Small Hepatocellular Carcinoma Research Articles

Risk factors for recurrence beyond Milan criteria after radiofrequency ablation in transplantable small hepatocellular carcinoma.

This study aimed to determine the risk factors of recurrence beyond Milan criteria in patients with transplantable early hepatocellular carcinoma (HCC) after the first Radiofrequency ablation (RFA). 95 patients with newly diagnosed transplantable small HCC with single ≤3 cm lesions were analyzed retrospectively. During the 39-month median follow-up period, 12 (21.8%) patients with HCC < 2 cm and 22 (56.4%) patients with HCC ≥ 2 cm relapsed beyond Milan criteria (p = 0.001). The 1- and 3-year recurrence rates beyond Milan criteria were 6.3% and 14.7% in the HCC <2 cm group, compared with 24.1% and 55.6% in HCC ≥2 cm group (p < 0.0001). HCC ≥2 cm, red blood cell distribution width-to-lymphocyte ratio (RLR) ≥ 18.3, alpha-fetoprotein (AFP) >15 ng/ml and early recurrence after RFA were independent predictors of recurrence exceeding Milan criteria. Close follow-up and early liver transplantation should be initiated to obtain the best survival benefit for patients with transplantable early single small HCC with a tumor diameter ≥2 cm and higher RLR and AFP levels before the first RFA and early recurrence after RFA (recurrence within 2 years).

Comparative Study of Laparoscopic Hepatectomy, Open Hepatectomy and Percutaneous Radiofrequency Ablation for Small Hepatocellular Carcinoma: An Ancillary Study of Randomized Controlled Trial (SURF Trial)

Introduction: To evaluate the efficacy of laparoscopic hepatectomy (LH) for small hepatocellular carcinoma (≤3 tumors within 3 cm), we compared short- and long-term outcomes between LH, open hepatectomy (OH), and radiofrequency ablation (RFA) as an ancillary study of a nationwide multicenter randomized controlled trial (RCT), SURF trial. Methods: This study enrolled 398 patients who underwent treatment of early hepatocellular carcinoma (HCC): SURF RCT: n=137, SURF cohort: n=261. Primary endpoints were overall survival (OS) and recurrence-free survival (RFS). Secondary endpoints were short-term outcomes, and relationship between tumor conditions and prognosis by each therapy. Results: There were 38 patients in the LH group, 139 patients in the OH group, and 221 patients in the RFA group. Clinicopathological data were adjusted using an inverse probability of treatment-weighted analysis. The 5-year rates of RFS and OS were not significantly different in the LH, OH, and RFA groups: 50%, 41.6%, and 41.8%, respectively (p=0.89); 85.2%, 80.1%, and 80.1%, respectively (p=0.83). The median postoperative hospital stays in the LH, OH, and RFA groups were 11, 13, and 7 days (p <0.01). The OH rate was significantly higher than RFA for the following factors: maximum tumor diameter >2 cm (OR=3.13; 95% CI=1.72–5.69), proximity to major vessels (OR=2.08; 95% CI=1.01–4.30), and good liver function (OR=0.46; 95% CI=0.22–0.93). Conclusions: Prognosis after LH for early HCC treatment was not significantly different from that of OH and RFA. LH is a feasible and effective treatment for early HCC with wide variety of tumor conditions.

射频消融与肝切除手术治疗小肝癌疗效及安全性的Meta分析

射频消融与肝切除手术治疗小肝癌疗效及安全性的Meta分析

Establishment of a nomogram for survival rate after liver resection for primary small hepatocellular carcinoma based on SEER data and external validation

Establishment of a nomogram for survival rate after liver resection for primary small hepatocellular carcinoma based on SEER data and external validation

Impact of resection versus radiofrequency ablation on medium-sized hepatocellular carcinomas: Long-term outcome and prognostic factors

