Nationwide study on survival and recurrence of hepatocellular carcinoma after ablation as first treatment

Background Hepatocellular carcinoma (HCC) is a common cancer worldwide with high mortality and recurrence rates. We aimed to report survival and recurrence rates following ablation as the first treatment using real-world data. Methods This study was based on data from a database and medical records. Variables associated with survival were investigated using the Kaplan-Meier estimator and Cox regression, and for recurrence with the Aalen-Johansen estimator and cause-specific Cox regression. Results From 2013 to 2023, 395 patients were included. Among them, 80% were men, the median age was 66 years, and 91% had cirrhosis. A complete ablation response was achieved in 86.1% of cases. Median survival was 3.4 years, and the five-year survival rate was 37.3%. Adjusted analysis showed a worse prognosis in patients with a tumor diameter ≥3 cm compared to <3 cm, performance status 1 and ≥ 2 compared to 0, and a percutaneous approach compared to open. Two-thirds developed recurrence, of whom 40.5% had de novo HCC, and 18% had local recurrence. Adjusted analysis showed that diameter ≥3 cm compared to <3 cm and three or more tumors had a higher recurrence risk. Conclusion Recurrence remains challenging, particularly for patients with larger and multiple tumors, and studies investigating the treatment of recurrence are warranted. Clinical trials register NCT05498779.