Radiofrequency ablation versus repeat resection for recurrent hepatocellular carcinoma (≤ 5 cm) after initial curative resection

Yuemin Feng¹, Hao Wu¹, Daniel Q Huang², Chenghui Xu¹, Hang Zheng¹, Mayumi Maeda³, Xinya Zhao⁴, Le Wang⁵, Feng Xiao^{1

6}, Huanran Lv⁷, Tiantian Liu¹, Jianni Qi⁸, Jie Li⁹, Ning Zhong¹⁰, Chuanxi Wang¹¹, Hong Feng¹¹, Bo Liang¹², Wanhua Ren⁹, Chengyong Qin¹, Mindie H Nguyen³, Qiang Zhu¹³

Affiliations

¹ Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China.
² Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore.
³ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
⁴ Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
⁵ Department of Geriatrics, Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
⁶ Department of Gastroenterology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, Shandong Province, China.
⁷ Department of Gastroenterology, Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, China.
⁸ Department of Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
⁹ Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
¹⁰ Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
¹¹ Department of Cancer Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
¹² Department of Ultrasonic Intervention, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
¹³ Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China. zhuqiang@sdu.edu.cn.

PMID: 32529568
DOI: 10.1007/s00330-020-06990-8

Comparative Study

Radiofrequency ablation versus repeat resection for recurrent hepatocellular carcinoma (≤ 5 cm) after initial curative resection

Yuemin Feng et al. Eur Radiol. 2020 Nov.

. 2020 Nov;30(11):6357-6368.

doi: 10.1007/s00330-020-06990-8. Epub 2020 Jun 11.

Authors

Affiliations

¹ Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China.
² Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore.
³ Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
⁴ Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
⁵ Department of Geriatrics, Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
⁶ Department of Gastroenterology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, Shandong Province, China.
⁷ Department of Gastroenterology, Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, China.
⁸ Department of Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
⁹ Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
¹⁰ Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
¹¹ Department of Cancer Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
¹² Department of Ultrasonic Intervention, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
¹³ Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China. zhuqiang@sdu.edu.cn.

PMID: 32529568
DOI: 10.1007/s00330-020-06990-8

Abstract

Objectives: Recurrence rate is up to 70% at 5 years for hepatocellular carcinoma (HCC) after initial resection, but the management of recurrent HCC remains unclear. To compare the efficacy and safety of radiofrequency ablation (RFA) and repeat resection as the first-line treatment in recurrent HCC.

Methods: This multicenter retrospective study analyzed 290 patients who underwent RFA (n = 199) or repeat resection (n = 91) between January 2006 and December 2016 for locally recurrent HCC (≤ 5 cm) following primary resection. We compared the overall survival (OS), progression-free survival (PFS), and complications between the two treatment groups for the total cohort and the propensity score matched (PSM) cohort.

Results: The 1-, 3-, and 5-year OS (90.7%, 69.04%, 55.6% vs. 87.7%, 62.9%, 38.1%, p = 0.11) and PFS (56.5%, 27.9%, 14.6% vs. 50.2%, 21.9%, 19.2%, p = 0.80) were similar in the RFA group and the repeat resection group. However, RFA was superior to repeat resection in complication rate and hospital stay (p ≤ 0.001). We observed similar findings in the PSM cohort of 48 pairs of patients and when OS and PFS were measured from the time of the primary resection. The OS of the RFA group was significantly better than repeat resection group among those with 2 or 3 recurrent tumor nodules in both the total cohort (p = 0.009) and the PSM cohort (p = 0.018).

Conclusion: RFA has the same efficacy as repeat resection in recurrent HCC patients, but with fewer complications. RFA is more efficient and safer than repeat resection in patients with 2 or 3 recurrent tumor nodules.

Key points: • Recurrence rate is up to 70% at 5 years for hepatocellular carcinoma (HCC) after initial resection. • RFA has the same efficacy as repeat resection in recurrent HCC patients, but with fewer complications. • RFA may be preferred for those with 2 or 3 recurrent HCC nodules.

Keywords: Hepatectomy; Hepatocellular carcinoma; Radiofrequency ablation; Treatment outcome.

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References

1. Marrero JA, Kulik LM, Sirlin CB et al (2018) Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 68:723–750 - DOI
1. Hasegawa K, Kokudo N, Makuuchi M et al (2013) Comparison of resection and ablation for hepatocellular carcinoma: a cohort study based on a Japanese nationwide survey. J Hepatol 58:724–729 - DOI
1. Chan AWH, Zhong J, Berhane S et al (2018) Development of pre and post-operative models to predict early recurrence of hepatocellular carcinoma after surgical resection. J Hepatol 69:1284–1293 - DOI
1. Tabrizian P, Jibara G, Shrager B, Schwartz M, Roayaie S (2014) Recurrence of hepatocellular cancer after resection: patterns, treatments, and prognosis. Ann Surg 261:947–955 - DOI
1. Poon RT, Fan ST, Lo CM, Liu CL, Wong J (2002) Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function. Implication for a strategy of salvage transplantation. Ann Surg 235:373–382

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Radiofrequency ablation versus repeat resection for recurrent hepatocellular carcinoma (≤ 5 cm) after initial curative resection

Affiliations

Radiofrequency ablation versus repeat resection for recurrent hepatocellular carcinoma (≤ 5 cm) after initial curative resection

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous