Radiofrequency ablation for peribiliary hepatocellular carcinoma: propensity score matching analysis

Abstract

Objectives: At present, there are no established clinical guidelines for radiofrequency ablation (RFA) of peribiliary hepatocellular carcinoma (HCC). Therefore, the aim of this study was to compare the long-term outcomes of RFA for peribiliary vs. non-peribiliary HCC.

Methods: This retrospective study included 282 patients with peribiliary HCC (n = 109) or non-peribiliary HCC (n = 173) who received RFA between February 2013 and May 2021. Local tumor progression (LTP), overall survival (OS), disease-free survival (DFS), and complications were compared before and after propensity score matching (PSM).

Results: Before PSM, there were no significant differences in 5-year LTP rates (26.3% vs. 23.6%, p = 0.602), OS rates (56.6% vs. 68.0%, p = 0.586), or DFS rates (22.9% vs. 25.7%, p = 0.239) between the peribiliary and non-peribiliary groups. After PSM, there were no significant differences in the 1-, 3-, and 5-year LTP rates (13.0%, 23.1%, and 26.3% vs. 12.1%, 25.1%, and 28.2%, respectively, p = 0.857), OS rates (97.2%, 73.5%, and 56.6% vs. 95.3%, 79.5%, and 70.6%, p = 0.727), or DFS rates (59.4%, 29.4%, and 22.9% vs. 64.2%, 33.1%, and 23.8%, p = 0.568) between the peribiliary non-peribiliary groups. Peribiliary location was not a significant prognostic factor for LTP (p = 0.622) or OS (p = 0.587). In addition, mild intrahepatic bile duct dilatation was more frequent in the peribiliary group (9.2% vs. 2.8%, p = 0.045).

Conclusion: Long-term outcomes of RFA were similar for peribiliary and non-peribiliary HCC. RFA is a viable alternative for treatment of peribiliary HCC.

Critical relevance statement: The local tumor progression (LTP), overall survival (OS), and disease-free survival (DFS) rates after radiofrequency ablation (RFA) were similar for peribiliary and non-peribiliary hepatocellular carcinoma (HCC).

Key points: There are currently no clinical guidelines for radiofrequency ablation (RFA) of peribiliary hepatocellular carcinoma (HCC). Local tumor progression, overall survival, and disease-free survival after RFA were similar for peribiliary and non-peribiliary HCC. RFA is a viable alternative for the treatment of peribiliary HCC.

Keywords: Hepatocellular carcinoma; Peribiliary location; Radiofrequency ablation; Therapeutic outcome.

Fig. 1

Flow chart for patient selection. HCC, hepatocellular carcinoma; RFA, radiofrequency ablation

Fig. 2

Images of peribiliary HCC (a, b) and non-peribiliary HCC (c). a Axial CT image of peribiliary HCC (black arrowhead) adjacent to the first-order branches of the intrahepatic bile duct (white arrow) with distance ≤ 5 mm. b Axial CT image of peribiliary HCC (black arrowhead) adjacent to the second-order branches of the intrahepatic bile duct (white arrow) with distance ≤ 5 mm. c Axial CT image of non-peribiliary HCC (black arrowhead) distal to the intrahepatic bile duct (white arrow) with distance > 5 mm

Fig. 3

Cumulative LTP curves of the peribiliary and non-peribiliary groups. There was no significant difference in cumulative LTP between the peribiliary and non-peribiliary groups in the total cohort (a) and PSM cohort (b)

Fig. 4

OS curves were of the peribiliary and non-peribiliary groups. There was no significant difference in OS between the peribiliary and non-peribiliary groups in the total cohort (a) and PSM cohort (b)

Fig. 5

DFS curves of the peribiliary and non-peribiliary groups. There was no significant difference in DFS between the peribiliary and non-peribiliary groups in the total cohort (a) and PSM cohort (b)

Fig. 6

LTP and OS curves of the first- and second-order branch groups. There were no significant differences in (a) LTP and (b) OS between the two groups