BACKGROUND: Radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) is widely utilized as a bridge to liver transplant with limited evidence to support efficacy. The purpose of the present study was to measure the effect of RFA on time to drop-off in HCC-listed patients. METHODS: Patients with Milan criteria tumours listed between January 1999 and June 2007 were stratified into RFA (n= 77) and No Treatment groups (n= 93). RESULTS: The primary effectiveness of RFA was 83% (complete radiographic response). RFA was associated with a longer median wait time to transplant (9.5 vs. 5 months). Tumour-specific drop-off events were equivalent between RFA (21%) and No Treatment (12%) groups (P= 0.11). Controlling for wait time, there was no difference in overall (P= 0.56) or tumour-specific drop-off (P= 0.94). Furthermore, there were no differences in 5-year overall or tumour-free survivals from list date or transplant. Using multivariate analysis, the likelihood of receiving a transplant and patient survivals were associated with tumour characteristics (AFP, tumour number and size) and not with bridge therapy or waiting time. DISCUSSION: RFA allows patients to be maintained longer on the waiting list without negative consequences on drop-off or survival compared with no treatment. Post-transplant outcomes are affected more by tumour characteristics than RFA or wait time.
BACKGROUND: Radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) is widely utilized as a bridge to liver transplant with limited evidence to support efficacy. The purpose of the present study was to measure the effect of RFA on time to drop-off in HCC-listed patients. METHODS:Patients with Milan criteria tumours listed between January 1999 and June 2007 were stratified into RFA (n= 77) and No Treatment groups (n= 93). RESULTS: The primary effectiveness of RFA was 83% (complete radiographic response). RFA was associated with a longer median wait time to transplant (9.5 vs. 5 months). Tumour-specific drop-off events were equivalent between RFA (21%) and No Treatment (12%) groups (P= 0.11). Controlling for wait time, there was no difference in overall (P= 0.56) or tumour-specific drop-off (P= 0.94). Furthermore, there were no differences in 5-year overall or tumour-free survivals from list date or transplant. Using multivariate analysis, the likelihood of receiving a transplant and patient survivals were associated with tumour characteristics (AFP, tumour number and size) and not with bridge therapy or waiting time. DISCUSSION: RFA allows patients to be maintained longer on the waiting list without negative consequences on drop-off or survival compared with no treatment. Post-transplant outcomes are affected more by tumour characteristics than RFA or wait time.
Authors: Francis Y Yao; Milan Kinkhabwala; Jeanne M LaBerge; Nathan M Bass; Robert Brown; Robert Kerlan; Alan Venook; Nancy L Ascher; Jean C Emond; John P Roberts Journal: Am J Transplant Date: 2005-04 Impact factor: 8.086
Authors: David S K Lu; Nam C Yu; Steven S Raman; Charles Lassman; Myron J Tong; Carolyn Britten; Francisco Durazo; Sammy Saab; Steven Han; Richard Finn; Jonathan R Hiatt; Ronald W Busuttil Journal: Hepatology Date: 2005-05 Impact factor: 17.425
Authors: Ankit Bharat; Daniel B Brown; Jeffrey S Crippin; Jennifer E Gould; Jeffrey A Lowell; Surendra Shenoy; Niraj M Desai; William C Chapman Journal: J Am Coll Surg Date: 2006-08-17 Impact factor: 6.113