Resection For Small Hepatocellular Carcinoma Research Articles

Effectiveness of Anatomical Resection for Small Hepatocellular Carcinoma: a Propensity Score–Matched Analysis of a Multi-institutional Database

BackgroundThe superiority of outcomes associated with anatomical resection (AR) versus those associated with non-anatomical resection (NAR) remains controversial in patients with hepatocellular carcinoma (HCC). The aim of this study was to evaluate the significance of AR on therapeutic outcomes of patients with small HCCs (≤ 5 cm), using propensity score–matched (PSM) analysis. MethodsA total of 195 patients who had undergone elective hepatic resection for small HCCs (≤ 5 cm) were included in this study. We conducted PSM analysis for baseline characteristics (age, sex, hepatitis virus status, retention rate of indocyanine green at 15 min, and Child-Pugh grade), preoperative serum α-fetoprotein, and tumor characteristics (tumor size, tumor number, portal vein invasion, and surgical margin status) to eliminate potential selection bias. The prognostic significance of AR on the disease-free and overall survival was analyzed in patients selected by PSM analysis. ResultsApplying PSM analysis, the patients were divided into PSM-AR (N = 66) and PSM-NAR (N = 66) groups. Disease-free survival was significantly better in the PSM-AR group than that of the PSM-NAR group (P = 0.018), while there was no significant difference in the overall survival between the PSM-AR and PSM-NAR groups (P = 0.292). The univariate HRs of the PSM-AR group were 0.55 (95% CI, 0.33–0.90) for disease-free survival and 0.61 (95% CI, 0.24–1.53) for overall survival, respectively. Remnant liver recurrence was significantly lower in the AR group (P = 0.014). ConclusionsAR may improve the disease-free survival in HCC patients with tumors of ≤5 cm diameter.

Utility of cone unit liver resection for small hepatocellular carcinoma: a propensity score matched analysis

BackgroundAnatomical resection (AR) is performed widely for hepatocellular carcinoma (HCC). However, it is controversial whether typical AR, which removes the whole feeding territory of the tumor-bearing portal branch bordered by the landmark veins, is necessary. The aim of this study was to investigate the utility of small AR, so-called cone unit resection, for small HCC. MethodsBetween 2007 and 2019, 372 hepatectomies were performed for HCC. Among them, 91 initial resections for small (<5 cm) solitary HCC were performed by typical AR (n = 44) or cone unit AR (n = 47). Propensity score matching was performed and clinicopathological features including prognosis were compared. ResultsAt baseline, platelet count was higher, and liver function (serum albumin level) and indocyanine green retention at 15 min were better in the typical AR than cone unit AR group. There was no significant difference between the typical AR and cone unit AR group for tumor characteristics, short- and long-term outcomes. Even after propensity score matching (n = 29), the short- and long-term outcomes were also equivalent in between the two groups. ConclusionThere was no difference in prognosis of typical and cone unit AR. Therefore, cone unit AR is a feasible procedure for small HCC.

3:00 PM Abstract No. 32 Ablation versus surgical resection for small hepatocellular carcinoma: a risk-adjusted SEER-Medicare analysis

To compare the all-cause survival, cancer-specific survival and progression-free survival of surgical resection (SR) versus ablation (AB) for small hepatocellular carcinoma. Our sample consisted of treatment-naïve patients who underwent AB or SR for small HCC (≤5 cm) from 2009-2016 in the SEER-Medicare database. Patients who had a non-HCC malignancy diagnosis within 5 years, lost entitlement 1 year prior to treatment or underwent liver transplant were excluded. Unadjusted and Cox regression model analysis of all-cause survival, cancer-specific survival and progression-free survival were compared. Cox regression model included basic demographic factors, socioeconomic factors, medical comorbidities, and liver disease prognostic indicators. A total of 767 patients who received AB and 214 who received SR met our study inclusion criteria. There were no significant differences between groups for age, gender, socioeconomic factors or the number of medical comorbidities. However, there were significant differences in prognostic indicators for and etiology of liver disease (all P values < 0.05). Unadjusted and adjusted all-cause survival, cancer-specific survival and progression-free survival were all superior in the SR group with all P values <0.001. With SR as a reference group, the unadjusted HRs (95% CI) for all cause survival, cancer-specific survival and disease-specific survival following AB were 2.32 (1.82-2.94), 2.45 (1.70-3.53), and 2.48 (2.01-3.06), respectively. The fully adjusted HRs (95% CI) for all cause survival, cancer-specific survival and disease-specific survival following AB were 1.83 (1.41-2.36), 2.28 (1.54-3.38) and 2.08 (1.65-2.62), respectively. In this national sample of patients with small hepatocellular carcinoma, compared to AB, SR is associated with better all cause survival, cancer-specific survival, and disease-specific survival. After adjusting for known socioeconomic factors, medical comorbidities and liver disease prognostic indicators, the differences between groups decreased. Unmeasured and unaccounted for confounders may account for at least part of the remaining differences between these groups.

