CIO 2021-14 Percutaneous Ablation in the Treatment of Hepatocellular Carcinoma: Outcomes of a 7-Year Institutional Experience

Purpose: The objective of this study is to examine the safety and efficacy of ablative procedures in patients with hepatocellular carcinoma (HCC), by evaluating the clinical, biochemical and radiologic response to therapy as well as overall survival outcomes.

Material and Methods: A retrospective review of 419 consecutive patients diagnosed with HCC, treated with percutaneous ablation at a tertiary academic medical center from June 2013 to June 2020, was conducted. Data evaluated included demographics, disease and tumor burden scores, and functional status. Procedural outcomes included procedural course, complication rates, treatment response, and survival.

Results: A total of 419 patients, including 313 males (74.7%) and 106 females (25.3%) with a mean age of 63.8 ± 6.64 years, made up the study cohort. 120 patients (28.9%) presented with solitary lesions and 295 patients (71.1%) had multifocal involvement, with a mean tumor size of 2.26 ± 0.92 cm. A majority of the therapies performed were microwave ablations (n=408, 98.3%), with 6 radiofrequency ablations (1.4%) and 1 cryoablation (0.2%). Treatment response was radiographically assessed up to 6 months post-ablation and graded as complete response (82.0%), partial response (7.1%), stable disease (5.3%), and progressive disease (5.6%). At 6 months post-treatment, 383 patients (92.7%) maintained or improved functional and performance status according to ECOG performance scores. At 12 months post-treatment, 349 patients (84.5%) maintained or improved ECOG scores. Following the ablation, 342 patients (82.4%) required no further treatment for the treated lesion, while 53 (12.8%) underwent another TACE, 20 (4.8%) received Y90 treatment, and 17 (4.1%) required another ablation for the same lesion. 97 (23.4%) of the treated patients went on to receive liver transplant. The average progression-free survival in the study population was 22 months with a survival of 99.8% (n=414), 86.7% (n=360), 68.4% (n=284), 63.9% (n=265) at 30 days, 1 year, 3 years, and 5 years respectively. The overall mean survival was 31.8 months post-procedure.

Conclusions: Analysis of data from this large retrospective single-institutional experience demonstrated safety and efficacy of ablation therapies for treatment of HCC with promising tumor response rates and enduring clinical and functional outcomes including prolonged survival.