Radiofrequency ablation versus surgical resection for hepatocellular carcinoma within the Milan criteria: A study of 281 Western patients

Hocquelet, Arnaud; Balageas, P.; Laurent, Césari; Blanc, Jean‐Frédéric; Frulio, Nora; Salut, Cécile; Cassinotto, Christophe; Saric, Jean; Possenti, Laurent; Bernard, Pierre–Henri; Montaudon, Michel; Trillaud, Hervé

doi:10.3109/02656736.2015.1068382

Cited by 45 publications

(58 citation statements)

References 47 publications

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“…The results demonstrate significantly higher local and global tumor progression rates in the group with tumor surface with insufficient margin 4 425 mm 2 , which supports the proposal that tumors with large areas with margins r 5 mm have higher risk of recurrence arising from untreated satellite nodules. The present results highlight the utility of this concept based on tumor surface exposed to margins r 5 mm, and not only on two-dimensional minimal margins.…”

Section: Discussionsupporting

confidence: 82%

“…Several limitations should be emphasized in this retrospective proof-of-concept study, including its small sample size, even though we used propensity-score matching to avoid selection bias (2,15). Although encouraging results were obtained, a per-ablation procedure validation is needed.…”

Section: Discussionmentioning

confidence: 99%

“…One-and 2-year overall survival rates were higher for patients with insufficient margins r 425 mm 2 than for patients with insufficient margins 4 425 mm 2 , at 100% and 100%, respectively, versus 87.5% and 37.5%, respectively (P ¼ .008).…”

Section: Overall Survival and Disease Recurrence (Any Pattern)mentioning

confidence: 92%

“…Percutaneous thermal ablation, especially radiofrequency (RF) ablation, is a safe and effective treatment for hepatocellular carcinoma (HCC) (1,2), providing similar outcomes to surgical resection (2). However, despite progress in RF devices (3)(4)(5)(6), the prognosis of cirrhotic patients with HCC treated by RF ablation as first-line is still impaired by local tumor progression (LTP) occurring within 2 years after RF ablation (7).…”

mentioning

confidence: 99%

“…LTP occurs in 10%-21% of patients and is associated with poor prognosis (2,6). The likelihood of local progression increases with tumor size as a result of satellite nodules (8), which is why a 5-mm minimum ablation margin is recommended by several studies (9,10).…”

mentioning

confidence: 99%

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Three-Dimensional Measurement of Hepatocellular Carcinoma Ablation Zones and Margins for Predicting Local Tumor Progression

Hocquelet

Trillaud

Frulio

et al. 2016

Journal of Vascular and Interventional Radiology

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Overall Survival and Disease Recurrence (Any Pattern)mentioning

confidence: 92%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Three-Dimensional Measurement of Hepatocellular Carcinoma Ablation Zones and Margins for Predicting Local Tumor Progression

Hocquelet

Trillaud

Frulio

et al. 2016

Journal of Vascular and Interventional Radiology

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Comparative effectiveness of first‐line radiofrequency ablation versus surgical resection and transplantation for patients with early hepatocellular carcinoma

Kutlu

Chan

Aloia

et al. 2017

Cancer

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Although RFA frequently is used as first-line treatment of HCC tumors measuring as large as 50 mm, it is associated with worse results than RXN or TXP for tumors measuring >30 mm. To the best of the authors' knowledge, the results of the current study are the first to demonstrate that although RFA is an appropriate option for patients with HCC tumors measuring ≤30 mm, its use for tumors even slightly larger than 30 mm is associated with inferior outcomes. Cancer 2017;123:1817-1827. © 2017 American Cancer Society.

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Small Steatotic HCC: A Radiological Variant Associated With Improved Outcome After Ablation

et al. 2020

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Percutaneous thermal ablation is a validated treatment option for small hepatocellular carcinoma (HCC). Steatotic HCC can be reliably detected by magnetic resonance imaging. To determine the clinical relevance of this radiological variant, we included 235 patients (cirrhosis in 92.3%, classified Child‐Pugh A in 97%) from a prospective database on percutaneous thermal ablation for <3 cm HCC. Among these patients, 52 (22.1%) had at least one steatotic HCC nodule. Nonalcoholic steatohepatitis was more frequent in patients with than without steatotic HCC (P = 0.057), whereas body mass index, diabetes mellitus, liver steatosis, and liver fat content did not differ between groups. Liver disease was less advanced in patients with than without steatotic HCC: lower total bilirubin (‐2.1 µmol/L; P = 0.035), higher albumin (+0.8 g/L; P = 0.035), and lower Model for End‐Stage Liver Disease score (‐0.8; P = 0.014). Tumor phenotype was less aggressive in patients with steatotic HCC: lower alpha‐fetoprotein (AFP) concentration (P = 0.019), less frequent AFP > 100 ng/mL (P = 0.045), and multifocality (P = 0.015). During the follow‐up (median: 28.3 months), overall mortality (3.8% vs. 23.5%; P = 0.001) and HCC‐specific mortality (0.0% vs. 14.2%; P = 0.002) rates were lower in patients with steatotic HCC. Early (<2 years) recurrence was also less frequent (32.7% vs. 49.2%; P = 0.041). The mean time to intrahepatic distant recurrence (16.4 vs. 9 months, P = 0.006) and the median time to recurrence and recurrence‐free survival (32.4 vs. 18.6 months, P = 0.024 and 30.4 vs. 16.4 months, P = 0.018) were longer in patients with steatotic versus nonsteatotic HCC. The 3‐year overall survival was 94.4% and 70.9% in steatotic and nonsteatotic HCC (P = 0.008). In multivariate analysis, steatotic HCC (hazard ratio = 0.12; P = 0.039) and AFP (HR=1.002; P < 0.001) independently predicted overall survival. Conclusion: Small steatotic HCC detected by magnetic resonance imaging is associated with a less aggressive tumor phenotype. In patients with such radiological variant, percutaneous thermal ablation results in improved outcome.

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Radiofrequency ablation versus surgical resection for hepatocellular carcinoma within the Milan criteria: A study of 281 Western patients

Abstract: This large Western study has shown that OS and DFS did not differ after RFA (using mainly multipolar devices) and SR, for HCC within the Milan criteria in a European population, with a shorter hospitalisation time and a lower complication rate for RFA.

Cited by 45 publications

References 47 publications

Three-Dimensional Measurement of Hepatocellular Carcinoma Ablation Zones and Margins for Predicting Local Tumor Progression

Three-Dimensional Measurement of Hepatocellular Carcinoma Ablation Zones and Margins for Predicting Local Tumor Progression

Comparative effectiveness of first‐line radiofrequency ablation versus surgical resection and transplantation for patients with early hepatocellular carcinoma

Small Steatotic HCC: A Radiological Variant Associated With Improved Outcome After Ablation

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