Abstract
BackgroundRandomized trials suggest that radiofrequency ablation (RFA) may be more effective than percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC). However, the survival advantage of RFA needs confirmation in daily practice.MethodsWe conducted a population-based cohort study using the Taiwan Cancer Registry, National Health Insurance claim database and National Death Registry data from 2004 through 2009. Patients receiving PEI or RFA as first-line treatment for newly-diagnosed stage I-II HCC were enrolled.ResultsA total of 658 patients receiving RFA and 378 patients receiving PEI treatment were included for final analysis. The overall survival (OS) rates of patients in the RFA and PEI groups at 5-year were 55% and 42%, respectively (p < 0.01). Compared to patients that received PEI, those that received RFA had lower risks of overall mortality and first-line treatment failure (FTF), with adjusted hazard ratios (HRs) [95% confidence interval (CI)] of 0.60 (0.50-0.73) for OS and 0.54 (0.46-0.64) for FTF. The favorable outcomes for the RFA group were consistently significant for patients with tumors > 2 cm as well as for those with tumors < 2 cm. Consistent results were also observed in other subgroup analyses defined by gender, age, tumor stage, and co-morbidity status.ConclusionRFA provides better survival benefits than PEI for patients with unresectable stage I-II HCC, irrespective of tumors > 2 cm or ≤ 2 cm, in contemporary clinical practice.
Highlights
Hepatocellular carcinoma (HCC) is the leading cause of death from cancer in many countries [1,2,3,4]
Among the 1,036 eligible patients, 310 (82%) in the percutaneous ethanol injection (PEI) group and 459 (70%) in the radiofrequency ablation (RFA) group, whose National Health Insurance (NHI) claim data of the first treatment course corresponded to the Taiwan Cancer Registry (TCR) records, were selected for time to first-line treatment failure (FTF) analysis
In this population-based study of East-Asian patients with stage I-II hepatocellular carcinoma (HCC), RFA was associated with significantly better overall survival (OS) and lower risk of FTF, compared to PEI
Summary
Hepatocellular carcinoma (HCC) is the leading cause of death from cancer in many countries [1,2,3,4]. Among the available locoregional therapies, percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) have been widely used for small unresectable HCCs [7,8]. The estimated 5-year survival of patients receiving PEI or RFA for early-stage HCC exceeds 50% [11,12], and the 5year survival rate for untreated patients is less than 20% [13]. Randomized trials suggest that radiofrequency ablation (RFA) may be more effective than percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC). Patients receiving PEI or RFA as first-line treatment for newly-diagnosed stage I-II HCC were enrolled. Conclusion: RFA provides better survival benefits than PEI for patients with unresectable stage I-II HCC, irrespective of tumors > 2 cm or ≤ 2 cm, in contemporary clinical practice
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