title: Ablation therapy in containing extension of hepatocellular carcinoma: a simulative analysis of dropout from the waiting list for liver transplantation.
abstract: The dropout from the waiting list for liver transplantation among patients with hepatocellular carcinoma (HCC) is reportedly as high as 12% to 40% per year, mostly due to tumor progression. Considering the scarcity of donor organs, it would be beneficial if we could retain them within the Milan criteria with a bridging therapy. We retrospectively analyzed the prognosis of 288 HCC patients with relatively preserved liver function we treated with ablation therapy between 1997 and 2001, concentrating on whether they subsequently remained in the criteria, and analyzed the risk factors of dropout with Cox proportional hazards model. During a median follow-up period of 39 months (range, 1-86 months), 33 (11%) died without tumor progression, while 85 (30%) dropped out due to tumor progression. The overall dropout rate was 9.0% and 32.8% at 1 and 3 years, respectively, and that due to tumor progression was 6.2% and 23.0%. Cox regression analysis indicated that a high serum level of alpha-fetoprotein or des-gamma-carboxy prothrombin, and a tumor size exceeding 3 cm in diameter affected the dropout due to tumor progression, while low albumin concentration was a risk factor of death independently of tumor progression. In conclusion, local ablation therapy for HCC was effective in containing the tumor progression within the Milan criteria in selected patients.
authors.affiliation: Department of Gastroenterology, University of Tokyo, Graduate School of Medicine, Tokyo, Japan. nyamshiki-gi@umin.ac.jp
authors.forename: Noriyo
authors.initials: N
authors.lastname: Yamashiki
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tateishi
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Shiina
authors.forename: Takuma
authors.initials: T
authors.lastname: Teratani
authors.forename: Shinpei
authors.initials: S
authors.lastname: Sato
authors.forename: Norio
authors.initials: N
authors.lastname: Mine
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kondo
authors.forename: Takao
authors.initials: T
authors.lastname: Kawabe
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy; D017115:Catheter Ablation / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014850:Waiting Lists