SNFGE SNFGE
 
Thématique :
- Foie
- Carcinome hépatocellulaire (CHC)
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2017/06  
 
  2017 Jun;65(6):1979-1990  
  doi: 10.1002/hep.29098  
 
  Radiofrequency ablation of hepatocellular carcinoma as bridge therapy to liver transplantation: A 10-year intention-to-treat analysis.  
 
  Lee MW, Raman SS, Asvadi NH, Siripongsakun S, Hicks RM, Chen J, Worakitsitisatorn A, McWilliams J, Tong MJ, Finn RS, Agopian VG, Busuttil RW, Lu DSK  
  https://www.ncbi.nlm.nih.gov/pubmed/28170115  
 
 

Abstract

In a long-term (10-year) study of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) as bridging therapy in patients listed for orthotopic liver transplantation (LT), we evaluated the impact of RFA on waiting list dropout rate, post-LT tumor recurrence, and long-term intention-to-treat, disease-specific survival (DSS). From March 2004 to October 2014, RFA was performed as the initial stand-alone bridge therapy to LT for 121 patients (men/women ratio, 83:38; mean age, 60.0 years) with 156 de novo HCCs (mean size, 2.4 cm). Follow-up period from initial RFA ranged from 1.3 to 128.0 months (median, 42.9 months). We assessed the overall and tumor-specific waiting list dropout rates, post-LT tumor recurrence, and 10-year post-LT and intention-to-treat survival rates. Dropout from the waiting list due to tumor progression occurred in 7.4% of patients. HCC recurrence after LT occurred in 5.6% of patients. The post-LT overall survival (OS) rate at 5 and 10 years was 75.8% and 42.2%, respectively, and the recurrence-free survival (RFS) rate was 71.1% and 39.6%, respectively. Intention-to-treat OS, RFS, and DSS rates for the entire study population at 5 and 10 years were 63.5% and 41.2%, 60.8% and 37.7%, and 89.5% and 89.5%, respectively.

CONCLUSION:

RFA as a first-line stand-alone bridge therapy to LT achieves excellent long-term overall and tumor-specific survivals, with a low dropout rate from tumor progression despite long wait list times and a sustained low tumor recurrence rate upon post-LT follow-up of up to 10 years. (Hepatology 2017;65:1979-1990).

 

 
Question posée
 
Impact de la radiofréqunece en traitement de première intention sur le taux de sortie de liste, la récidive post-transplantation hépatique, et la survie spécifique à long terme des patients inscrits sur liste de transplantation hépatique pour carcinome hépatocellulaire.
 
Question posée
 
Les survies globale et spécifique sont excellentes, le taux de sortie de liste est faible malgré le long temps d’attente sur liste et le taux de rechute tumorale prolongée est faible.
 
Commentaires

Chez les patients strictement dans les critères de Milan avec cirrhose surtout d’origine virale, la radiofréquence en traitement d’attente est justifiée.

 
www.snfge.org