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Comparative Study
. 2011 Jan;13(1):24-32.
doi: 10.1111/j.1477-2574.2010.00228.x. Epub 2010 Nov 8.

Radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation

Derek A DuBay  1 , Charbel Sandroussi, John R Kachura, Chia Sing Ho, J Robert Beecroft, Charles M Vollmer, Anand Ghanekar, Markus Guba, Mark S Cattral, Ian D McGilvray, David R Grant, Paul D Greig
Affiliations
Comparative Study

Radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation

Derek A DuBay et al. HPB (Oxford). 2011 Jan.

Abstract

Background: Radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) is widely utilized as a bridge to liver transplant with limited evidence to support efficacy. The purpose of the present study was to measure the effect of RFA on time to drop-off in HCC-listed patients.

Methods: Patients with Milan criteria tumours listed between January 1999 and June 2007 were stratified into RFA (n= 77) and No Treatment groups (n= 93).

Results: The primary effectiveness of RFA was 83% (complete radiographic response). RFA was associated with a longer median wait time to transplant (9.5 vs. 5 months). Tumour-specific drop-off events were equivalent between RFA (21%) and No Treatment (12%) groups (P= 0.11). Controlling for wait time, there was no difference in overall (P= 0.56) or tumour-specific drop-off (P= 0.94). Furthermore, there were no differences in 5-year overall or tumour-free survivals from list date or transplant. Using multivariate analysis, the likelihood of receiving a transplant and patient survivals were associated with tumour characteristics (AFP, tumour number and size) and not with bridge therapy or waiting time.

Discussion: RFA allows patients to be maintained longer on the waiting list without negative consequences on drop-off or survival compared with no treatment. Post-transplant outcomes are affected more by tumour characteristics than RFA or wait time.

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Figures

Figure 1
Figure 1
(a) Overall drop-off from the waiting list. (b) Tumour-specific drop-off from the waiting list
Figure 2
Figure 2
(a) Overall survival in all hepatocellular carcinoma (HCC) patients. Time is calculated from the date of listing. (b) Tumour-free survival in all HCC patients. Time is calculated from the date of listing
Figure 3
Figure 3
(a) Overall survival in hepatocellular carcinoma (HCC) patients that received a liver transplant. Time is calculated from the date of transplantation. (b) Tumour-free survival in HCC patients that received a liver transplant. Time is calculated from the date of transplantation
See this image and copyright information in PMC

References

    1. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–699. - PubMed
    1. Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology. 1999;30:1434–1440. - PubMed
    1. Shah SA, Cleary SP, Tan JC, Wei AC, Gallinger S, Grant DR, et al. An analysis of resection vs transplantation for early hepatocellular carcinoma: defining the optimal therapy at a single institution. Ann Surg Oncol. 2007;14:2608–2614. - PubMed
    1. Freeman RB, Edwards EB, Harper AM. Waiting list removal rates among patients with chronic and malignant liver diseases. Am J Transplant. 2006;6:1416–1421. - PubMed
    1. Di Bisceglie AM. Pretransplant treatments for hepatocellular carcinoma: do they improve outcomes? Liver Transpl. 2005;11(Suppl 2):S10–S13. - PubMed

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