Effectiveness of Anatomical Resection for Small Hepatocellular Carcinoma: A Propensity Score Matching Analysis of a Multi-Institutional Database

Effectiveness of Anatomical Resection for Small Hepatocellular Carcinoma: A Propensity Score Matching Analysis of a Multi-Institutional Database

Microwave ablation provided better overall survival than liver resection for small hepatocellular carcinoma in patients with borderline liver function

Background: Microwave ablation (MWA) is showed to be at least as effective as, if not superior than, radiofrequency ablation in treating HCC. Studies comparing MWA and liver resection are lacking. The aim of this study is to evaluate the survival of patients who were treated with liver resection and MWA and to evaluate if the newly developed Albumin-Bilirubin (ALBI) grade can help in patient selections for liver resection or ablation. Methods: This is a retrospective analysis on patients who received curative liver resection and MWA for primary HCC from March 2009 to December 2015. Baseline clinical and laboratory parameters were retrieved and reviewed from the hospital database. Propensity score matching was used at 1:1 ratio. The ALBI grade was evaluated for their abilities of patient selection. Results: A total of 442 patients underwent MWA and liver resection for primary HCC during the study period. Propensity scoring matching was used and resulted in 63 matched pairs for further analysis. While liver resection still offered better overall and disease-free survivals in patients with ALBI grade 1, MWA provided a significantly better overall survival in patients with ALBI grade 2 or 3. (p=0.025) Conclusion: Microwave ablation, as a treatment for HCC, offered superior overall survival to liver resection in patients ALBI grade 2 or 3.

Radiofrequency Ablation versus Resection for Small Hepatocellular Carcinoma: Are Randomized Controlled Trials Still Needed?

Radiofrequency Ablation versus Resection for Small Hepatocellular Carcinoma: Are Randomized Controlled Trials Still Needed?

Long-Term Survival Analysis of Stereotactic Ablative Radiotherapy Versus Liver Resection for Small Hepatocellular Carcinoma

To compare the efficacy of stereotactic ablative radiation therapy (SABR) versus liver resection for small hepatocellular carcinoma (HCC) ≤5cm with Child-Pugh A cirrhosis. This retrospective study included 117 patients with small HCCs with 1 or 2 nodules. Eighty-two patients received SABR (SABR group), and 35 patients underwent liver resection (resection group). Overall survival (OS) and progression-free survival (PFS) were analyzed. One-to-one matched pairs between the 2 groups were created using propensity score matching to reduce the potential confounding effect of treatment and selection bias. There was no between-group difference in OS and PFS. Before propensity score matching, the 1-, 3-, and 5-year OS was 96.3%, 81.8%, and 70.0% in the SABR group and 93.9%, 83.1%, and 64.4% in the resection group, respectively (P=.558). The 1-, 3- and 5-year PFS was 81.4%, 50.2%, and 40.7% in the SABR group and 68.0%, 58.3%, and 40.3% in the resection group, respectively (P=.932). After propensity score matching, 33 paired patients were selected from the SABR and resection groups. The 1-, 3-, and 5-year OS was 100%, 91.8%, and 74.3% in the SABR group and 96.7%, 89.3%, and 69.2% in the resection group, respectively (P=.405). The 1-, 3-, and 5-year PFS was 84.4%, 59.2%, and 43.9% in the SABR group and 69.0%, 62.4%, and 35.9% in the resection group, respectively (P=.945). There was a similarity of hepatotoxicity between the 2 groups. The SABR group showed fewer complications, such as hepatic hemorrhage, hepatic pain, and weight loss. Acute nausea was significantly more frequent in the SABR group than in the resection group. For patients with small primary HCC with 1 or 2 nodules and Child-Pugh A cirrhosis, SABR has local effects that are similar to those with liver resection. Stereotactic ablative radiation therapy has an advantage over resection in being less invasive.

