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01.04.2015 | Hepatobiliary Tumors | Ausgabe 4/2015

Annals of Surgical Oncology 4/2015

Cryoablation Provides Superior Local Control of Primary Hepatocellular Carcinomas of >2 cm Compared with Radiofrequency Ablation and Microwave Coagulation Therapy: An Underestimated Tool in the Toolbox

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 4/2015
Autoren:
MD Shigenori Ei, MD, PhD Taizo Hibi, MD, PhD Minoru Tanabe, MD, PhD Osamu Itano, MD, PhD Masahiro Shinoda, MD, PhD Minoru Kitago, MD, PhD Yuta Abe, MD, PhD Hiroshi Yagi, MD, PhD Koji Okabayashi, MD, PhD Daisuke Sugiyama, MD, PhD Go Wakabayashi, MD, PhD Yuko Kitagawa
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1245/​s10434-014-4114-7) contains supplementary material, which is available to authorized users.

Abstract

Background

Although cryoablation (Cryo) has been advocated as an effective locoregional therapy for hepatocellular carcinoma (HCC), few studies have compared the outcomes with those of radiofrequency ablation (RFA) and microwave coagulation therapy (MCT).

Methods

Consecutive patients with primary HCCs of <5 cm received Cryo or RFA/MCT between 1998 and 2011 and were monitored for local recurrence (defined as a recurrent tumor at or in direct contact with the ablated area) and overall complication rates.

Results

The median tumor size was 2.5 cm in the Cryo group (n = 55) and 1.9 cm in the RFA/MCT group (n = 64; P < 0.001), but other patient characteristics were similar. Multivariate Cox regression analysis revealed Cryo as the only independent factor for improved 2-year local recurrence-free survival, with a hazard ratio (HR) of 0.3 (95 % confidence interval, 0.1–0.9; P = 0.02). Tumor diameter was a negative indicator of local recurrence-free survival (HR, 2.0; 95 % confidence interval, 1.1–3.5; P = 0.02). Subgroup analysis of patients with tumors of >2 cm demonstrated significantly better local recurrence rates in the Cryo group compared with the RFA/MCT group (21 vs. 56 % at 2 years; P = 0.006). Overall complication rates and incidences of Clavien–Dindo classification grade ≥III were identical (both P = 1.00). No in-hospital mortality occurred.

Conclusions

Appropriate use of Cryo, as shown in this series, is safe and provides significantly improved local control for the treatment of primary HCCs of >2 cm compared with RFA/MCT.

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Zusatzmaterial
Supplementary Figure. A 3.5-cm hepatocellular carcinoma (white arrow) located in left medial section (Couinaud segment 4) in close proximity to the umbilical portion and hepatic hilum before (a) and after (b) cryoablation (TIFF 1521 kb)
10434_2014_4114_MOESM1_ESM.tiff
Literatur
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