SIR 2024
Interventional Oncology
Justin McWilliams, MD, FSIR
Professor of Interventional Radiology
David Geffen School of Medicine at UCLA
Financial relationships: Full list of relationships is listed on the CME information page.
Sean Pianka, MD
Medical student
David Geffen School of Medicine, UCLA
Disclosure information not submitted.
Serinee Tran, BS
Medical student
David Geffen School of Medicine at UCLA
Disclosure information not submitted.
David S. Lu, MD (he/him/his)
Professor of Radiology, and Surgery
David Geffen School of Medicine at UCLA
Disclosure information not submitted.
Steven Raman, MD, FSAR, FSIR
Professor of Radiology, Urology and Surgery
David Geffen School of Medicine At UCLA
Financial relationships: Full list of relationships is listed on the CME information page.
Edward W. Lee, MD
Associate Professor
University of California, Los Angeles
Disclosure information not submitted.
Siddharth Padia, MD
Professor
David Geffen School of Medicine at UCLA
Financial relationships: Full list of relationships is listed on the CME information page.
Matthew Quirk
Disclosure information not submitted.
Vatche Agopian, MD
Professor
Department of Surgery, David Geffen School of Medicine at UCLA
Disclosure information not submitted.
To determine if treatment-naive Child-Pugh class A patients aged 60 to 80 with hepatocellular carcinoma (HCC) within Milan criteria, who had thermal ablation with complete response at 6 months, benefited from subsequent orthotopic liver transplantation (OLT) versus surveillance with on-demand re-treatment.
Materials and Methods:
Patients aged 60 to 80 with Child-Pugh class A cirrhosis who underwent radiofrequency or microwave ablation of previously untreated, unresectable HCC within Milan criteria at a single institution between 1/1/2011 and 12/31/2020 were retrospectively reviewed. Those patients who achieved complete mRECIST response at 6-months comprised the study population, which was separated into two groups according to those who did and who did not receive subsequent OLT. Patients in both groups received routine follow-up and treatment of HCC recurrence was performed on an as-needed basis. Review of the electronic medical record was performed to determine date of death or last known follow-up for patients in both groups. Kaplan-Meier survival curves and a log-rank test with a significance level of 0.05 were used to compare overall survival from date of ablation between the two groups, as well as sub-group analysis of Child-Pugh A5 patients and Child-Pugh A6 patients.
Results:
101 patients met the study criteria and comprised the study population. 24 patients received OLT at a mean of 2.4 years post-ablation, while 77 patients did not receive OLT. Mean follow-up time from the ablation date was 8.2 years for the OLT group and 5.6 years for the non-OLT group. Kaplan-Meier survival analysis showed similar survival between the two groups (p=0.18). 5-year survival was 90.5% for the OLT group versus 76.6% for the non-OLT group. Subgroup analysis of Child-Pugh A5 patients (n=81) showed identical survival between the OLT and non-OLT groups (p=0.98), with 5-year survival of 88.2% for the OLT group and 86.8% for the non-OLT group. Subgroup analysis of Child-Pugh A6 patients (n=20) showed superior survival for the OLT group (p=0.008), with 5-year survival of 100% for the OLT group versus 33.3% for the non-OLT group.
Conclusion:
Child-Pugh class A cirrhotic patients of advanced age in whom complete response is achieved with thermal ablation showed similar long-term survival with surveillance and on-demand re-treatment compared with OLT. Subgroup analysis showed that Child-Pugh class A5 patients had equal survival with surveillance versus OLT, while Child-Pugh class A6 patients demonstrated significant survival benefit with OLT.