Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—: A Multiparametric Prediction

Sergio Muñoz-Martínez; Victor Sapena; Ángeles García-Criado; Anna Darnell; Alejandro Forner; Ernest Belmonte; Marco Sanduzzi-Zamparelli; Jordi Rimola; Alexandre Soler; Neus Llarch; Gemma Iserte; Ezequiel Mauro; Carmen Ayuso; Jose Rios; Jordi Bruix; Ramon Vilana; María Reig

doi:10.3390/cancers15133269

Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—: A Multiparametric Prediction

Sergio Muñoz-Martínez, Victor Sapena, Ángeles García-Criado, Anna Darnell, Alejandro Forner, Ernest Belmonte, Marco Sanduzzi-Zamparelli, Jordi Rimola, Alexandre Soler, Neus Llarch, Gemma Iserte, Ezequiel Mauro, Carmen Ayuso, Jose Rios, Jordi Bruix, Ramon Vilana^*, María Reig^*

^*Autor corresponent d’aquest treball

Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i Salut Pública

Producció científica: Contribució a revista › Article › Recerca › Avaluat per experts

6 Cites (Scopus)

Resum

Background: L'ablació és un tractament de primera línia per als carcinomes hepatocel·lulars (HCC) en estadi BCLC-0/A. No obstant això, hi ha poques dades sobre el resultat dels pacients després d'una recurrència. El present estudi avalora l'impacte del procés de presa de decisions clíniques en les característiques inicials i posteriors a la recurrència. Mètodes: Es van avaluar els pacients amb BCLC-0/A tractats amb ablació percutània entre gener de 2010 i novembre de 2018. Les dades clíniques i radiològiques com ara l'edat, la ubicació del tumor en el moment de l'ablació, el patró de recurrència/progressió i les malalties concomitants durant el seguiment es van registrar. La ubicació del tumor es va dividir en llocs "subòptims" o "òptims" per a l'ablació. El procés de presa de decisions clíniques es basava en la càrrega tumoral, la disfunció hepàtica o les malalties concomitants. L'anàlisi estadística incloïa el temps fins a la recurrència/progressió, censura en el moment de la mort, data de l'últim seguiment o trasplantament de fetge i el temps fins a un esdeveniment es va estimar mitjançant els models de Kaplan-Meier i Cox per avaluar el risc d'un esdeveniment de mort i canviar l'estratègia del tractament. Resultats: Es van incloure 225 pacients [39,1% BCLC-0 i 60,9% BCLC-A], 190 tenien HCC unifocal i un 82,6% tenia una mida < 3 cm. La taxa de resposta completa i la mitjana de supervivència global van ser del 96% i el 60,7 mesos respectivament. El nombre de nòduls d'HCC (hazard ratio-HR 3.1), Child-Pugh (HR 2.4) i puntuació Albumin-Bilirubin (HR 3.2) es va associar a un risc més elevat de mort durant el seguiment. L'HCC en una ubicació "subòptima" presentava un temps més curt fins a la recurrència. Quan les malalties concomitants impedien un tractament loco-regional o sistèmic addicional, el risc de mort augmentava significativament (HR 2.0, p = 0.0369) comparat amb els que van rebre tractament. Conclusions: Aquests resultats exposen l'impacte de les comorbiditats no hepàtiques quan es considera un tractament per a la recurrència després d'una ablació en el món real i en assajos clínics. En última instància, hem identificat una població òrfena per a la qual calen intervencions efectives.

Idioma original	Anglès
Número d’article	3269
Pàgines (de-a)	3269
Nombre de pàgines	19
Revista	Cancers
Volum	15
Número	13
DOIs	https://doi.org/10.3390/cancers15133269
Estat de la publicació	Publicada - 21 de juny 2023

SDG de les Nacions Unides

Aquest resultat contribueix als següents objectius de desenvolupament sostenible.

