Prognosis of Early-Stage Hepatocellular Carcinoma: Comparison between Trans-Arterial Chemoembolization and Radiofrequency Ablation.

Byung-Yoon Yun,Beom Kyung Kim,Sang Hoon Ahn,Seung Up Kim,Hye Won Lee,Jun Yong Park,Do Young Kim,In Kyung Min

doi:10.3390/cancers12092527

Byung-Yoon Yun, Beom Kyung Kim + Show 6 more

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https://doi.org/10.3390/cancers12092527

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Journal: Cancers	Publication Date: Sep 5, 2020
Citations: 21	License type: CC BY 4.0

Affiliation: Severance Hospital, Yonsei University

Abstract

Simple SummaryRadiofrequency ablation (RFA) is a curative treatment for early-stage hepatocellular carcinoma (HCC) ineligible for surgery or liver transplantation. However, trans-arterial chemoembolization (TACE) might be an alternative when RFA is contraindicated due to structural problems. Among treatment-naive HCC patients fulfilling the Milan criteria who underwent RFA (n = 136) or TACE (n = 268), complete response (CR) and 5-year recurrence-free survival (RFS) rates were higher in the RFA group than in the TACE group (94.1% vs. 71.6% and 35.8% vs. 17.0%, respectively; both p < 0.001), whereas 5-year overall survival (OS) rates were not significantly different (65.5% vs. 72.3%, respectively; p = 0.100). After propensity-score matching, similar results were also reproduced. Hence, TACE could be an effective alternative to RFA in terms of OS rates. However, TACE should be confined only to RFA-difficult cases, given its lower CR and RFS rates and multi-disciplinary approaches are desirable in decision-making.Radiofrequency ablation (RFA) is a curative treatment for early-stage hepatocellular carcinoma (HCC) ineligible for surgery or liver transplantation. However, trans-arterial chemoembolization (TACE) might be an alternative when RFA is contraindicated due to structural problems. Here, we aimed to compare their long-term outcomes. Treatment-naive HCC patients fulfilling the Milan criteria who underwent RFA (n = 136) or TACE (n = 268) were enrolled. Complete response (CR) and 5-year recurrence-free survival (RFS) rates were higher in the RFA group than in the TACE group (94.1% vs. 71.6% and 35.8% vs. 17.0%, respectively; both p < 0.001), whereas 5-year overall survival (OS) rates were not significantly different (65.5% vs. 72.3%, respectively; p = 0.100). Multivariate analysis showed that RFA was associated with better RFS (adjusted hazard ratio [aHR] 0.628; p = 0.001) than TACE, but not with better OS (aHR 1.325; p = 0.151). The most common 1st-line treatment after recurrence were TACE (n = 53), followed by RFA (n = 21) among the RFA group and TACE (n = 150), followed by RFA (n = 44) among the TACE group. After propensity-score matching, similar results were reproduced. Hence, TACE could be an effective alternative to RFA in terms of OS rates. However, TACE should be confined only to RFA-difficult cases, given its lower CR and RFS rates and multi-disciplinary approaches are desirable in decision-making.

Highlights

Hepatocellular carcinoma (HCC) is a major health problem both in Korea and worldwide [1,2,3]
In the real-world practice, a substantial proportion of hepatocellular carcinoma (HCC) patients are treated with various non-surgical options, primarily owing to tumor burden, the limited hepatic functional reserves, shortage of organ donors, high morbidities and mortalities associated with surgery, and patients’ refusals [5,6,7,8,9,10]
When tumors are located in the sub-capsular region, dome, or adjacent to intestinal loops or the bile duct, Radiofrequency ablation (RFA) is technically not feasible owing to higher risks of bleeding, perforation, or bile leakage [15]

Summary

Introduction

Hepatocellular carcinoma (HCC) is a major health problem both in Korea and worldwide [1,2,3]. In the real-world practice, a substantial proportion of HCC patients are treated with various non-surgical options, primarily owing to tumor burden, the limited hepatic functional reserves, shortage of organ donors, high morbidities and mortalities associated with surgery, and patients’ refusals [5,6,7,8,9,10]. When tumors are located in the sub-capsular region, dome, or adjacent to intestinal loops or the bile duct, RFA is technically not feasible owing to higher risks of bleeding, perforation, or bile leakage [15]. In such cases, hepatic resection and OLT are not feasible options. While selective trans-arterial chemoembolization (TACE) could be a viable alternative, it is primarily optimized as a palliative treatment for intermediate-to-advanced-stage HCC, despite several retrospective cohort studies indicating acceptable survival outcomes for patients with treatment-naïve early-stage

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