Background: Liver resection (LR) is considered the main therapeutic strategy for small hepatocellular carcinomas (HCCs) (<3 cm). Recently, the efficacy of complete response after radiofrequency ablation (RFA) in medium-sized HCCs (3–5 cm) has been proposed. Comparative analyses of LR and RFA in HCC patients with single or multiple nodules and tumor sizes ranging from 3 to 5 cm are lacking. Aim: The purpose of this study is to compare the long-term outcomes of 132 patients diagnosed with medium-sized HCCs between 2010 and 2017 who underwent LR (n = 72) or RFA (n = 60) and met the inclusion criteria. Methods: Data were retrospectively analyzed using a prospective database. The treatment-related outcomes and risk factors of overall survival (OS) and disease-free survival (DFS) were investigated using univariate and multivariate Cox regression analyses. Results: The hospital stay was shorter in the RFA group than in the LR group (5.4 days vs. 14.3 days, respectively; P < 0.0001). RFA was associated with fewer treatment-related complications. OS and DFS were better in the LR group than in the RFA group. Treatment modality and albumin and alpha-fetoprotein levels were predictors for OS, while treatment modality and tumor number were predictors for DFS. Conclusion: LR is an effective treatment for patients with medium-sized HCCs in terms of long-term outcomes (OS and DFS), while RFA may be used as an alternative treatment to LR with comparable OS.

Open Liver Resection, Laparoscopic Liver Resection, and Radiofrequency Ablation for Elderly Cirrhotic Patients with a Preserved Liver Function (Child-Pugh A) and Solitary Small Hepatocellular Carcinoma (≤30 mm)

Background: Thinking about the increment in overall life expectancy and the hepatocellular carcinoma (HCC) rising incidence , more patients aged≥70years are considered for HCC treatment. Elderly patients with a single HCC≤3 cm and preserved liver function have the highest probability to be cured if treated. The most appropriate treatment strategies are yet a problem that is debated.

CT imaging combined with multimodal magnetic resonance imaging in the diagnosis of small hepatocellular carcinoma in the background of cirrhosis.

article: CT imaging combined with multimodal magnetic resonance imaging in the diagnosis of small hepatocellular carcinoma in the background of cirrhosis - Minerva Surgery 2022 Jan 13 - Minerva Medica - Journals

Surgery versus Radiofrequency Ablation for Small Hepatocellular Carcinoma: A Randomized Controlled Trial (SURF Trial)

Introduction: It remains unclear which surgery or radiofrequency ablation (RFA) is the more effective treatment for small hepatocellular carcinoma (HCC). We aimed to compare survival between patients undergoing surgery (surgery group) and patients undergoing RFA (RFA group). Methods: We conducted a randomized controlled trial involving 49 institutions in Japan. Patients with Child-Pugh scores ≤7, largest HCC diameter ≤3 cm, and ≤3 HCC nodules were considered eligible. The co-primary endpoints were recurrence-free survival (RFS) and overall survival (OS). The current study reports the final result of RFS, and the follow-up of OS is still ongoing. Results: During 2009–2015, 308 patients were registered. After excluding ineligible patients, the surgery and RFA groups included 150 and 151 patients, respectively. Baseline factors did not differ significantly between the groups. In both groups, 90% of patients had solitary HCC. The median largest HCC diameter was 1.8 cm (interquartile range [IQR], 1.5–2.2 cm) in the surgery group and 1.8 cm (IQR, 1.5–2.3 cm) in the RFA group. The median procedure duration (274 vs. 40 min, p < 0.01) and the median duration of hospital stay (17 days vs. 10 days, p < 0.01) were longer in the surgery group than in the RFA group. RFS did not differ significantly between the groups as the median RFS was 3.5 (95% confidence interval [CI], 2.6–5.1) years in the surgery group and 3.0 (95% CI, 2.4–5.6) years in the RFA group (hazard ratio, 0.92; 95% CI, 0.67–1.25; p = 0.58). Discussion/Conclusion: Our study did not show which surgery or RFA is the better treatment option for small HCC.