ODG 3 – Bona salut i benestar

Accés al document

10.3390/cancers15133269Llicència: Creative Commons Reconeixement

https://ddd.uab.cat/record/319580

Altres arxius i enllaços

Com citar-ho

Muñoz-Martínez, S., Sapena, V., García-Criado, Á., Darnell, A., Forner, A., Belmonte, E., Sanduzzi-Zamparelli, M., Rimola, J., Soler, A., Llarch, N., Iserte, G., Mauro, E., Ayuso, C., Rios, J., Bruix, J., Vilana, R., & Reig, M. (2023). Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—: A Multiparametric Prediction. Cancers, 15(13), 3269. Article 3269. https://doi.org/10.3390/cancers15133269

@article{93d43169d4b04bca92deb4dc2f9cab59,

title = "Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—: A Multiparametric Prediction",

abstract = "Background: Ablation is a first-line treatment for Barcelona Clinic Liver Cancer (BCLC)-0/A hepatocellular carcinoma (HCC). However, there are scarce data about patients{\textquoteright} outcomes after recurrence. The present study evaluates the impact of patient and tumor characteristics at baseline and at recurrence on the Clinical Decision-Making process. Methods: We evaluated BCLC-0/A patients treated with percutaneous ablation from January 2010 to November 2018. Clinical and radiological data such as age, tumor location at ablation, pattern of recurrence/progression, and comorbidities during follow-up were registered. Tumor location was divided into {\textquoteleft}suboptimal{\textquoteright} vs. {\textquoteleft}optimal{\textquoteright} locations for ablation. The Clinical Decision-Making was based on tumor burden, liver dysfunction, or comorbidities. The statistical analysis included the time-to-recurrence/progression, censoring at time of death, date of last follow-up or liver transplantation, and time-to-event was estimated by the Kaplan–Meier method and Cox regression models to evaluate the risk of an event of death and change of treatment strategy. Results: A total of 225 patients [39.1\% BCLC-0 and 60.9\% BCLC-A] were included, 190 had unifocal HCC and 82.6\% were ≤3 cm. The complete response rate and median overall survival were 96\% and 60.7 months. The HCC nodules number (Hazard Ratio—HR 3.1), Child-Pugh (HR 2.4), and Albumin-Bilirubin score (HR 3.2) were associated with increased risk of death during follow-up. HCC in {\textquoteleft}suboptimal location{\textquoteright} presented a shorter time to recurrence. When comorbidities prevented further loco-regional or systemic treatment, the risk of death was significantly increased (HR 2.0, p = 0.0369) in comparison to those who received treatment. Conclusions: These results expose the impact of non-liver comorbidities when considering treatment for recurrence after ablation in the real-world setting and in research trials. Ultimately, we identified an orphan population for which effective interventions are needed.",

keywords = "Ablation, Clinical decision-making, Comorbidities, Elderly, Hepatocellular carcinoma, Pattern of progression, Survival",

author = "Sergio Mu{\~n}oz-Mart{\'i}nez and Victor Sapena and {\'A}ngeles Garc{\'i}a-Criado and Anna Darnell and Alejandro Forner and Ernest Belmonte and Marco Sanduzzi-Zamparelli and Jordi Rimola and Alexandre Soler and Neus Llarch and Gemma Iserte and Ezequiel Mauro and Carmen Ayuso and Jose Rios and Jordi Bruix and Ramon Vilana and Mar{\'i}a Reig",

note = "Publisher Copyright: {\textcopyright} 2023 by the authors.",

year = "2023",

month = jun,

day = "21",

doi = "10.3390/cancers15133269",

language = "English",

volume = "15",

pages = "3269",

journal = "Cancers",

issn = "2072-6694",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "13",

}

Muñoz-Martínez, S, Sapena, V, García-Criado, Á, Darnell, A, Forner, A, Belmonte, E, Sanduzzi-Zamparelli, M, Rimola, J, Soler, A, Llarch, N, Iserte, G, Mauro, E, Ayuso, C, Rios, J, Bruix, J, Vilana, R & Reig, M 2023, 'Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—: A Multiparametric Prediction', Cancers, vol. 15, núm. 13, 3269, pàg. 3269. https://doi.org/10.3390/cancers15133269

