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11.06.2020 | Interventional

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

verfasst von: Yuemin Feng, Hao Wu, Daniel Q. Huang, Chenghui Xu, Hang Zheng, Mayumi Maeda, Xinya Zhao, Le Wang, Feng Xiao, Huanran Lv, Tiantian Liu, Jianni Qi, Jie Li, Ning Zhong, Chuanxi Wang, Hong Feng, Bo Liang, Wanhua Ren, Chengyong Qin, Mindie H. Nguyen, Qiang Zhu

Erschienen in: European Radiology | Ausgabe 11/2020

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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.

Nur mit Berechtigung zugänglich

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 68:723–750CrossRef

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 58:724–729CrossRef

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 69:1284–1293CrossRef

Tabrizian P, Jibara G, Shrager B, Schwartz M, Roayaie S (2014) Recurrence of hepatocellular cancer after resection: patterns, treatments, and prognosis. Ann Surg 261:947–955CrossRef

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

Xu XF, Xing H, Han J et al (2018) Risk factors, patterns, and outcomes of late recurrence after liver resection for hepatocellular carcinoma: a multicenter study from China. JAMA Surg 154:209–217CrossRef

Lacaze L, Scotté M (2015) Surgical treatment of intra hepatic recurrence of hepatocellular carcinoma. World J Hepatol 116:1755–1760CrossRef

Ma KW, Chok KSH, She BWH et al (2017) Defining optimal surgical treatment for recurrent hepatocellular carcinoma. -a propensity score matched analysis. Liver Transpl 24:1062–1069CrossRef

Peng SK, Chan ACY, Tan TC et al (2016) Efficacy of radiofrequency ablation compared with transarterial chemoembolization for the treatment of recurrent hepatocellular carcinoma: a comparative survival analysis. HPB (Oxford) 18:72–78

10.

Yagi R, Midorikawa Y, Moriguchi M et al (2018) Liver resection for recurrent hepatocellular carcinoma to improve survivability: a proposal of indication criteria. Surgery 163:1250–1256CrossRef

11.

European Association for the Study of the Liver (2018) EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236

12.

Chu HH, Kim JH, Kim PN et al (2019) Surgical resection versus radiofrequency ablation very early-stage HCC (≤ 2 cm single HCC): a propensity score analysis. Liver Int 39:2397–2407CrossRef

13.

Liu H, Wang ZG, Fu SY et al (2016) Randomized clinical trial of chemoembolization plus radiofrequency ablation versus partial hepatectomy for hepatocellular carcinoma within the Milan criteria. Br J Surg 103:348–356CrossRef

14.

Kyoung Doo S, Hyo Keun L, Hyunchul R et al (2015) Repeated hepatic resection versus radiofrequency ablation for recurrent hepatocellular carcinoma after hepatic resection: a propensity score matching study. Radiology 275:599–608CrossRef

15.

Peng Z, Wei M, Chen S et al (2018) Combined transcatheter arterial chemoembolization and radiofrequency ablation versus hepatectomy for recurrent hepatocellular carcinoma after initial surgery: a propensity score matching study. Eur Radiol 28:3522–3531CrossRef

16.

Takayama T, Sekine T, Makuuchi M et al (2000) Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet 356:802–807CrossRef

17.

Kang TW, Lim HK, Lee MW, Kim YS, Choi D, Rhim H (2014) Perivascular versus nonperivascular small HCC treated with percutaneous RF ablation: retrospective comparison of long-term therapeutic outcomes. Radiology 270:888–899CrossRef

18.

Lee S, Kang TW, Dong IC et al (2018) Radiofrequency ablation versus surgery for perivascular hepatocellular carcinoma: propensity score analyses of long-term outcomes. J Hepatol 69:70–78CrossRef

19.

Kang TW, Lim HK, Lee MW, Kim YS, Choi D, Rhim H (2013) First-line radiofrequency ablation with or without artificial ascites for hepatocellular carcinomas in a subcapsular location: local control rate and risk of peritoneal seeding at long-term follow-up. Clin Radiol 68:e641–e651CrossRef

20.

Kim YJ, Raman SS, Yu NC, Busuttil RW, Tong M, Lu DS (2008) Radiofrequency ablation of hepatocellular carcinoma: can subcapsular tumors be safely ablated? AJR Am J Roentgenol 190:1029–1034CrossRef

21.

