Uni-, Bi- or Trifocal Hepatocellular Carcinoma in Western Patients: Recurrence and Survival after Percutaneous Thermal Ablation

{Simple Summary Percutaneous thermal ablation (PTA) is a validated treatment for small (<3 cm) hepatocellular carcinoma (HCC). Multifocality is usually reported as a strong pejorative factor. Yet, the current literature lacks data on the influence in Western patients of HCC nodule numbers on recurrence and survival after PTA. From a prospective cohort of patients who underwent PTA for <3 cm HCC, we retrospectively compared recurrence and survival, according to the number of nodules. We found that bi- and trifocal HCC significantly increased the risk of distant recurrence, especially very early (<6 months) distant recurrence. Overall survival after PTA of trifocal HCC proved to be significantly below what was expected after a curative treatment, ranging between that of BCLC A and of BCLC B patients. Liver transplantation should certainly be considered earlier in this sub-population. Reasonable hopes come from adjuvant/neoadjuvant trials based on immunotherapies alone or in combination. Multifocality is usually reported as a pejorative factor after percutaneous thermal ablation (PTA) of HCC but little is known in Western series. Recurrence and survival were extracted from a prospective database of all patients who underwent PTA for <= 3 cm HCC. From January 2015 to April 2020, we analyzed 281 patients with unifocal (n = 216), bifocal (n = 46) and trifocal (n = 16) HCC. PTA of bi- and trifocal HCC resulted in a high risk of very early (<6 months) distant recurrence (38.8% and 50%, respectively). Median RFS was 23.3 months (95% CI:18.6-30.4), 7.7 months (95% CI:5.1-11.43