Mid-term outcome of percutaneous thermal ablation for intrahepatic recurrent hepatocellular carcinoma after liver transplantation

A prediction model of major complications after radiofrequency ablation for recurrent hepatocellular carcinoma patients

BACKGROUND

Postoperative major complications are potentially fatal to recurrent hepatocellular carcinoma (RHCC) patients. We aimed to construct a prediction model of major complications after RFA for RHCC patients.

METHODS

We retrospectively reviewed the medical records of 407 RHCC patients who underwent RFA as second treatment. Patients were divided into two groups according to the date of RFA: training cohort (277 patients treated in 2010-2016) and validation cohort (130 patients treated in 2017-2019). 23 clinicopathological variables were recorded and analyzed. The logistic regression model was used to build a prediction model.

RESULT

Major complications developed in 3.6 % of RHCC patients after RFA. In the multivariate analysis, tumor adjacent vessels (p = 0.004) and hepatitis C (p = 0.022) were associated with postoperative complications. The prediction model was described as follow: Risk score (major complication) = 5.180 + 3.391*tumor location+3.389*hepatic etiology, the Youden index was 0.642, the best cut-off value of the model was 8.57 (sensitivity, 78.57 %, specificity, 84.03 %). The area under the receiver operating characteristic curve of the predictive model was 0.85 (95 % CI, 0.82 to 0.88). The validation of the model demonstrated acceptable results, the sensitivity was 80.00 %, specificity was 98.40 %.

CONCLUSIONS

This study developed a simple and reliable prediction model of postoperative major complications after RFA for RHCC patients.

Irreversible Electroporation of Recurrent Hepatocellular Carcinoma After Liver Transplantation: Report of Two Cases

The treatment strategies of post-transplant hepatocellular carcinoma (HCC) recurrence have not been completely clarified. Thermal ablative techniques have been increasingly performed for the treatment of post-transplant HCC recurrences. However, thermal ablation can create abnormal communication with the biliary tract and the ablation site by causing biliary injury. This abnormal communication may cause bacterial contamination and abscess formation. Irreversible electroporation (IRE) is a nonthermal ablative technique which may reduce the risk of abscess development at the ablation site due to its low risk of thermal injury to the biliary system. IRE may also preserve the perilesional blood vessels. This report describes two cases of post-transplant intrahepatic HCC recurrence which were successfully treated with IRE.