Long-term outcomes of combined transarterial chemoembolization and radiofrequency ablation versus RFA monotherapy for single hepatocellular carcinoma ≤3 cm: emphasis on local tumor progression

Purpose To compare the long-term outcomes of combined transarterial chemoembolization and radiofrequency ablation (TACE-RFA) with radiofrequency ablation (RFA) monotherapy for small (≤3 cm) hepatocellular carcinomas (HCCs). Methods A total of 248 patients with 329 HCC nodules who underwent TACE-RFA or RFA monotherapy as the only first-line treatment between January 2009 and December 2020 were included in this study. The technical success, complications, survival rate, and local tumor progression (LTP) rate were compared between the two treatments. Results The 1-, 3- and 5-year survival rates were similar between the two groups (98.7%, 93.0% and 75.9% vs 97.4%, 88.0% and 77.4%; p = 0.444). The 1-, 3-, and 5-year cumulative LTP rates were significantly lower in the TACE-RFA group than in the RFA monotherapy group (2.9%, 9.2%, and 13.8% vs. 5.2%, 17.0%, and 21.0%; p = 0.043). Subgroup analyses suggested that TACE-RFA showed significantly lower LTP rates than RFA monotherapy for small HCC with tumor size>2cm (p = 0.008), subphrenic location (p = 0.021), and perivessel (p = 0.030). Furthermore, HCC with well-defined lipiodol deposition in the TACE-RFA group showed better local tumor control than the small HCC in the RFA monotherapy group (p = 0.013). There was no significant difference in the technical success rates (p = 0.064) and complication rates (p = 0.952) between the two groups. Conclusions TACE-RFA is superior to RFA monotherapy in providing local tumor control for small HCC with tumor size 2–3 cm in diameter, subphrenic location, perivessel and HCCs with well-defined lipiodol deposition by TACE before RFA.

Efficacy of Superselective Conventional Transarterial Chemoembolization Using Guidance Software for Hepatocellular Carcinoma within Three Lesions Smaller Than 3 cm.

Simple SummaryAlthough transarterial chemoebolization (TACE) is indicated for small hepatocellular carcinoma (HCC) as a second choice, TACE for small HCC is frequently difficult and less effective because of less hypervascularity and the presence of tumor portions receiving a dual blood supply. The aim of this study was to evaluate the efficacy of superselective cTACE under guidance software for patients with HCC within three lesions smaller than 3 cm. By using TACE guidance software, 81.2% of HCC lesions could be completely embolized and the cumulative local tumor progression rates in 303 tumors at 1, 3, 5, and 7 years were 17.8, 27.8, 32.0, and 36.0%, respectively. The 1-, 3-, 5-, and 7-year overall and recurrence-free survival rates in 175 patients were 97.1 and 68.7, 82.8 and 34.9, 64.8 and 20.2, and 45.3 and 17.3%, respectively. Our results indicate the efficacy of superselective cTACE using guidance software for HCC within three lesions smaller than 3 cm.The indication of transarterial chemoembolization (TACE) has advanced to hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage A when surgical resection (SR), thermal ablation, and bridging to transplantation are contraindicated; however, TACE for small HCC is frequently difficult and ineffective because of less hypervascularity and the presence of tumor portions receiving a dual blood supply. Here, we report outcomes of superselective conventional TACE (cTACE) for 259 patients with HCCs within three lesions smaller than 3 cm using guidance software. Automated tumor feeder detection (AFD) functionality was applied to identify tumor feeders on cone-beam computed tomography during hepatic arteriography (CBCTHA) data. When it failed, the feeder was identified by manual feeder detection functionality and/or selective angiography and CBCTHA. Regarding the technical success in 382 tumors (mean diameter, 17.2 ± 5.9 mm), 310 (81.2%) were completely embolized with a safety margin (5 mm wide for HCC ≤25 mm and 10 mm wide for HCC >25 mm). In 61 (16.0%), the entire tumor was embolized but the safety margin was not uniformly obtained. The entire tumor was not embolized in 11 (2.9%). Regarding the tumor response at 2–3 months after cTACE in 303 tumors excluding those treated with combined radiofrequency ablation (RFA) or SR and lost to follow-up, 287 (94.7%) were classified into complete response, seven (2.3%) into partial response, and nine (3.0%) into stable disease. The mean follow-up period was 44.9 ± 27.6 months (range, 1–109) and the cumulative local tumor progression rates at 1, 3, 5, and 7 years were 17.8, 27.8, 32.0, and 36.0%, respectively. The 1-, 3-, 5-, and 7-year overall and recurrence-free survival rates in 175 patients, excluding those with Child–Pugh C class, who died of other malignancies, or who underwent combined RFA or hepatic resection, were 97.1 and 68.7, 82.8 and 34.9, 64.8 and 20.2, and 45.3 and 17.3%, respectively. Our results indicate the efficacy of superselective cTACE using guidance software for HCC within three lesions smaller than 3 cm.