Feng YM, Xing W, Le W et al (2017) Efficacy and safety of combination therapy of chemoembolization and radiofrequency ablation with different time intervals for hepatocellular carcinoma patients. Surg Oncol 26:236–241CrossRef

22.

Kang TW, Kim JM, Rhim H et al (2015) Small hepatocellular carcinoma: radiofrequency ablation versus nonanatomic resection--propensity score analyses of long-term outcomes. Radiology 275:908–919CrossRef

23.

Chen MS, Li JQ, Zheng Y et al (2006) A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 243:321–328CrossRef

24.

Xia Y, Li J, Liu G et al (2019) Long-term effects of repeat hepatectomy vs percutaneous radiofrequency ablation among patients with recurrent hepatocellular carcinoma: a randomized clinical trial. JAMA Oncol. https://doi.org/10.1001/jamaoncol.2019.4477

25.

Sun WC, Chen I, Liang HL et al (2017) Comparison of repeated surgical resection and radiofrequency ablation for small recurrent hepatocellular carcinoma after primary resection. Oncotarget 8:104571–104581CrossRef

26.

Feng Q, Chi Y, Liu Y, Zhang L, Liu Q (2015) Efficacy and safety of percutaneous radiofrequency ablation versus surgical resection for small hepatocellular carcinoma: a meta-analysis of 23 studies. J Cancer Res Clin Oncol 141:1–9CrossRef

27.

Fu C, Liu N, Deng Q, Li X, Ma K, Bie P (2014) Radiofrequency ablation vs. surgical resection on the treatment of patients with small hepatocellular carcinoma: a system review and meta-analysis of five randomized controlled trials. Hepato-gastroenterology 61:1722–1729PubMed

28.

Zhao C, Jin M, Le RH et al (2018) Poor adherence to hepatocellular carcinoma surveillance: a systematic review and meta-analysis of a complex issue. Liver Int 38:503–514CrossRef

29.

Wang C, Zhao C, Le AK et al (2015) 729 Poor adherence and poor persistency of consistent adherence to AASLD guidelines for hepatocellular carcinoma (HCC) screening and surveillance in chronic hepatitis B (CHB) patients at both university and community clinics: a multicenter U.S. cohort stud. Gastroenterology 148:S992–S993CrossRef

30.

Feng K, Yan J, Li X et al (2012) A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol 57:794–802CrossRef

31.

Wang JH, Wang CC, Hung CH, Chen CL, Lu SN (2012) Survival comparison between surgical resection and radiofrequency ablation for patients in BCLC very early/early stage hepatocellular carcinoma. J Hepatol 56:412–418CrossRef

32.

Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:052–060CrossRef

33.

Kaibori M, Matsui Y, Hijikawa T, Uchida Y, Kwon AH, Kamiyama Y (2006) Comparison of limited and anatomic hepatic resection for hepatocellular carcinoma with hepatitis C. Surgery 139:385–394CrossRef

34.

Zhao Y, Wang WJ, Guan S et al (2013) Sorafenib combined with transarterial chemoembolization for the treatment of advanced hepatocellular carcinoma: a large-scale multicenter study of 222 patients. Ann Oncol 24:1786–1792CrossRef

35.

Chen VL, Yeh ML, Le AK et al (2018) Anti-viral therapy is associated with improved survival but is underutilised in patients with hepatitis B virus-related hepatocellular carcinoma: real-world east and west experience. Aliment Pharmacol Ther 48:44–54CrossRef

Titel: Radiofrequency ablation versus repeat resection for recurrent hepatocellular carcinoma (≤ 5 cm) after initial curative resection
verfasst von: Yuemin Feng
Hao Wu
Daniel Q. Huang
Chenghui Xu
Hang Zheng
Mayumi Maeda
Xinya Zhao
Le Wang
Feng Xiao
Huanran Lv
Tiantian Liu
Jianni Qi
Jie Li
Ning Zhong
Chuanxi Wang
Hong Feng
Bo Liang
Wanhua Ren
Chengyong Qin
Mindie H. Nguyen
Qiang Zhu
Publikationsdatum: 11.06.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 11/2020
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-06990-8

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