Risk Factors For Intrahepatic Spread Of Hepatocellular Carcinoma After Local Ablative Therapy

Background:Hepatocellular carcinoma(HCC)is the fifth most commonly diagnosed cancer and the second leading cause of cancer death in the world.At present,the treatment method of HCC is still a comprehensive treatment mode of surgery,but less than 15%of HCC patients have a chance to receive radical treatment.In recent years,the non-surgical treatment methods of HCC,such as local ablation therapy(LAT),have become more important.With the extensive development of LAT,postoperative intrahepatic dissemination(IHD)case reports gradually increase,but its risk factors have never been fully clarified.This study aimed to elucidate the local histological changes,the effect of radiofrequency ablation treatment,and the risk factors of IHD after LAT for HCC.Methods:Clinical data of 540 liver cancer patients who received LAT between March2010 and August 2016 at the National Medical University Hospital of Islamabad were collected for analysis.Filtting 17 patients who relapsed after receiving LAT treatment and underwent liver resection.Eight of the 17 patients had recurrent recurrence of IHD,and nine patients had a local recurrence.Collecting pathological histology,imaging and basic clinical characteristics of these 8 patients with IHD.To investigate the mechanism of changes in tumor cell biology,histology and clinical characteristics caused by LAT of HCC.Prognostic outcomes of IHD patients were analyzed by survival analysis.Results:8 patients with IHD had a mean tumor diameter of 2.1 cm,62.5% of the tumors were adjacent to the portal trunk or section,and 25% had preoperative puncture biopsy before LAT.Of these,25% of the patients underwent RFA,25% of the patients underwent PEIT,37.5% of the patients underwent MCT,and 12.5% of the patients underwent PEIT combined with RFA.In the subsequent surgical resection,62.5% of the patients had a surgical margin of less than 1cm,and all patients relapsed within 3 months after surgery and died within 1 year.Histologically,50% of patients had poorly differentiated or moderately to poorly differentiated tumors,and the remaining 50% had moderately differentiated tumors.All patients developed multiple intrahepatic metastases(IM)and major or segmental portal vein tumor thrombus(PVTT)in the same segment.Conclusions:Key mechanisms of tissue injury involve inactivation of important enzymes,amount and duration of applied thermal energy.LAT for HCCs(even those less than 3cm in diameter)adjacent less than 5 mm to the main or sectional portal veinous branch possibly promotes intrahepatic dissemination.