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| Pàgina inicial > Articles > Articles publicats > Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients-A Multiparametric Prediction |
(Universitat de Barcelona) (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva i Salut Pública) (Hospital Clínic i Provincial de Barcelona) (Hospital Clínic i Provincial de Barcelona) (Hospital Clínic i Provincial de Barcelona) (Hospital Clínic i Provincial de Barcelona) (Hospital Clínic i Provincial de Barcelona) (Hospital Clínic i Provincial de Barcelona) (Hospital Clínic i Provincial de Barcelona) (Hospital Clínic i Provincial de Barcelona) (Hospital Clínic i Provincial de Barcelona) (Universitat de Barcelona) (Hospital Clínic i Provincial de Barcelona) (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva i Salut Pública) (Hospital Clínic i Provincial de Barcelona) (Hospital Clínic i Provincial de Barcelona) (Hospital Clínic i Provincial de Barcelona)
| Data: | 2023 |
| Resum: | 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. |
| Ajuts: | Instituto de Salud Carlos III PI18/00542 Instituto de Salud Carlos III PI18/00079 Instituto de Salud Carlos III FI19/00222 Instituto de Salud Carlos III PI18/00768 Ministerio de Economía y Competitividad PI15/00145 Instituto de Salud Carlos III PI18/00358 |
| Drets: | Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.  |
| Llengua: | Anglès |
| Document: | Article ; recerca ; Versió publicada |
| Matèria: | Hepatocellular carcinoma ; Ablation ; Comorbidities ; Elderly ; Clinical decision-making ; Survival ; Pattern of progression |
| Publicat a: | Cancers, Vol. 15 Num. 13 (June 2023) , ISSN 2072-6694 |
