Relationship between post-ablation fever and prognosis in initial hepatocellular carcinoma: A 15-year multicenter, retrospective cohort study

Qian Cai; Chuan Pang; Zhen Wang; Jianming Li; Yuqing Dai; Fang-Ying Fan; Zhong-Qi Wang; Xin Hu; Lijuan Li; Xu-Wei Chen; Ran Ji; Qian Mei; Chao Zhang; Ping Liang; Xiaoling Yu; Fang-Yi Liu; Zhigang Cheng; Jie Yu

doi:10.1097/JS9.0000000000002066

Relationship between post-ablation fever and prognosis in initial hepatocellular carcinoma: A 15-year multicenter, retrospective cohort study

Int J Surg. 2024 Sep 18. doi: 10.1097/JS9.0000000000002066. Online ahead of print.

Authors

Qian Cai¹, Chuan Pang¹, Zhen Wang¹, Jianming Li¹, Yuqing Dai¹, Fang-Ying Fan¹, Zhong-Qi Wang², Xin Hu³, Lijuan Li¹, Xu-Wei Chen⁴, Ran Ji¹, Qian Mei⁵, Chao Zhang⁶, Ping Liang¹, Xiaoling Yu¹, Fang-Yi Liu¹, Zhigang Cheng¹, Jie Yu¹

Affiliations

¹ Senior Department of Oncology, Department of Interventional Ultrasound, the Fifth Medical Center of PLA General Hospital, Beijing, China.
² Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital & Chinese PLA Medical College, Beijing, China.
³ Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
⁴ Department of Breast and Thyroid Surgery, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China.
⁵ Department of Bio-therapeutic, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
⁶ Senior Department of Infectious Diseases, the Fifth Medical Center of PLA General Hospital, Beijing, China.

PMID: 39291970
DOI: 10.1097/JS9.0000000000002066

Abstract

Background: Fever is a common side effect following thermal ablation in patients with hepatocellular carcinoma (HCC), yet its impact on prognosis remains unclear.

Materials and methods: This retrospective study included initial HCC patients who underwent US-guided percutaneous microwave ablation at 13 hospitals between January 2006 and February 2021. All patients were categorized into afebrile, transient low-grade fever (TLF), and prolonged or high-grade fever (PHF) groups. Primary outcomes included very early recurrence (VER) and early recurrence (ER), secondary outcomes were disease-free survival (DFS) and overall survival (OS). Fever cut-offs for VER/ER were established using restrictive cubic splines and adjusted Cox model. Survival analyses used the Kaplan-Meier method.

Results: A total of 1458 initial HCC patients (mean age, 59±11[SD]; 1146 men). Compared to afebrile individuals, patients with TLF (temperatures ranging 37.0-38.8°C for 1-2 d), showed independent protective effects against VER (HR, 0.73; 95% CI: 0.57,0.95; P=0.02) and ER (HR, 0.66; 95% CI: 0.54,0.81; P<0.001), however, PHF showed no differences in VER (HR, 0.99; 95% CI: 0.76,1.30; P=0.96) and ER (HR, 0.86; 95% CI: 0.69,1.07; P=0.17). With a median follow-up of 47 months (IQR:26-79), the median DFS for TLF patients was 40 months, superior to afebrile (30 mo, P=0.019) and PHF patients (33 mo, P=0.049). The 5-year OS rate for TLF patients was 73.2%, higher than afebrile (69.3%, P=0.02) and PHF patients (66.7%, P=0.03). No significant difference was found in DFS and OS between afebrile and PHF patients (P=0.90 and 0.71). Notably, TLF patients exhibited the highest lymphocyte counts increasing median 7 days after ablation (P<0.001 vs. afebrile and P=0.01 vs. PHF).

Conclusion: Transient low-grade fever following percutaneous microwave ablation in hepatocellular carcinoma patients demonstrated protection against early recurrence, possibly attributed to the short-term activation of lymphocytes.