Safety and efficacy of percutaneous radiofrequency ablation for hepatocellular carcinoma: a textbook outcome analysis

Background: The Textbook Outcome (TO) is a quality indicator accounting for both efficacy and safety. Herein, we aimed to assess TO in patients with hepatocellular carcinoma (HCC) undergoing percutaneous radiofrequency ablation (RFA). Methods: All consecutive patients undergoing RFA for HCC between 2014 and 2020, were included. TO was defined as 1) no post-RFA complications or mortality within 30 days after RFA, 2) no prolonged hospital stay 3) no 30-day readmission and 4) the achievement of a complete response (CR) of the target lesion/s at 1-month. Results: Overall, 50.3% of 376 patients fulfilled all the quality indicators to achieve TO. Probabilities of TO achievement decreased in presence of moderate comorbidities (odds ratio[OR]:0.43; 95%C.I.:0.22–0.80;p=0.008), a performance status of 1 (OR: 0.58;95%C.I.:0.37–0.89; p=0.013), the treatment of 2 nodules (OR: 0.71; 95%C.I.:0.41–0.98; p=0.048) or ≥3 nodules (OR: 0.41; 95%C.I.: 0.22 – 0.78; p = 0.007); the treatment of 2-3cm nodules (OR:0.49;95%C.I.:0.31–0.79;p=0.003) or >3cm nodules (OR: 0.36;95%C.I.:0.18–0.73;p=0.004). Risk-stratification provided TO achievement ranging between 77.9% and 14.3%. Patients with TO also had improved survival (p = 0.028). Conclusion: About half of patients get TO from RFA. Stratification by clinical and tumoral characteristic should aid provision of RFA in clinical practice, facilitating patient information and providing reference values for future comparative studies.