11

N2 - Background Intrahepatic distant recurrence (IDR) is a significant problem for patients who have undergone radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). The objective of the study was to investigate risk factors and to predict outcomes of recurrent IDR within Milan criteria after complete RFA for primary early-stage HCC. Method This retrospective study reviewed 449 patients with intrahepatic distant recurrent HCC after complete RFA for early-stage HCC. After excluding 100 patients who were beyond Milan criteria, with incomplete lab data, or had follow-up less than three months, a total of 349 patient cases were compiled and their baseline characteristics, further treatment modalities after tumor recurrence and survival were analyzed. Results After a median follow-up of 36.2 months, 92 patients had expired. The majority of patients were male (59.9%) with a median age of 64.3 years (range:38–88). The cumulative 5-year overall survival (OS) rates after treatment for recurrent HCC was 67.2%. On multivariate analysis, end-stage renal disease(Hazard ratio (H.R.) = 2.33, p = 0.021), m-ALBI grade 2a (H.R. = 2.86, p = 0.003) and m-ALBI grades 2b or 3 (H.R. = 2.30, p = 0.009), APRI greater than 1 (H.R. = 1.92, p = 0.036) and 2nd recurrence occurring within 1 year (H.R. = 2.69, p<0.001) were significantly associated with worse survival. The cumulative 5-year 2nd recurrence rate was 87.4%. On multivariate analysis, male gender (H.R. = 1.47, p = 0.01), age greater than 65 years (H.R. = 1.72, p<0.001), an alpha fetoprotein level greater than 20ng/ ml (H.R. = 1.41, p = 0.016), surgical treatment for recurrent HCC (H.R. = 0.25, p = 0.007), tumor number greater than 1 (H.R. = 1.35, p = 0.046), and IDR developing within 2 years (H. R. = 1.67, p = 0.001) were prognostic factors for 2nd recurrence. Conclusion Our study suggested that presence of end-stage renal disease, m-ALBI grades 2 and 3, APRI >1 and time to 2nd HCC recurrence were all associated with overall survival while the 2nd HCC recurrence was associated with male gender, age ≥65 years, α-fetoprotein level >20 ng/mL, non-surgical therapy, time to IDR, and tumor number> 1.

AB - Background Intrahepatic distant recurrence (IDR) is a significant problem for patients who have undergone radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). The objective of the study was to investigate risk factors and to predict outcomes of recurrent IDR within Milan criteria after complete RFA for primary early-stage HCC. Method This retrospective study reviewed 449 patients with intrahepatic distant recurrent HCC after complete RFA for early-stage HCC. After excluding 100 patients who were beyond Milan criteria, with incomplete lab data, or had follow-up less than three months, a total of 349 patient cases were compiled and their baseline characteristics, further treatment modalities after tumor recurrence and survival were analyzed. Results After a median follow-up of 36.2 months, 92 patients had expired. The majority of patients were male (59.9%) with a median age of 64.3 years (range:38–88). The cumulative 5-year overall survival (OS) rates after treatment for recurrent HCC was 67.2%. On multivariate analysis, end-stage renal disease(Hazard ratio (H.R.) = 2.33, p = 0.021), m-ALBI grade 2a (H.R. = 2.86, p = 0.003) and m-ALBI grades 2b or 3 (H.R. = 2.30, p = 0.009), APRI greater than 1 (H.R. = 1.92, p = 0.036) and 2nd recurrence occurring within 1 year (H.R. = 2.69, p<0.001) were significantly associated with worse survival. The cumulative 5-year 2nd recurrence rate was 87.4%. On multivariate analysis, male gender (H.R. = 1.47, p = 0.01), age greater than 65 years (H.R. = 1.72, p<0.001), an alpha fetoprotein level greater than 20ng/ ml (H.R. = 1.41, p = 0.016), surgical treatment for recurrent HCC (H.R. = 0.25, p = 0.007), tumor number greater than 1 (H.R. = 1.35, p = 0.046), and IDR developing within 2 years (H. R. = 1.67, p = 0.001) were prognostic factors for 2nd recurrence. Conclusion Our study suggested that presence of end-stage renal disease, m-ALBI grades 2 and 3, APRI >1 and time to 2nd HCC recurrence were all associated with overall survival while the 2nd HCC recurrence was associated with male gender, age ≥65 years, α-fetoprotein level >20 ng/mL, non-surgical therapy, time to IDR, and tumor number> 1.

UR - https://www.scopus.com/pages/publications/85096029540

U2 - 10.1371/journal.pone.0242113

DO - 10.1371/journal.pone.0242113

M3 - 文章

C2 - 33170894

AN - SCOPUS:85096029540

SN - 1932-6203

VL - 15

JO - PLoS ONE

JF - PLoS ONE

IS - 11 November

M1 - e0242113

ER -

Predicting outcomes for recurrent hepatocellular carcinoma within Milan criteria after complete radiofrequency ablation

Abstract

Bibliographical note

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