Surgery versus radiofrequency ablation in patients with Child- Pugh class-A/single small (≤3 cm) hepatocellular carcinoma.

Background/AimsWe compared the post-treatment overall survival (OS) and recurrence-free survival (RFS) between patients with Child-Turcotte-Pugh (CTP) class-A and single small (≤3 cm) hepatocellular carcinoma (HCC) treated by surgical resection (SR) and radiofrequency ablation (RFA).MethodsWe retrospectively analyzed 391 HCC patients with CTP class-A who underwent SR (n=232) or RFA (n=159) as first-line therapy for single small (≤3 cm) HCC. Survival was compared according to the tumor size (≤2 cm/2–3 cm) and the presence of cirrhosis. Inverse probability of treatment weighting (IPW) method was used to estimate the average causal effect of treatment.ResultsThe median follow-up period was 64.8 months (interquartile range, 0.1–162.6). After IPW, the estimated OS was similar in the SR and RFA groups (P=0.215), and even in patients with HCC of ≤2 cm (P=0.816) and without cirrhosis (P=0.195). The estimated RFS was better in the SR group than in the RFA groups (P=0.005), also in patients without cirrhosis (P<0.001), but not in those with HCC of ≤2 cm (P=0.234). The weighted Cox proportional hazards model with IPW provided adjusted hazard ratios (95% confidence interval) for OS, and the RFS after RFA versus SR were 0.698 (0.396–1.232) (P=0.215) and 1.698 (1.777–2.448) (P=0.005), respectively.ConclusionsSR was similar for OS compared to RFA, but was better for RFS in patients with CTP class-A and single small (≤3 cm) HCC. The RFS was determined by the presence or absence of cirrhosis. Hence, SR rather than RFA should be considered in patients without cirrhosis to prolong the RFS, although there is no OS difference.

Guidewire-catheter induced hydrodissection to assist radiofrequency ablation for subcapsular hepatocellular carcinoma with iodized oil retention in patients with failed artificial ascites due to perihepatic adhesion.

We aimed to evaluate the usefulness of guidewire-catheter induced hydrodissection (GIH) to assist radiofrequency ablation (RFA) for subcapsular hepatocellular carcinoma (HCC) with iodized oil retention in patients with failed artificial ascites due to perihepatic adhesion. This retrospective study included 17 patients with small subcapsular HCC ineligible for ultrasonography-guided RFA who received RFA under guidance of fluoroscopy and cone-beam computed tomography immediately after iodized oil transarterial chemoembolization (TACE) between April 2011 and January 2016. In the study patients, creation of artificial ascites to protect the perihepatic structures failed due to perihepatic adhesion and GIH was attempted to separate the perihepatic structures from the ablation zone. The technical success rate of GIH, technique efficacy of RFA with GIH, local tumor progression (LTP), peritoneal seeding, and complications were evaluated. The technical success rate of GIH was 88.24% (15 of 17 patients). Technique efficacy was achieved in all 15 patients receiving RFA with GIH. During an average follow-up period of 48.1 months, LTP developed in three patients. Cumulative LTP rates at 1, 2, 3, and 5 years were 13.3%, 20.6%, 20.6%, and 20.6%, respectively. No patient had peritoneal seeding. Two of the 15 patients receiving RFA with GIH had a CIRSE grade 3 liver abscess, but none had complications associated with thermal injury to the diaphragm or abdominal wall near the ablation zone. GIH can be a useful method to assist RFA for subcapsular HCC with iodized oil retention in patients with failed artificial ascites due to perihepatic adhesion.

