Loo KF

Woodman RJ

Bogatic D

Chandran V

Muller K

Chinnaratha MA

Bate J

Campbell K

Maddison M

Narayana S

Le H

Pryor D

Wigg A

2022-07-24

BACKGROUND AND AIM: The rate of contraindications to percutaneous ablation (PA) for inoperable early hepatocellular carcinoma (HCC) and subsequent outcomes is not well described. We investigated the prevalence and outcomes of inoperable early HCC patients with contraindications to PA, resulting in treatment stage migration (TSM). METHODS: Barcelona Clinic Liver Cancer (BCLC) 0/A patients diagnosed between September 2013 and September 2019 across five hospitals were identified. Primary endpoint was proportion of BCLC 0/A HCCs with contraindications to PA. Secondary endpoints included overall survival (OS), local tumor control (LTC), and recurrence-free survival (RFS). The causal effects of PA versus TSM were assessed using a potential outcome means (POM) framework in which the average treatment effects (ATEs) of PA were estimated after accounting for potential selection bias and confounding. RESULTS: Two hundred twenty patients with inoperable BCLC 0/A HCC were identified. One hundred twenty-two patients (55.5%) had contraindications to PA and received TSM therapy, 98 patients (44.5%) received PA. The main contraindication to PA was difficult tumor location (51%). Patients who received TSM therapy had lower median OS (2.4 vs 5.3 years), LTC (1.0 vs 4.8 years), and RFS (0.8 vs 2.9 years); P < 0.001, respectively, compared with PA. The ATE for PA versus TSM yielded an additional 1.11 years (P = 0.019), 2.45 years (P < 0.001), and 1.64 years (P < 0.001) for OS, LTC, and RFS, respectively. Three-year LTC after PA was suboptimal (65%). CONCLUSION: Our study highlights high rates of contraindication to PA in early HCCs, resulting in TSM and poorer outcomes. The LTC rate for PA appears suboptimal despite being considered as curative therapy. Both findings support the exploration of improved treatment options for early HCCs.

Hepatology and Liver Transplant Medicine Unit Southern Adelaide Local Health Network Adelaide South Australia Australia.

College of Medicine and Public Health Flinders University Adelaide South Australia Australia.

Department of Medicine Royal Adelaide Hospital Adelaide South Australia Australia.

Department of Gastroenterology and Hepatology Lyell McEwin Hospital Adelaide South Australia Australia.

Faculty of Health and Medical Sciences The University of Adelaide Adelaide South Australia Australia.

Department of Gastroenterology and Hepatology Royal Adelaide Hospital Adelaide South Australia Australia.

Department of Gastroenterology and Hepatology Royal Darwin Hospital Darwin Northern Territory Australia.

Department of Radiation Oncology Royal Adelaide Hospital Adelaide South Australia Australia.

The University of South Australia Adelaide South Australia Australia.

Department of Radiation Oncology Princess Alexandra Hospital Brisbane Queensland Australia.

Queensland University of Technology Brisbane Queensland Australia.

© 2022 The Authors. JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

JGH Open. 2022 Jul 24;6(9):599-606. doi: 10.1002/jgh3.12793. eCollection 2022 Sep.

0000-0002-9296-5998

https://pubmed.ncbi.nlm.nih.gov/36091321/?otool=iaurydwlib

https://hdl.handle.net/10137/12268

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High rates of treatment stage migration for early hepatocellular carcinoma and association with adverse outcomes: An Australian multicenter study.

Journal Article

Publication