TY - JOUR

T1 - Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—

T2 - A Multiparametric Prediction

AU - Muñoz-Martínez, Sergio

AU - Sapena, Victor

AU - García-Criado, Ángeles

AU - Darnell, Anna

AU - Forner, Alejandro

AU - Belmonte, Ernest

AU - Sanduzzi-Zamparelli, Marco

AU - Rimola, Jordi

AU - Soler, Alexandre

AU - Llarch, Neus

AU - Iserte, Gemma

AU - Mauro, Ezequiel

AU - Ayuso, Carmen

AU - Rios, Jose

AU - Bruix, Jordi

AU - Vilana, Ramon

AU - Reig, María

PY - 2023/6/21

Y1 - 2023/6/21

N2 - Background: Ablation is a first-line treatment for Barcelona Clinic Liver Cancer (BCLC)-0/A hepatocellular carcinoma (HCC). However, there are scarce data about patients’ outcomes after recurrence. The present study evaluates the impact of patient and tumor characteristics at baseline and at recurrence on the Clinical Decision-Making process. Methods: We evaluated BCLC-0/A patients treated with percutaneous ablation from January 2010 to November 2018. Clinical and radiological data such as age, tumor location at ablation, pattern of recurrence/progression, and comorbidities during follow-up were registered. Tumor location was divided into ‘suboptimal’ vs. ‘optimal’ locations for ablation. The Clinical Decision-Making was based on tumor burden, liver dysfunction, or comorbidities. The statistical analysis included the time-to-recurrence/progression, censoring at time of death, date of last follow-up or liver transplantation, and time-to-event was estimated by the Kaplan–Meier method and Cox regression models to evaluate the risk of an event of death and change of treatment strategy. Results: A total of 225 patients [39.1% BCLC-0 and 60.9% BCLC-A] were included, 190 had unifocal HCC and 82.6% were ≤3 cm. The complete response rate and median overall survival were 96% and 60.7 months. The HCC nodules number (Hazard Ratio—HR 3.1), Child-Pugh (HR 2.4), and Albumin-Bilirubin score (HR 3.2) were associated with increased risk of death during follow-up. HCC in ‘suboptimal location’ presented a shorter time to recurrence. When comorbidities prevented further loco-regional or systemic treatment, the risk of death was significantly increased (HR 2.0, p = 0.0369) in comparison to those who received treatment. Conclusions: These results expose the impact of non-liver comorbidities when considering treatment for recurrence after ablation in the real-world setting and in research trials. Ultimately, we identified an orphan population for which effective interventions are needed.

AB - Background: Ablation is a first-line treatment for Barcelona Clinic Liver Cancer (BCLC)-0/A hepatocellular carcinoma (HCC). However, there are scarce data about patients’ outcomes after recurrence. The present study evaluates the impact of patient and tumor characteristics at baseline and at recurrence on the Clinical Decision-Making process. Methods: We evaluated BCLC-0/A patients treated with percutaneous ablation from January 2010 to November 2018. Clinical and radiological data such as age, tumor location at ablation, pattern of recurrence/progression, and comorbidities during follow-up were registered. Tumor location was divided into ‘suboptimal’ vs. ‘optimal’ locations for ablation. The Clinical Decision-Making was based on tumor burden, liver dysfunction, or comorbidities. The statistical analysis included the time-to-recurrence/progression, censoring at time of death, date of last follow-up or liver transplantation, and time-to-event was estimated by the Kaplan–Meier method and Cox regression models to evaluate the risk of an event of death and change of treatment strategy. Results: A total of 225 patients [39.1% BCLC-0 and 60.9% BCLC-A] were included, 190 had unifocal HCC and 82.6% were ≤3 cm. The complete response rate and median overall survival were 96% and 60.7 months. The HCC nodules number (Hazard Ratio—HR 3.1), Child-Pugh (HR 2.4), and Albumin-Bilirubin score (HR 3.2) were associated with increased risk of death during follow-up. HCC in ‘suboptimal location’ presented a shorter time to recurrence. When comorbidities prevented further loco-regional or systemic treatment, the risk of death was significantly increased (HR 2.0, p = 0.0369) in comparison to those who received treatment. Conclusions: These results expose the impact of non-liver comorbidities when considering treatment for recurrence after ablation in the real-world setting and in research trials. Ultimately, we identified an orphan population for which effective interventions are needed.

KW - Ablation

KW - Clinical decision-making

KW - Comorbidities

KW - Elderly

KW - Hepatocellular carcinoma

KW - Pattern of progression

KW - Survival

UR - https://www.scopus.com/pages/publications/85164975541

UR - https://www.mendeley.com/catalogue/e4579f4c-6f26-3ead-bc24-620e8893d449/

U2 - 10.3390/cancers15133269

DO - 10.3390/cancers15133269

M3 - Article

C2 - 37444380

AN - SCOPUS:85164975541

SN - 2072-6694

VL - 15

SP - 3269

JO - Cancers

JF - Cancers

IS - 13

M1 - 3269

ER -

Risk of Treatment Failure and Death after Ablation in Hepatocellular Carcinoma Patients—: A Multiparametric Prediction

Resum

SDG de les Nacions Unides

Accés al document

Altres arxius i enllaços

Fingerprint

Com citar-ho