A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma

Abstract

Objective: To compare the results of percutaneous local ablative therapy (PLAT) with surgical resection in the treatment of solitary and small hepatocellular carcinoma (HCC).

Summary background data: PLAT is effective in small HCC. Whether it is as effective as surgical resection in the long-term survivals remains unknown.

Methods: We conducted a prospective randomized trial on 180 patients with a solitary HCC <or=5 cm to receive either PLAT or surgical resection. The patients were regularly followed up after treatment with physical examination, blood, and radiologic tests.

Results: Of the 90 patients who were randomized to PLAT, only 71 received PLAT because 19 withdrew their consent. Of the 90 patients who were randomized to surgical resection, a single Couinaud liver segment resection was carried out in 69 patients, 2 segments in 16 patients, and 3 or more segments in 3 patients. Ethanol injection was given during open surgery in 2 patients. Only 1 patient died after surgical resection within the same hospital admission. Posttreatment complications were more often and severe after surgery than PLAT. The 1-, 2-, 3-, and 4-year overall survival rates after PLAT and surgery were 95.8%, 82.1%, 71.4%, 67.9% and 93.3%, 82.3%, 73.4%, 64.0%, respectively. The corresponding disease-free survival rates were 85.9%, 69.3%, 64.1%, 46.4% and 86.6%, 76.8%, 69%, 51.6%, respectively. Statistically, there was no difference between these 2 treatments.

Conclusion: PLAT was as effective as surgical resection in the treatment of solitary and small HCC. PLAT had the advantage over surgical resection in being less invasive.

FIGURE 1. Patient numbers for the intention-to-treat analysis.

FIGURE 2. Overall and disease-free survivals for patients randomized to percutaneous local ablative therapy (PLAT, n = 90, including 19 patients who withdrew their consent after randomization and received surgical resection) or surgical resection (SR).

FIGURE 3. Overall and disease-free survivals for patients randomized to percutaneous local ablative therapy (PLAT, n = 90, including 19 patients who withdrew their consent after randomization and received surgical resection) or surgical resection (SR) for tumors less than 3 cm (A), and between 3.1 cm and 5 cm (B).

FIGURE 4. Overall and disease-free survivals for patients treated with percutaneous local ablative therapy (PLAT, n = 71) or surgical resection (SR, n = 90).

FIGURE 5. Overall and disease-free survivals with percutaneous local ablative therapy (PLAT, n = 71) and surgical resection (SR, n = 90) for tumor less than 3 cm (A), and between 3.1 cm and 5 cm (B).