Long-term Effects of Repeat Hepatectomy vs Percutaneous Radiofrequency Ablation Among Patients With Recurrent Hepatocellular Carcinoma

Abstract

IMPORTANCE Repeat hepatectomy and percutaneous radiofrequency ablation (PRFA) are most commonly used to treat early-stage recurrent hepatocellular carcinoma (RHCC) after initial resection, but previous studies comparing the effectiveness of the 2 treatments have reported conflicting results.OBJECTIVE To compare the long-term survival outcomes after repeat hepatectomy with those after PRFA among patients with early-stage RHCC. DESIGN, SETTING, AND PARTICIPANTSThis open-label randomized clinical trial was conducted at the Eastern Hepatobiliary Surgery Hospital and the National Center for Liver Cancer of China. A total of 240 patients with RHCC (with a solitary nodule diameter of Յ5 cm; 3 or fewer nodules, each Յ3 cm in diameter; and no macroscopic vascular invasion or distant metastasis) were randomized 1:1 to receive repeat hepatectomy or PRFA between

Proton beam radiotherapy vs. radiofrequency ablation for recurrent hepatocellular carcinoma: A randomized phase III trial

“…However, PBT and RFA yielded OS rates that were similar to those observed for RFA in randomized trials comparing the efficacy of RFA and surgical resection in early HCC. [31][32][33][34] Although the noninferiority of PBT compared to RFA was not shown in terms of the 2-year PFS as well as 3and 4-year OS in the PP analysis (Figure 2), the HRs in the PFS and OS between RFA and PBT were consistently not significant in both the ITT and PP analyses (p > 0.05 each) ( Figures 3E-H). In the best tumor response evaluation, PBT, unlike RFA, have a lagging in local control, so the median time to the best tumor response was 4.4 m (range, 1-13).…”

Radiofrequency Ablation Versus Hepatic Resection for Recurrent Hepatocellular Carcinoma: An Updated Meta-analysis

“…First, in previous studies, the number of included studies was small, and non-RCTs were included in the evaluation. Second, though several studies reported generally comparable outcomes between RHR and RFA, a tendency toward longer OS and PFS was observed in the RHR group compared with the RFA group [22,27,29]. Third, two recent high-quality studies revealed that RHR was still the most effective treatment, followed by RFA for RHCC [17,18], and the results may play an important role in the meta-analysis.…”

“…All of the studies reported 1-, 3-and 5-year OS rates [15-18, 20-22, 26, 27, 29], while only 6 studies [16, 20-22, 26, 27] reported 1-, 3-and 5-year PFS rates. Major complications were reported in 7 studies [15,16,18,20,22,26,27]. The characteristics of the eligible studies are shown in Table 2.…”

“…The median OS was only reported in 2 of the 10 included studies [22,27], of which the median OS ranged from 47.1 to 48 months in the RHR group and from 37.5 to 40 months in the RFA group. Meta-analysis showed that the pooled HR was 0.77 (95% CI = 0.65-0.92, P = 0.004), and RHR resulted in signi cantly better OS than RFA.…”

“…However, the evidence for these studies was poor because of the few included studies and the lack of randomized controlled trials (RCTs). Recently, several articles, including an RCT, have been published, which have never been included in previous meta-analyses [17,18,[20][21][22].…”