Liver resection for recurrent hepatocellular carcinoma after radiofrequency ablation therapy

Abstract

Aim: Although radiofrequency ablation (RFA) is an effective local treatment of hepatocellular carcinoma (HCC), local recurrence is relatively frequent. We aimed to elucidate the validity of salvage liver resection for recurrent HCC after RFA.Methods: Patients who underwent liver resection for recurrent HCC after RFA (LR after RFA) and those who underwent second liver resection for recurrent HCC (second LR) were included. The short-term outcomes were compared between the two groups. The survival rates between the two groups were compared after propensity-score matching to adjust for the variables, including patient background, liver function, and tumor status.Results: Major resection was frequently carried out in the LR after RFA group, but there was no significant difference both in operative data and complication rate between LR after RFA (n = 54) and second LR (n = 266) groups. After a median followup period of 1.8 years (range, 0.2-10.5), the median overall survival was 4.4 years (95% confidence interval [CI], 2.2not applicable) and 5.6 years (95% CI, 4.5-7.3; P = 0.023) in the LR after RFA group (n = 54) and second LR group (n = 54), respectively, and recurrence-free survival was 1.3 years (0.4-2.2) and 1.2 years (0.5-1.8, P = 0.469), respectively. The only independent factor for overall survival of the LR after RFA group was local recurrence (hazard ratio, 2.73; 1.06-9.00). Conclusions: Salvage liver resection of recurrent HCC afterRFA could be recommended due to the safety of the procedure, especially in patients without local tumor progression after RFA.

Treatment of Hepatocellular Carcinoma in the Precision Medicine Era: From Treatment Stage Migration to Therapeutic Hierarchy

“…However, evidence from clinical practice has indicated that BCLC A patients failing local ablation could be effectively treated with LR prior to adopting rescue chemoembolization. (39) Another example of evidence-based right-to-left sequential migration is downstaging, in which locoregional therapies would allow the reinclusion of those patients in the LT criteria who were initially considered not transplantable. (3) The evidence of the success of right-to-left treatment stage migration is probably the main reason prompting the necessity to interpret the BCLC algorithm with flexibility, as recognized by the latest EASL and AASLD guidelines as well.…”

“…However, evidence from clinical practice has indicated that BCLC A patients failing local ablation could be effectively treated with LR prior to adopting rescue chemoembolization. ( 39 ) Another example of evidence‐based right‐to‐left sequential migration is downstaging, in which locoregional therapies would allow the reinclusion of those patients in the LT criteria who were initially considered not transplantable. ( 3 )…”

Follow-up schedule for initial recurrent hepatocellular carcinoma after ablation based on risk classification

“…The diameter and number of primary HCC were not significantly related to HCC re-recurrences in this study. Although some studies have demonstrated that the diameter and number of primary HCC had no significant association with the prognosis after initial recurrence, some researchers have reported a significant correlation between the tumor size and survival [18][19][20].…”

High serum serotonin as a favorable prognostic factor for patients with hepatocellular carcinoma

“…A P-value of less than 0.10 was set as the cut-off value for elimination. The following 18 variables, considered as potential confounders, were examined: age (≥ 70 versus < 70 years), sex, positive for hepatitis B or C virus, alcohol abuse, diabetes mellitus, platelet count (≥ 15 × 10 4 versus < 15 × 10 4 /mL), serotonin (≥ 90.5 versus < 90.5 ng/mL), Child-Pugh score (5 vs ≥ 6), indocyanine green clearance rate at 15 minutes (ICGR15) (≥ 15 versus < 15%), esophageal varices, serum alpha-fetoprotein level (≥ 100 versus < 100 ng/mL), serum DCP level (≥ 100 versus < 100 mAU/mL), tumor size (≥ 3.0 versus < 3.0 cm), tumor number (single versus multiple), poorly differentiated, tumor thrombus, and liver cirrhosis [21,22]. Statistical signi cance was set at P < 0.05.…”