bbec59e410e7916704eb75cb82f95320 cancers-15-03269.pdf b9dea03fb6b2e8822288aa394bf2abf35dc7c238 cancers-15-03269.pdf c17f5ec73fb9bf66415d1f11cdfea9d629431c3eb2dbd6f7de42169ad85d9124 cancers-15-03269.pdf Title: Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—A Multiparametric Prediction Subject: Background: Ablation is a first-line treatment for Barcelona Clinic Liver Cancer (BCLC)-0/A hepatocellular carcinoma (HCC). However, there are scarce data about patients’ outcomes after recurrence. The present study evaluates the impact of patient and tumor characteristics at baseline and at recurrence on the Clinical Decision-Making process. Methods: We evaluated BCLC-0/A patients treated with percutaneous ablation from January 2010 to November 2018. Clinical and radiological data such as age, tumor location at ablation, pattern of recurrence/progression, and comorbidities during follow-up were registered. Tumor location was divided into ‘suboptimal’ vs. ‘optimal’ locations for ablation. The Clinical Decision-Making was based on tumor burden, liver dysfunction, or comorbidities. The statistical analysis included the time-to-recurrence/progression, censoring at time of death, date of last follow-up or liver transplantation, and time-to-event was estimated by the Kaplan–Meier method and Cox regression models to evaluate the risk of an event of death and change of treatment strategy. Results: A total of 225 patients [39.1% BCLC-0 and 60.9% BCLC-A] were included, 190 had unifocal HCC and 82.6% were 3 cm. The complete response rate and median overall survival were 96% and 60.7 months. The HCC nodules number (Hazard Ratio—HR 3.1), Child-Pugh (HR 2.4), and Albumin-Bilirubin score (HR 3.2) were associated with increased risk of death during follow-up. HCC in ‘suboptimal location’ presented a shorter time to recurrence. When comorbidities prevented further loco-regional or systemic treatment, the risk of death was significantly increased (HR 2.0, p = 0.0369) in comparison to those who received treatment. Conclusions: These results expose the impact of non-liver comorbidities when considering treatment for recurrence after ablation in the real-world setting and in research trials. Ultimately, we identified an orphan population for which effective interventions are needed. Keywords: hepatocellular carcinoma; ablation; comorbidities; elderly; clinical decision-making; survival; pattern of progression Author: Sergio Muñoz-Martínez, Victor Sapena, Ángeles García-Criado, Anna Darnell, Alejandro Forner, Ernest Belmonte, Marco Sanduzzi-Zamparelli, Jordi Rimola, Alexandre Soler, Neus Llarch, Gemma Iserte, Ezequiel Mauro, Carmen Ayuso, Jose Rios, Jordi Bruix, Ramon Vilana and María Reig Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Wed Jun 21 09:56:48 2023 CEST ModDate: Wed Jun 21 11:06:38 2023 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 19 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 841255 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- LUWBVJ+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 YPNOIN+VnURWPalladioL Type 1 Custom yes yes no 15 0 PSFKQN+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 AVTYOX+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 RMKOVN+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 CCGMBL+CMSY10 Type 1 Builtin yes yes no 32 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 51 0 PXBUSD+URWPalladioL-BoldItal Type 1 Custom yes yes no 76 0 JMEMCH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 102 0 JMEMDI+PalatinoLinotype CID TrueType Identity-H yes yes yes 105 0 JMEMDJ+PalatinoLinotype TrueType WinAnsi yes yes no 111 0 JMEMDL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 114 0 JMENCG+PalatinoLinotype TrueType MacRoman yes yes no 117 0 JMEMCH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 133 0 JMEMDI+PalatinoLinotype CID TrueType Identity-H yes yes yes 136 0 JMEMDJ+PalatinoLinotype TrueType WinAnsi yes yes no 142 0 JMEMDL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 145 0 JMENCG+PalatinoLinotype TrueType MacRoman yes yes no 148 0 TTFQJI+CMBSY10 Type 1 Builtin yes yes no 162 0 ITYRUV+VnURWPalladioL-Italic Type 1 Custom yes yes no 187 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-10-04 03:10:51 CEST RepresentationInformation: cancers-15-03269.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-10-03 16:30:37 CEST Size: 841255 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 355 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Patients and Methods Destination: section.2 Children: Item: Title: Study Definitions Destination: subsection.2.1 Item: Title: Ablation Techniques Used in the Study Destination: subsection.2.2 Item: Title: Pattern of Recurrence/Progression after the First Percutaneous Ablation Destination: subsection.2.3 Item: Title: Follow-Up Protocol Destination: subsection.2.4 Item: Title: Statistical Analysis Destination: subsection.2.5 Item: Title: Results Destination: section.3 Children: Item: Title: Baseline Characteristics and Percutaneous Ablation Procedure Destination: subsection.3.1 Item: Title: Failure of Ablation Strategy Destination: subsection.3.2 Item: Title: Adverse Events Destination: subsection.3.3 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.A. Info: Title: Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients A Multiparametric Prediction Author: Sergio Muñoz-Martínez, Victor Sapena, Ángeles García-Criado, Anna Darnell, Alejandro Forner, Ernest Belmonte, Marco Sanduzzi-Zamparelli, Jordi Rimola, Alexandre Soler, Neus Llarch, Gemma Iserte, Ezequiel Mauro, Carmen Ayuso, Jose Rios, Jordi Bruix, Ramon Vilana and María Reig Subject: Background: Ablation is a first-line treatment for Barcelona Clinic Liver Cancer (BCLC)-0/A hepatocellular carcinoma (HCC). However, there are scarce data about patients’ outcomes after recurrence. The present study evaluates the impact of patient and tumor characteristics at baseline and at recurrence on the Clinical Decision-Making process. Methods: We evaluated BCLC-0/A patients treated with percutaneous ablation from January 2010 to November 2018. Clinical and radiological data such as age, tumor location at ablation, pattern of recurrence/progression, and comorbidities during follow-up were registered. Tumor location was divided into ‘suboptimal’ vs. ‘optimal’ locations for ablation. The Clinical Decision-Making was based on tumor burden, liver dysfunction, or comorbidities. The statistical analysis included the time-to-recurrence/progression, censoring at time of death, date of last follow-up or liver transplantation, and time-to-event was estimated by the Kaplan Meier method and Cox regression models to evaluate the risk of an event of death and change of treatment strategy. Results: A total of 225 patients [39.1% BCLC-0 and 60.9% BCLC-A] were included, 190 had unifocal HCC and 82.6% were 3 cm. The complete response rate and median overall survival were 96% and 60.7 months. The HCC nodules number (Hazard Ratio HR 3.1), Child-Pugh (HR 2.4), and Albumin-Bilirubin score (HR 3.2) were associated with increased risk of death during follow-up. HCC in ‘suboptimal location’ presented a shorter time to recurrence. When comorbidities prevented further loco-regional or systemic treatment, the risk of death was significantly increased (HR 2.0, p = 0.0369) in comparison to those who received treatment. Conclusions: These results expose the impact of non-liver comorbidities when considering treatment for recurrence after ablation in the real-world setting and in research trials. Ultimately, we identified an orphan population for which effective interventions are needed. 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