Published online Aug 28, 2020. doi: 10.3748/wjg.v26.i32.4833
Peer-review started: April 2, 2020
First decision: April 29, 2020
Revised: May 4, 2020
Accepted: August 12, 2020
Article in press: August 12, 2020
Published online: August 28, 2020
Extrahepatic metastasis (EHM) of hepatocellular carcinoma (HCC) is related to dismal prognosis.
The characteristics and risk factors of EHM of HCC after radiofrequency ablation are not elucidated.
To investigate the clinical features and risk factors of EHM after radiofrequency ablation for HCC.
Patients who underwent radiofrequency ablation for HCC were identified from the two tertiary hospitals in South Korea from 2008 to 2017. Univariate analyses were performed using the chi-squared test or Student’s t-test, and univariate and multivariate analyses were performed via logistic regression, as appropriate.
During a median follow-up period of 1,204 days, EHM was diagnosed in 44 patients (6.7%). The 10-year cumulative rate of HCC recurrence and EHM was 92.7% and 33.7%, respectively. The median time to the diagnosis of EHM was 2.68 years, and 68.2% of patients developed EHM within 2 years of the first recurrence, regardless of recurrence-free survival. EHM was mostly diagnosed via abdominal CT/MRI in 33 (75.0%) and 38 of 44 patients (86.4%) with EHM had either positive abdominal CT scan results or serum alpha-fetoprotein (AFP) level elevation. In multivariate analysis, recurrence-free survival < 2 years, ablation zone/tumor size < 2, and alpha-fetoprotein level > 400 IU/mL were associated with a high EHM risk.
EHM occurs following multiple intrahepatic recurrences after radiofrequency ablation and combined contrast-enhanced abdominal CT and serum AFP were useful for surveillance.
Patients especially with high-risk factors such as recurrence-free survival < 2 years, ablation zone/tumor size < 2, and alpha-fetoprotein level > 400 IU/mL, require close follow-up for EHM.