Journal of vascular and interventional radiology : JVIR · 2026
Thermal Ablation with or without Liver Transplantation for Hepatocellular Carcinoma in Older Adults with Child-Pugh Class A Cirrhosis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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McWilliams Justin P, Ramakrishnan Abinaya, Lee Edward W, Padia Siddharth A, Pianka Sean, Tran Serinee, Lu David, Raman Steven, Saab Sammy, Shetty Akshay, Agopian Vatche
Аннотация
PURPOSE: To determine whether older adults with early-stage hepatocellular carcinoma (HCC) and Child-Pugh Class A cirrhosis derive additional survival benefit from orthotopic liver transplantation (OLT) following complete percutaneous thermal ablation (TA).
MATERIALS AND METHODS: This study reviewed 98 patients aged 60-80 years with very-early-stage or early-stage HCC (Barcelona Clinic Liver Cancer 0/A) and Child-Pugh Class A cirrhosis, treated between 2011 and 2020, who had complete response to TA at 6 months. Patients were stratified by whether or not they underwent subsequent OLT. Primary outcomes were overall survival (OS) and cancer-specific survival (CSS) at 5 and 10 years. Intention-to-treat, subgroup, and multivariate and time-varying Cox regression analyses were performed.
RESULTS: No statistically significant differences in OS (P = .075) or CSS (P = .49) were observed between OLT and non-OLT groups. Five-year OS was 92.0% (OLT) versus 81.2% (non-OLT), and 10-year OS was 81.2% versus 61.9%. Five-year CSS was 100.0% (OLT) versus 92.3% (non-OLT), and 10-year CSS was 89.1% versus 86.3%. Intention-to-treat analysis showed no difference between groups (P = .76), with 5-year OS of 85.1% (OLT waitlisted) versus 83.5% (nonwaitlisted), and 10-year OS of 71.0% versus 66.6%. In time-varying Cox regression analysis, transplantation was not significantly associated with OS (P = .24).
CONCLUSIONS: For older adults with early-stage HCC and well-compensated cirrhosis who undergo successful TA, no statistically significant survival advantage was detected for those who received subsequent OLT compared with active surveillance.
MATERIALS AND METHODS: This study reviewed 98 patients aged 60-80 years with very-early-stage or early-stage HCC (Barcelona Clinic Liver Cancer 0/A) and Child-Pugh Class A cirrhosis, treated between 2011 and 2020, who had complete response to TA at 6 months. Patients were stratified by whether or not they underwent subsequent OLT. Primary outcomes were overall survival (OS) and cancer-specific survival (CSS) at 5 and 10 years. Intention-to-treat, subgroup, and multivariate and time-varying Cox regression analyses were performed.
RESULTS: No statistically significant differences in OS (P = .075) or CSS (P = .49) were observed between OLT and non-OLT groups. Five-year OS was 92.0% (OLT) versus 81.2% (non-OLT), and 10-year OS was 81.2% versus 61.9%. Five-year CSS was 100.0% (OLT) versus 92.3% (non-OLT), and 10-year CSS was 89.1% versus 86.3%. Intention-to-treat analysis showed no difference between groups (P = .76), with 5-year OS of 85.1% (OLT waitlisted) versus 83.5% (nonwaitlisted), and 10-year OS of 71.0% versus 66.6%. In time-varying Cox regression analysis, transplantation was not significantly associated with OS (P = .24).
CONCLUSIONS: For older adults with early-stage HCC and well-compensated cirrhosis who undergo successful TA, no statistically significant survival advantage was detected for those who received subsequent OLT compared with active surveillance.