Comparative analysis of intraoperative radiofrequency ablation versus non-anatomical hepatic resection for small hepatocellular carcinoma: short-term result

Backgrounds/AimsTo compare the clinical outcomes of intraoperative radiofrequency ablation (RFA) and non-anatomical hepatic resection (NAHR) for small hepatocellular carcinoma (HCC).MethodsFrom February 2007 to January 2015, clinical outcomes of thirty four patients with HCC receiving RFA or NAHR were compared, retrospectively.ResultsThere was no difference of patient and tumor characteristic between the two groups that received RFA or NAHR. The 1, 2, and 3-year recurrence rates following RFA were 32.2%, 32.2% and 59.3% respectively, and 6.7%, 33.3% and 33.3% following NAHR respectively (p=0.287). The 1, 2 and 3-year overall survival (OS) rates following RFA were 100%, 88.9% and 76.2% respectively, and 100%, 85.6% and 85.6%, respectively, following NAHR (p=0.869). We did not find a definite statistical difference in recurrence rate and OS rate between the two groups. In the multivariate analysis, number of tumor was an independent prognostic factor for recurrence and albumin was an independent prognostic factor for OS.ConclusionsWe recommend non-anatomical hepatic resection rather than intraoperative RFA in small sized HCC, due to a higher recurrence rate in intraoperative RFA. Intraoperative RFA was inferior to non-anatomical hepatic resection in terms of recurrence rate. We need to select the optimal treatment considering liver function and possibility of recurrence.

Comparison of the therapeutic effects of microwave ablation and surgical resection for small hepatocellular carcinoma.

e15124 Background: To compare the clinical effects of microwave ablation (MWA) and surgical resection in the treatment of small hepatocellular carcinoma (SHCC). Methods: 65 SHCC patients with intac...

Radiofrequency Ablation versus Hepatic Resection for Small Hepatocellular Carcinomas: A Meta-Analysis of Randomized and Nonrandomized Controlled Trials

ObjectivesTo evaluate the efficacy and safety of radiofrequency ablation (RFA) versus hepatic resection (HR) for early hepatocellular carcinoma (HCC) meeting the Milan criteria.MethodsA meta-analysis was conducted, and PubMed, Web of Science, the Cochrane Library, CBM, CNKI and VIP databases were systematically searched through November 2012 for randomized and nonrandomized controlled trials (RCTs and NRCTs). The Cochrane Collaboration's tool and modified MINORS score were applied to assess the quality of RCTs and NRCTs, respectively. The GRADE approach was employed to evaluate the strength of evidence.ResultsThree RCTs and twenty-five NRCTs were included. Among 11,873 patients involved, 6,094 patients were treated with RFA, and 5,779 with HR. The pooled results of RCTs demonstrated no significant difference between groups for 1- and 3-year overall survival (OS), recurrence-free survival (RFS) and disease-free survival (DFS) (p>0.05). The 5-year OS (Relative Risk, RR 0.72, 95% CI 0.60 to 0.88) and RFS (RR 0.56, 95% CI 0.40 to 0.78) were lower with RFA than with HR. The 3- and 5-year recurrences with RFA were higher than with HR (RR 1.48, 95% CI 1.14 to 1.94, and RR 1.52, 95% CI 1.18 to 1.97, respectively), but 1-year recurrence and in-hospital mortality showed no significant differences between groups (p>0.05). The complication rate (RR 0.18, 95% CI 0.06 to 0.53) was lower and hospital stays (Mean difference -8.77, 95% CI −10.36 to −7.18) were shorter with RFA than with HR. The pooled results of NRCTs showed that the RFA group had lower 1-, 3- and 5-year OS, RFS and DFS, and higher recurrence than the HR group (p<0.05). But for patients with very early stage HCC, RFA was comparable to HR for OS and recurrence.ConclusionThe effectiveness of RFA is comparable to HR, with fewer complications but higher recurrence, especially for very early HCC patients.