Correlation of Clinicopathological Profile, Prognostic Factors, and Survival Outcomes with Baseline Alfa-Fetoprotein Levels in Patients With Hepatocellular Carcinoma: A Biomarker that is Bruised but Not Broken

The role of Alfa-fetoprotein (AFP) in the management of hepatocellular carcinoma (HCC) is still debated, with differences in recommendations between international guidelines. We analyzed the relationship of the clinicopathological profile, prognostic features, and survival outcomes with baseline serum AFP levels in patients with HCC. Retrospective analysis of a prospectively accrued dataset of consecutive HCC patients was done. 508 treatment naive patients were included in the analysis. AFP at presentation was normal (<10ng/ml) in 18% patients. Patients with very high AFP (>400ng/ml) had poor hepatic reserves (higher mean serum bilirubin, AST, ALT, INR, and lower mean albumin) and advanced disease at presentation (higher incidence of extrahepatic metastasis, and less proportion of patients with well-differentiated tumors). AFP >400ng/ml was an independent predictor for presence of portal vein tumor thrombosis (PVTT) (OR, 4.08; 95% CI, 2.34-7.12; P<0.001), higher tumor size (OR, 2.19; 95% CI, 1.36-3.54, P= 0.001) and advanced BCLC stage (OR, 4.19; 95% CI, 2.51-7.03; P<0.001). Two-third of patients with small HCC (MTD <3cm) and more than half with early-stage HCC (BCLC stage 0/A) had elevated AFP levels. No significant relationship was seen between overall survival (OS) and baseline AFP in patients who underwent surgery, but median OS in patients subjected to nonsurgical therapies was 19.4,10.5 and 5.7 months in patients having AFP <10ng/ml, 10-400ng/ml and >400ng/ml respectively (P= 0.003). AFP >400ng/ml was an independent predictor of survival in patients receiving any form of therapy (HR=2.23; 95% CI=1.19-4.18, P= 0.012). AFP as a biomarker still has a significant role to play in the management of HCC patients and is here to stay till the search for an ideal biomarker in HCC is over.

Uptake and Survival Outcomes Following Immune Checkpoint Inhibitor Therapy Among Trial-Ineligible Patients With Advanced Solid Cancers

