A comparison of prognoses between surgical resection and radiofrequency ablation therapy for patients with hepatocellular carcinoma and esophagogastric varices

Cheng-Yi Wei,Ping-Hsien Chen,Ming-Chih Hou,Yu-Hui Su,Chien-Wei Su,Yi-Hsiang Huang,Jaw-Ching Wu,Gar-Yang Chau,Teh-Ia Huo,Chien-An Liu,Han-Chieh Lin

doi:10.1038/s41598-020-74424-y

Abstract

There has been insufficient investigation of the differences in long-term outcomes between surgical resection (SR) and radiofrequency ablation (RFA) among patients with hepatocellular carcinoma (HCC) and esophagogastric varices (EGV). We retrospectively enrolled 251 patients with treatment-naïve HCC and EGV who underwent SR or RFA as a first-line treatment. Prognostic factors were analyzed using a Cox proportional hazards model. A total of 68 patients underwent SR, and the remaining 183 patients received RFA. Patients who underwent SR were younger, had better liver functional reserves, and had larger tumors. After a median follow-up duration of 45.1 months, 151 patients died. The cumulative 5-year overall survival (OS) rate was significantly higher among patients who underwent SR than those treated with RFA (66.7% vs. 36.8%, p < 0.001). Multivariate analysis showed that age > 65 years, multiple tumors, RFA, albumin bilirubin grade > 1, and the occurrence of major peri-procedural morbidity were the independent risk factors that are predictive of poor OS. In conclusion, SR could be recommended as a first-line treatment modality for HCC patients with EGV if the patients are carefully selected and liver function is well preserved.

Highlights

Among the 2046 consecutive HCC patients who underwent SR, 1883 patients had a International multicenter retrospec- record of EV status, including 196 patients with EV and 1687 patients without EV
SR could be recommended as the first-line treatment modality for HCC patients with EGV if the patients are carefully selected and liver function is well preserved
The diagnosis of HCC was established based on the criteria from the American Association for the Study of Liver Disease c onsensus[52]

Summary

Results

The multivariate analysis revealed that the independent risk factors for poorer OS were age > 65 years (hazard ratio (HR): 1.721; 95% confidence interval (CI): 1.213–2.441; p = 0.002), having multiple tumors (HR: 1.630; 95% CI: 1.129–2.354; p = 0.009), RFA (HR: 2.271; 95% CI: 1.427– 3.616; p = 0.001), ALBI grade > 1 (HR: 1.583; 95% CI: 1.032–2.427; p = 0.035), and the development of major peri-procedure morbidity (HR: 3.201; 95% CI: 1.774–5.777; p < 0.001). 169 patients developed tumor recurrence, and the median recurrence time was 15.2 (IQR 7.3–31.5) months. In the SR group, 49 patients had tumor recurrence with a median development time of 20.8 (IQR 12.4–38.5) months. Among patients who underwent RFA, 120 of them developed tumor recurrence within a median time of 11.9 (IQR 5.4–27.2) months.

Discussion

Summary

Methods