The role of biopsy of the nontumorous liver parenchyma in patients considered for partial resection of small hepatocellular carcinoma

We read with interest the article by Roayaie et al. reporting on resection of hepatocellular carcinoma (HCC) ≤2 cm in two Western centers.1 This elegant study shows that excellent results (e.g., up to 80% 5-year survival) can be achieved with adequate surgical resection in selected patients with small HCC. These results are in line with the study from our group published this year in HEPATOLOGY concerning potentially transplantable patients who were resected first in a strategy of salvage transplantation in cases of recurrence.2 In the context of organ shortage, we fully agree with the conclusion that resection should continue to be a first-line option in patients with preserved liver function.1 In addition to classical tumor factors, these two studies confirm that nonanatomic resection and presence of cirrhosis were associated with a higher risk of recurrence. In our series, for instance, 64% of the patients who did not experience recurrence after resection had stage 3 fibrosis. The feasibility of anatomic resection, which was independently associated with less recurrence, as well as postoperative morbidity, obviously depends upon the extent of underlying fibrosis. Although Roayaie et al. have shown that advances in the management of HCC could come from the underlying liver parenchyma, they do not mention the usefulness of preoperative biopsy of nontumorous liver parenchyma, to better select the optimal candidates for resection. The importance of nontumorous parenchyma is illustrated by the finding by the same group that gene expression signatures in the adjacent liver parenchyma, but not in the tumor, were highly correlated to recurrence and survival after resection.3 Overall, these data strongly suggest that in addition to tumor status, careful assessment of nontumorous liver parenchyma with preoperative biopsy of the nontumorous parenchyma should be incorporated in the decision-making of patients with small HCC who are potential candidates for resection.

Traditional herbal medicine in preventing recurrence after resection of small hepatocellular carcinoma: a multicenter randomized controlled trial

BackgroundDisease recurrence is a main challenge in treatment of hepatocellular carcinoma (HCC). There is no generally accepted method for preventing recurrence of HCC after resection. ObjectiveTo compare the efficacy of a traditional herbal medicine (THM) regimen and transarterial chemoembolization (TACE) in preventing recurrence in post-resection patients with small HCC. Design, setting, participants and interventionsThis is a multicenter, open-label, randomized, controlled study, which was undertaken in five centers of China. A total of 379 patients who met the eligibility criteria and underwent randomization were enrolled in this trial. One hundred and eighty-eight patients were assigned to the THM group and received Cinobufacini injection and Jiedu Granule, and the other 191 patients were assigned to the TACE group and received one single course of TACE. Main outcome measuresPrimary outcome measures were the annual recurrence rate and the time to recurrence. Incidence of adverse events was regarded as the secondary outcome measure. ResultsAmong the 364 patients who were included in the intention-to-treat analysis, 67 patients of the THM group and 87 of the TACE group had recurrence, with a hazard ratio of 0.695 (P = 0.048). Median recurrence-free survival of the patients in the THM and TACE groups was 46.89 and 34.49 months, respectively. Recurrence rates at 1, 2 and 3 years were 17.7%, 33.0% and 43.5% for the THM group, and 28.8%, 42.5% and 54.0% for the TACE group, respectively (P = 0.026). Multivariate analysis indicated that the THM regimen had a big advantage for prolonging the recurrence-free survival. Adverse events were mild and abnormality of laboratory indices of the two groups were similar. ConclusionIn comparison with TACE therapy, the THM regimen was associated with diminished risk of recurrence of small-sized HCC after resection, with comparable adverse events. Trial registrtion identifierThis trial was registered in the Chinese Clinical Trial Registry with the identifier ChiCTR–TRC-07000033.