Immune checkpoint inhibitors (ICIs) are part of standard of care for patients with many advanced solid tumors. Patients with poor performance status or organ dysfunction are traditionally ineligible to partake in pivotal randomized clinical trials of ICIs. To assess ICI use and survival outcomes among patients with advanced cancers who are traditionally trial ineligible based on poor performance status or organ dysfunction. This retrospective cohort study was conducted in 280 predominantly community oncology practices in the US and included 34 131 patients (9318 [27.3%] trial ineligible) who initiated first-line systemic therapy from January 2014 through December 2019 for newly diagnosed metastatic or recurrent nontargetable non-small cell lung, urothelial cell, renal cell, or hepatocellular carcinoma. Data analysis was performed from December 1, 2019, to June 1, 2021. Trial ineligibility (Eastern Cooperative Oncology Group performance status ≥2 or the presence of kidney or liver dysfunction); first-line systemic therapy. The association between trial ineligibility and ICI monotherapy uptake was assessed using inverse probability-weighted (IPW) logistic regressions. The comparative survival outcomes following ICI and non-ICI therapy among trial-ineligible patients were assessed using treatment IPW survival analyses. Because we observed nonproportional hazards, we reported 12-month and 36-month restricted mean survival times (RMSTs) and time-varying hazard ratios (HRs) of less than 6 months and 6 months or greater. Among the overall cohort (n = 34 131), the median (IQR) age was 70 (62-77) years; 23 586 (69%) were White individuals, and 14 478 (42%) were women. Over the study period, the proportion of patients receiving ICI monotherapy increased from 0% to 30.2% among trial-ineligible patients and 0.1% to 19.4% among trial-eligible patients. Trial ineligibility was associated with increased ICI monotherapy use (IPW-adjusted odds ratio compared with non-ICI therapy, 1.8; 95% CI, 1.7-1.9). Among trial-ineligible patients, there were no overall survival differences between ICI monotherapy, ICI combination therapy, and non-ICI therapy at 12 months (RMST, 7.8 vs 7.7 vs 8.1 months) or 36 months (RMST, 15.0 vs 13.9 vs 14.4 months). Compared with non-ICI therapy, ICI monotherapy showed evidence of early harm (IPW-adjusted HR within 6 months, 1.2; 95% CI, 1.1-1.2) but late benefit (adjusted HR among patients who survived 6 months, 0.8; 95% CI, 0.7-0.8). In this cohort study, compared with trial-eligible patients, trial-ineligible patients with advanced cancers preferentially received first-line ICI therapy. A survival difference was not detected between ICI and non-ICI therapies among trial-ineligible patients. Positive results for ICI in phase 3 trials may not translate to this vulnerable population.

Comparative long-term outcomes of laparoscopic hepatectomy and radiofrequency ablation for hepatocellular carcinoma located in the anterolateral segments of the liver.

Laparoscopic liver resection (LLR) is considered the standard surgical approach for resecting small hepatocellular carcinomas (HCC) located in the anterolateral segments of the liver. However, few studies have compared LLR and radiofrequency ablation (RFA) in such cases. We retrospectively compared the short- and long-term outcomes of 101 patients who underwent LLR and 264 patients who underwent RFA because of a newly diagnosed single, small (≤4cm) HCC located in the anterolateral segments of the liver. By applying 1:1 propensity score matching, we matched 61 patients in both groups. Although the 5-year overall survival rates were similar (83.6% vs 84.5%; P=.913), the 5-year disease-free survival rate was greater in the LLR group (56.4% vs 41.8%; P=.009). In patients with an α-fetoprotein level of ≥100ng/mL, the 5-year overall (100% vs 80.0%; P=.022) and disease-free survival (76.6% vs 45.5%; P=.006) rates were greater in the LCC group. For patients with a single, small HCC located in the anterolateral segments of the liver, LLR was associated with similar complication and overall survival rates, but better disease-free survival compared with RFA. LLR may be recommended for patients with higher α-fetoprotein levels.

Impact of dual-energy 50-keV virtual monoenergetic images on radiologist confidence in detection of key imaging findings of small hepatocellular carcinomas using multiphase liver CT.

Dual-energy virtual monoenergetic images can increase iodine signal, potentially increasing the conspicuity of hepatic masses. To determine if dual-energy 50-keV virtual monoenergetic images improve visualization of key imaging findings or diagnostic confidence for small (≤2 cm) hepatocellular carcinomas (HCC) at multiphase, contrast-enhanced liver computed tomography (CT). Patients with chronic liver disease underwent multiphase dual-energy CT imaging for HCC, with late arterial and delayed phase dual-energy 50-keV images reconstructed. Two non-reader subspecialized gastrointestinal (GI) radiologists established the reference standard, determining the location and diagnosis of all hepatic lesions using predetermined criteria. Three GI radiologists interpreted mixed kV CT images without or with dual-energy 50-keV images. Radiologists identified potential HCCs and rated their confidence (0-100 scales) in imaging findings of arterial enhancement, enhancing capsule, tumor washout, and LI-RADS 5 (2018) category. In total, 45 patients (14 women; mean age = 59.5 ± 10.9 years) with chronic liver disease were included. Of them, 19 patients had 25 HCCs ≤2 cm (mean size = 1.5 ± 0.4 cm). There were 17 LI-RADS 3 and 4 lesions and 19 benign lesions. Reader confidence in imaging findings of arterial enhancement, enhancing capsule, and non-peripheral washout significantly increased with dual-energy images (P ≤ 0.022). Overall confidence in HCC diagnosis increased significantly with dual-energy 50-keV images (52.4 vs. 68.8; P = 0.001). Dual-energy images demonstrated a slight but significant decrease in overall image quality. Radiologist confidence in key imaging features of small HCCs and confidence in imaging diagnosis increases with use of dual-energy 50-keV images at multiphase, contrast-enhanced liver CT.

