Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—A Multiparametric Prediction
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 recurre...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-06-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/13/3269 |
| _version_ | 1797592085929394176 |
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| 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 María Reig |
| author_facet | 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 María Reig |
| author_sort | Sergio Muñoz-Martínez |
| collection | DOAJ |
| description | 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, <i>p</i> = 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. |
| first_indexed | 2024-03-11T01:46:26Z |
| format | Article |
| id | doaj.art-b7fc947808234c3ca012bbb28c8f01b2 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T01:46:26Z |
| publishDate | 2023-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-b7fc947808234c3ca012bbb28c8f01b22023-11-18T16:14:30ZengMDPI AGCancers2072-66942023-06-011513326910.3390/cancers15133269Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—A Multiparametric PredictionSergio Muñoz-Martínez0Victor Sapena1Ángeles García-Criado2Anna Darnell3Alejandro Forner4Ernest Belmonte5Marco Sanduzzi-Zamparelli6Jordi Rimola7Alexandre Soler8Neus Llarch9Gemma Iserte10Ezequiel Mauro11Carmen Ayuso12Jose Rios13Jordi Bruix14Ramon Vilana15María Reig16Barcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainDepartment of Clinical Pharmacology, Medical Statistics Core Facility, Hospital Clinic of Barcelona, 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainDepartment of Clinical Pharmacology, Medical Statistics Core Facility, Hospital Clinic of Barcelona, 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainBarcelona Clinic Liver Cancer (BCLC) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainBackground: 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, <i>p</i> = 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.https://www.mdpi.com/2072-6694/15/13/3269hepatocellular carcinomaablationcomorbiditieselderlyclinical decision-makingsurvival |
| spellingShingle | 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 María Reig Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—A Multiparametric Prediction Cancers hepatocellular carcinoma ablation comorbidities elderly clinical decision-making survival |
| title | Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—A Multiparametric Prediction |
| title_full | Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—A Multiparametric Prediction |
| title_fullStr | Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—A Multiparametric Prediction |
| title_full_unstemmed | Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—A Multiparametric Prediction |
| title_short | Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—A Multiparametric Prediction |
| title_sort | risk of treatment failure and death after ablation in hepatocellular carcinoma patients a multiparametric prediction |
| topic | hepatocellular carcinoma ablation comorbidities elderly clinical decision-making survival |
| url | https://www.mdpi.com/2072-6694/15/13/3269 |
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