Radiofrequenzablation des hepatozellulären Karzinoms

Percutaneous radiofrequency ablation (RFA) is well established in the treatment of hepatocellular carcinoma (HCC). Due to its curative potential, it is the method of choice for non resectable BCLC (Barcelona Liver Clinic) 0 and A. RFA challenges surgical resection for small HCC and is the method of choice in bridging for transplantation and recurrence after resection or transplantation. The technical feasibility of RFA depends on the size and location of the HCC and the availability of ablation techniques (one needle techniques, multi-needle techniques). More recently, stereotactic multi-needle techniques with 3D trajectory planning and guided needle placement substantially improve the spectrum of treatable lesions including large volume tumors. Treatment success depends on the realization of ablations with large intentional margins of tumor free tissue (A0 ablation in analogy to R0 resection), which has to be documented by fusion of post- with pre-ablation images, and confirmed during follow-up imaging.

Could radiofrequency ablation replace liver resection for small hepatocellular carcinoma in patients with compensated cirrhosis? A 5-year follow-up

Treating hepatocellular carcinoma involves many different specialists and requires multidisciplinary management. In light of the current discussion on the role of ablative therapy, the aim of this study is to compare patients who undergo hepatic resection to those treated with radiofrequency ablation. The procedures have been conducted in two institutes following the same methodologies. Ninety-six patients with Child-Pugh class A cirrhosis, single or multinodular hepatocellular carcinoma (HCC) and a diameter less than or equal to 3 cm, have been included in this retrospective study: 52 patients have been treated by surgical resection and 44 by radiofrequency ablation. Patient characteristics, survival and disease-free survival have all been analysed. Disease-free survival was longer in the resection group in comparison to the radiofrequency group with a median disease-free time of 48 versus 34 months, respectively (P = 0.04, hazard ratio = 1.5, 95 % confidence interval = 0.9-2.5). In the resection group, median survival was 54 months with a survival rate at 1, 3 and 5 years of 100, 98 and 46.2 %. In the radiofrequency group, median survival was 40 months with 1-, 3- and 5-year survival rate of 95.5, 68.2 and 36.4 %. The current study shows that for small HCC in the presence of compensated cirrhosis, surgical resection gives better results than radiofrequency, both in terms of overall survival, as well as disease-free survival. Further evidence is required to clarify the role of ablative therapy as a curative treatment and whether it can replace surgery.

A traditional Chinese herbal medicine compound preparation versus interventional therapy after resection of small hepatocellular carcinoma: 22-year follow-up

ObjectiveTo compare the long-term effectiveness of compound Ruanjianhugan (RJH) tablets and interventional therapy (IT) in patients after resection of small hepatocellular carcinoma (HCC). MethodsA retrospective study was conducted in 399 patients after resection of small HCC who were admitted between January 1987 and December 2008 in the Department of Hepatobiliary Surgery and Center of Minimlly Invasive Surgery, First Affiliated Hospital of Guangxi Medical University. Four groups were based on different therapy modes: a TCM-only (TCMO) group, a TCM combined with interventional therapy (TCM-IT) group, an interventional therapy-only (ITO) group, and a simple operation (SO) group. Prognostic factors were correlated with overall survival (OS) and OS rates were calculated with the Kaplan-Meier method, and multivariate analyses for factors affecting survival were evaluated by the Cox proportional hazard model. ResultsThe median OS was 151.20 months in the TCM-IT group, 43.87 months in the ITO group, and 20.77 months in the SO group. All survival rates of the TCMO group were higher than those of the other three groups (>50%). The 5-, 10-, and 15-year OS in the TCMO and ITO patients were 83.94%, 45.50%, and 71.22% and 33.34%, 55.58%, and 9.26%, respectively (risk ratio, 0.209; 95% confidence interval, 0.126–0.347; P=0.000). Multivariate analysis revealed that the independent risk factors were therapy mode (P=0.000), sex (P=0.005), family history (P=0.011), TNM Classification of Malignant Tumor staging (P=0.000), medical care-seeking behavior (P=0.021), and maximum diameter (P=0.030). ConclusionLong-term oral use of compound RJH tablets may improve OS for small HCC after resection compared with IT.