An Optimal Ablative Margin of Small Single Hepatocellular Carcinoma Treated with Image-Guided Percutaneous Thermal Ablation and Local Recurrence Prediction Base on the Ablative Margin: A Multicenter Study.

ObjectiveTo explore the best ablative margin (AM) for single hepatocellular carcinoma (HCC) patients with image-guided percutaneous thermal ablation (IPTA) based on MRI–MRI fusion imaging, and to develop and validate a local tumor progression (LTP) predictive model based on the recommended AM.MethodsBetween March 2014 and August 2019, 444 treatment-naïve patients with single HCC (diameter ≤3 cm) who underwent IPTA as first-line treatment from three hospitals were included, which were randomly divided into training (n= 296) and validation (n = 148) cohorts. We measured the ablative margin (AM) by MRI–MRI fusion imaging based on pre-ablation and post-ablation images. Then, we followed up their LPT and verified the optimal AM. Risk factors related to LTP were explored through Cox regression models, the nomogram was developed to predict the LTP risk base on the risk factors, and subsequently validated. The predictive performance and discrimination were assessed and compared with conventional indices.ResultsThe median follow-up was 19.9 months (95% CI 18.0–21.8) for the entire cohort. The results revealed that the tumor size (HR: 2.16; 95% CI 1.25–3.72; P = 0.003) and AM (HR: 0.72; 95% CI, 0.61–0.85; P < 0.001) were independent prognostic factors for LTP. The AM had a pronounced nonlinear impact on LTP, and a cut-off value of 5-mm was optimal. We developed and validated an LTP predictive model based on the linear tumor size and nonlinear AM. The model showed good predictive accuracy and discrimination (training set, concordance index [C-index] of 0.751; validation set, C-index of 0.756) and outperformed other conventional indices.ConclusionThe 5-mm AM is recommended for the best IPTA candidates with single HCC (diameter ≤3 cm). We provided an LTP predictive model that exhibited adequate performance for individualized prediction and risk stratification.

The effects of ultrasound-guided radiofrequency ablation and laparoscopic hepatectomy in the treatment of small hepatocellular carcinoma: a retrospective analysis.

BackgroundHepatocellular carcinoma (HCC) is a commonly-seen cancer in the clinical setting. Laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) are used for the treatment of HCC, yet the effects and safety difference of LH and RFA for HCC treatment need further investigation.MethodsThis study was a retrospective study design. HCC patients treated with LH or RFA in our hospital were identified. All the patients underwent 2-year long follow-up. The characteristics and details of LH and RFA groups during hospitalization were collected and compared. The Kaplan-Meier method was used to calculate the cumulative survival, and the survival curve was drawn and compared.ResultsA total of 94 HCC patients were included. The duration of surgery, estimated intraoperative blood loss, pain score on the first day after surgery, time to get out of bed after operation, time to oral eating, aspartate transaminase (AST) on the second day after surgery, C-reactive protein (CRP) on the second day after surgery, total medical cost in RFA group were significantly less than that of LH group (all P<0.05). The incidence of abdominal infection and biliary fistula in RFA group were significantly less than that of LH group (all P<0.05), and there was no significant difference in the incidence of bleeding and pleural effusion between two groups (all P>0.05). The 2-year overall survival and recurrence-free survival of the two groups had no significant statistical difference (all P>0.05).ConclusionsRFA and LH have similar effects in the treatment of small HCC. And RFA has the advantages of less trauma, shorter operation duration, and quick postoperative recovery.

