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Percutaneous Treatment of Localized Infiltrative Hepatocellular Carcinoma Developing on Cirrhosis

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Infiltrating hepatocellular carcinoma (HCC) is characterized by a difficult diagnosis, dismal prognosis, and limited therapeutic options. We describe long-term results of percutaneous treatment of infiltrative HCC, i.e., multibipolar radiofrequency ablation (mbpRFA) and percutaneous intra-arterial ethanol injection (PIAEI).

Methods

All cirrhotic patients with localized (up to two segments) infiltrating HCC treated by mbpRFA or PIAEI between 2002 and 2012 were included. Survival was analyzed using the Kaplan–Meier method, log-rank test, and Cox univariate followed by multivariate analyses.

Results

Fifty-one patients were considered eligible for mbpRFA (n = 20) or PIAEI (n = 31). Cirrhosis etiologies were alcohol (67 %), hepatitis C (33 %), hepatitis B (16 %), and/or NASH (16 %). HCC were multinodular in 31 % of cases, with a median main tumor size of 60 mm (range 30–200) and macrovascular invasion in 59 % of cases. The median serum level of alphafetoprotein was 125 ng/ml (range 2–215,000). Treatment-related adverse events occurred in 58 %, mainly postablation syndrome (31 %), and one death (2 %). Median overall survival was 18.3 months, with 63, 35, 20, and 12 % survival at 1, 2, 3, and 4 years, respectively. Baseline serum bilirubin >normal [hazard ratio (HR) 2.98; 95 % confidence interval (CI) 1.38–6.50; P = 0.0057] and tumor burden >70 mm (HR 1.02; 95 % CI 1.003–1.04; P = 0.0221) were associated with poorer overall survival. The radiological response using mRECIST criteria and an alphafetoprotein decrease 1 month post-procedure was associated with increased overall survival (P = 0.0002 and P = 0.024, respectively).

Discussion

Despite its overall poor prognosis, localized infiltrating HCC can be safely treated using percutaneous approaches, with potential survival benefits for these difficult-to-treat patients.

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Conflict of interest

Olivier Seror: consultant for pour Celon/Olympus, Angiodynamics, Bayer Healthcare and General Electric companies.

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Authors and Affiliations

  1. Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France

    Jean-Charles Nault, Gisèle Nkontchou, Pierre Nahon, Véronique Grando, Valérie Bourcier, Sandrine Barge & Nathalie Ganne-Carrie

  2. Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France

    Jean-Charles Nault, Pierre Nahon, Marianne Ziol, Nathalie Ganne-Carrie & Olivier Seror

  3. Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d’Universités et Etablissements Sorbonne Paris Cité, Paris, France

    Jean-Charles Nault, Pierre Nahon, Marianne Ziol, Nicolas Sellier, Nathalie Ganne-Carrie & Olivier Seror

  4. Department of Pathology, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France

    Marianne Ziol

  5. Radiology Department, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France

    Nicolas Sellier & Olivier Seror

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  1. Jean-Charles Nault
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  2. Gisèle Nkontchou
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Correspondence to Jean-Charles Nault.

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Nault, JC., Nkontchou, G., Nahon, P. et al. Percutaneous Treatment of Localized Infiltrative Hepatocellular Carcinoma Developing on Cirrhosis. Ann Surg Oncol 23, 1906–1915 (2016). https://doi.org/10.1245/s10434-015-5064-4

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  • DOI: https://doi.org/10.1245/s10434-015-5064-4

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