Liver Resection for Hepatocellular Carcinoma ≤3 cm: Results of an Italian Multicenter Study on 588 Patients

The best treatment for patients with small hepatocellular carcinoma (S-HCC) is still controversial. The aim of this study was to evaluate operative and long-term results after liver resection (LR) for S-HCC, defined as tumor ≤3 cm. Retrospective multicenter study of 588 LRs for S-HCC from 8 Italian hepatobiliary surgery units (years 1992 to 2008). Primary outcomes included operative risk. Logistic regression analysis was used to evaluate risk factors for postoperative mortality. Secondary outcomes were overall survival (OS) and disease-free survival (DFS), estimated by the Kaplan-Meier method. Postoperative mortality was 1.9%, morbidity was 35.7% (major morbidity 7.3%), and blood transfusion rate was 13.8%. Child-Pugh class B and blood transfusions were associated with higher postoperative mortality. Rates of microvascular invasion and microsatellite nodules were 37.0% and 23.1%. After a median follow-up of 38.4 months, 5- and 10-year OS rates were 52.8% and 20.3%, with DFS of 32.4% and 21.7%. Local recurrence rate was 1.4%. Between the years 2000 and 2008, 5-year OS was significantly higher than that between the years 1992 and 1999 (61.9% vs 42.6%; p < 0.001). In multivariable analysis, Child-Pugh class B, portal hypertension, and microsatellite lesions were independently associated with poor OS. Microsatellite lesion was the only variable independently associated with poor DFS. Liver resection for S-HCC has improved over the years, with decreased operative risk. Long-term survival after LR has increased. Despite small tumor size, rates of microsatellite nodules and microvascular invasion are not negligible. Presence of microsatellite lesions was the only variable identified as being associated with poor both OS and DFS.

Equivalent Outcomes After Anatomical and Non-anatomical Resection of Small Hepatocellular Carcinoma in Patients with Preserved Liver Function

Although anatomical resection (AR) is considered better than non-anatomical resection (NAR) for the treatment for hepatocellular carcinoma (HCC), there is only limited evidence in support of this argument. The aim of this study was to investigate whether AR is superior to NAR regarding postoperative outcomes in patients with small solitary HCC and preserved liver function. The study subjects were 92 curatively-resected patients with adequate liver function reserve (indocyanine green retention rate at 15 min <15%, prothrombin time >70%, serum albumin >3.5 g/dl) and macroscopically small (≤3.0 cm) solitary HCC without macroscopic vascular invasion; 30 patients underwent AR and 62 patients NAR. Postoperative short-term outcomes including mortality and morbidity and long-term outcomes were compared in the two groups. There was no significant difference in clinicopathological background in the two groups. Although resected liver volume was significantly larger in the AR group than the NAR group (p < 0.0001), no significant differences were detected in the incidence of mortality or morbidity. For long-term outcomes, there were no significant differences between the two groups in disease-free survival or overall survival. Multivariate analysis showed that the extent of surgical procedure was not a significant prognostic factor for disease-free or overall survival. AR of a solitary small HCC did not carry postoperative outcome advantages compared with NAR in patients with preserved liver function. We recommend NAR for hepatic resection of small solitary HCC in patients with preserved liver function.

Clinical outcomes of radiofrequency ablation and surgical resection for small hepatocellular carcinoma: A meta‐analysis

To evaluate the evidence comparing radiofrequency ablation (RFA) and surgical resection (RES) on the treatment of hepatocellular carcinoma (HCC) using meta-analytical techniques. Literature search was undertaken until March 2011 to identify comparative studies evaluating survival rates, recurrence rates, and complications. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated with either the fixed or random effect model. These studies included a total of 877 patients: 441 treated with RFA and 436 treated with RES. The overall survival was significantly higher in patients treated with RES than RFA at 1, 3 and 5 years (respectively: OR: 0.50, 95% CI: 0.29-0.86; OR: 0.51, 95% CI: 0.28-0.94; OR: 0.62, 95% CI: 0.45-0.84). In the RES group the 1, 3, and 5 years recurrence-free survival rates were significantly higher than the RFA group (respectively: OR: 0.65, 95% CI: 0.44-0.97; OR: 0.65, 95% CI: 0.47-0.89; OR: 0.52, 95% CI: 0.35-0.77). RFA had a higher rate of local recurrence (OR: 4.08, 95% CI: 2.03-8.20). For tumors ≤ 3 cm RES was better than RFA in the 3-year overall survival rates (OR: 0.38, 95% CI: 0.16-0.89). Surgical resection was superior to RFA in the treatment of HCC. However, the findings have to be carefully interpreted due to the lower level of evidence.