Resection or ablation versus transarterial therapy for Child-Pugh A patients with a single small hepatocellular carcinoma.

Data from a direct comparison of the long-term survival outcomes of surgical resection (SR) or radiofrequency ablation (RFA) versus transarterial therapy in Child-Turcotte-Pugh (CTP)-class A patients with a single small T1/T2 stage hepatocellular carcinoma (HCC) (≤3 cm) are still lacking. This study retrospectively compared the therapeutic outcomes of these treatment types for CTP-A patients with a single small HCC.Using a nationwide Korean registry, we identified 2314 CTP-A patients with SR (n = 722), RFA (n = 731), or transarterial therapy (n = 861) for a single (≤3 cm) T1/T2 stage HCC from 2008 to 2014. The posttreatment overall survival (OS) of transarterial therapy with either SR or RFA were compared using the Inverse Probability of treatment Weighting (IPW). The median follow-up period was 50 months (range 1–107 months).After IPW, the cumulative OS rates after SR or RFA were significantly higher than those after transarterial therapy in all subjects (all P values < .05). The OS rates after SR or RFA were better than those after transarterial therapy in patients with the hepatitis B or C virus (all P values < .05), and in patients aged <65 years (all P values < .05). The cumulative OSs between RFA and transarterial therapy were statistically comparable in patients with a 2 to 3 cm HCC and aged ≥65 years, respectively. For all subjects, the weighted Cox proportional hazards model using IPW provided the adjusted hazard ratios (95% confidence interval) for the OS after SR versus transarterial therapy and after RFA versus transarterial therapy of 0.42 (0.30–0.60) (P < .001) and 0.78 (0.61–0.99) (P = .044), respectively.In CTP-A patients with a single (≤3 cm) T1/T2 HCC, SR or RFA provides a better OS than transarterial therapy, regardless of the HCC etiology (hepatitis B virus or hepatitis C virus), especially in patients with HCC of <2 cm and aged <65 years.

Clinical outcomes of patients with two small hepatocellular carcinomas.

BACKGROUNDManagement of single small hepatocellular carcinoma (HCC) is straightforward with curative outcomes achieved by locoregional therapy or resection. Liver transplantation is often considered for multiple small or single large HCC. Management of two small HCC whether presenting synchronously or sequentially is less clear.AIMTo define the outcomes of patients presenting with two small HCC.METHODSRetrospective review of HCC databases from multiple institutions of patients with either two synchronous or sequential HCC ≤ 3 cm between January 2000 and March 2018. Primary outcomes were overall survival (OS) and transplant-free survival (TFS).RESULTS104 patients were identified (male n = 89). Median age was 63 years (interquartile range 58-67.75) and the most common aetiology of liver disease was hepatitis C (40.4%). 59 (56.7%) had synchronous HCC and 45 (43.3%) had sequential. 36 patients died (34.6%) and 25 were transplanted (24.0%). 1, 3 and 5-year OS was 93.0%, 66.1% and 62.3% and 5-year post-transplant survival was 95.8%. 1, 3 and 5-year TFS was 82.1%, 45.85% and 37.8%. When synchronous and sequential groups were compared, OS (1,3 and 5 year synchronous 91.3%, 63.8%, 61.1%, sequential 95.3%, 69.5%, 64.6%, P = 0.41) was similar but TFS was higher in the sequential group (1,3 and 5 year synchronous 68.5%, 37.3% and 29.7%, sequential 93.2%, 56.6%, 48.5%, P = 0.02) though this difference did not remain during multivariate analysis.CONCLUSIONTFS in patients presenting with two HCC ≤ 3 cm is poor regardless of the timing of the second tumor. All patients presenting with two small HCC should be considered for transplantation.