Prognosis of hepatocellular carcinoma in hemodialysis patients treated with radiofrequency ablation: a retrospective, single-center cohort study with propensity-score matching

Background The efficacy and safety of radiofrequency ablation (RFA) in patients with hepatocellular carcinoma (HCC) undergoing dialysis have not been well studied. This study aimed to compare the prognosis of HCC between patients on dialysis and those not on dialysis who were treated with RFA. Methods In this retrospective observational study, we examined consecutive patients with treatment-naïve localized HCC who underwent RFA between February 2000 and December 2021. Patients were categorized into two groups based on dialysis status (Dialysis Group, n = 32; Non-dialysis Group, n = 537) and followed until December 2023. The primary endpoint was overall survival (OS), assessed using Kaplan–Meier analysis. For propensity score matching, 1:2 matched pairs were generated based on age, sex, Child–Pugh score, tumor size, number of tumors, and HCV positivity. Causes of death and major complications during the first RFA session were also compared between groups. Results The study cohort had a mean age of 70.7 ± 9.4 years and included 399 male patients (70%). Hepatitis B was present in 47 patients (8.3%) and hepatitis C in 365 (64.1%). A total of 136 patients (23.9%) were heavy alcohol drinkers. In the entire cohort, OS was comparable between the Dialysis Group and Non-dialysis Groups (5-year survival: 73.1% vs. 55.3%, p  = 0.27). In the 1:2 propensity score-matched analysis, OS in the Dialysis Group remained comparable to that in the Non-dialysis Group (5-year survival: 73.1% vs. 64.9%, p  = 0.94). During follow-up, 313 patients (55.0%) died. Liver-disease-related deaths occurred in 42.1% of the Dialysis Group and 63.3% of the Non-dialysis Group, whereas cardiovascular deaths occurred in 10.5% and 1.4%, respectively. Major procedure-related complications during the first RFA session were observed in two patients (6.3%) in the Dialysis Group and 13 (2.4%) in the Non-dialysis Group. Conclusion The prognosis of patients with HCC treated with RFA was comparable between those on dialysis and those not on dialysis. However, liver-disease-related mortality was lower in the dialysis population. These findings suggest that dialysis status alone should not preclude curative RFA for localized HCC, provided that careful periprocedural management is ensured.