Comparison of percutaneous radiofrequency thermal ablation and surgical resection for small hepatocellular carcinoma

BackgroundThe purpose of this investigation was to compare the outcome of percutaneous radiofrequency thermal ablation therapy (PRFA) with surgical resection (SR) in the treatment of single and small hepatocellular carcinoma (HCC).MethodsWe conducted a retrospective cohort study on 231 treatment naive patients with a single HCC ≤ 3 cm who had received either curative PRFA (162 patients) or curative SR (69 patients). All patients were regularly followed up after treatment at our department with blood and radiologic tests.ResultsThe 1-, 3- and 5-year overall survival rates after PRFA and SR were 95.4%, 79.6% and 63.1%, respectively in the PRFA group and 100%, 81.4% and 74.6%, respectively in the SR group. The corresponding recurrence free survival rates at 1, 3 and 5 years after PRFA and SR were 82.0%, 38.3% and 18.0%, respectively in the PRFA group and 86.0%, 47.2% and 26.0%, respectively in the SR group. In terms of overall survival and recurrence free survival, there were no significant differences between these two groups. In comparison of PRFA group patients with liver cirrhosis (LC) (n = 127) and SR group patients with LC (n = 50) and in comparison of PRFA group patients without LC (n = 35) and SR group patients without LC (n = 19), there were also no significant differences between two groups in terms of overall survival and recurrence free survival. In the multivariate analysis of the risk factors contributing to overall survival, serum albumin level was the sole significant factor. In the multivariate analysis of the risk factors contributing to recurrence free survival, presence of LC was the sole significant factor. The rate of serious adverse events in the SR group was significantly higher than that in the PRFA group (P = 0.023). Hospitalization length in the SR group was significantly longer than in the PRFA group (P = 0.013).ConclusionsPRFA is as effective as SR in the treatment of single and small HCC, and is less invasive than SR. Therefore, PRFA could be a first choice for the treatment of single and small HCC.

Meta-analysis of radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma

BackgroundThere is no clear consensus on the better therapy [radiofrequency ablation (RFA) versus hepatic resection (HR)] for small hepatocellular carcinoma (HCC) eligible for surgical treatments. This study is a meta-analysis of the available evidence.MethodsSystematic review and meta-analysis of trials comparing RFA with HR for small HCC published from 1997 to 2009 in PubMed and Medline. Pooled odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or random effects model.ResultsOne randomized controlled trial, and 9 nonrandomized controlled trials studies were included in this analysis. These studies included a total of 1411 patients: 744 treated with RFA and 667 treated with HR. The overall survival was significantly higher in patients treated with HR than in those treated with RFA at 3 years (OR: 0.56, 95% CI: 0.44-0.71), and at 5 year (OR: 0.60, 95% CI: 0.36-1.01). RFA has a higher rates of local intrahepatic recurrence compared to HR (OR: 4.50, 95% CI: 2.45-8.27). In the HR group the 1, 3, and 5 years disease -free survival rates were significantly better than in the HR-treated patients (respectively: OR: 0.54, 95% CI: 0.35-0.84; OR: 0.44, 95% CI: 0.28-0.68; OR: 0.64, 95% CI: 0.42-0.99). The postoperative morbidity was higher with HR (OR: 0.29, 95% CI: 0.13-0.65), but no significant differences were found concerning mortality. For tumors ≤ 3 cm HR did not differ significantly from RFA for survival, as reported in three NRCTs .ConclusionsHR was superior to RFA in the treatment of patients with small HCC eligible for surgical treatments, particularly for tumors > 3 cm. However, the findings have to be carefully interpreted due to the lower level of evidence.