Results of Surgical and Nonsurgical Treatment for Small–Sized Hepatocellular Carcinomas: A Retrospective and Nationwide Survey in Japan

Abstract

Hepatic resection (HX), percutaneous ethanol injection (PEI), and transcatheter arterial embolization (TCAE) have all been used in the treatment of patients with small-sized hepatocellular carcinomas (HCCs). However, the indications for these therapeutic modalities remain unclear. Therefore, the first step to minimize the debate on these indications is to review the standard results from each treatment based on an extensive survey. The participants in this study were patients with HCCs less than 5 cm in diameter who were enrolled in The Liver Cancer Study Group of Japan. The survival rates in the HX (n = 8,010), PEI (n = 4,037), and TCAE (n = 841) groups were calculated in relation to the number of tumors and the clinical stage. In the clinical stage I cases with a solitary tumor less than 2 cm in diameter and in all clinical stages with a solitary tumor greater than 2 cm and in the clinical stage II cases with 2 tumors greater than 2 cm, the HX group showed higher survival rates than the nonsurgical groups. The HX group had a higher male/female ratio and a younger mean age than the PEI or TCAE group. The ratio of HBs antigen-positive cases/hepatitis C virus antibody-positive cases in the PEI group was lower than that in the corresponding HX group. In contrast, the PIVKA-II values in the HX group tended to be higher than in the PEI group. In conclusion, these findings will provide useful information for selection of a therapeutic modality for small-sized HCCs.

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

“…No RCTs have demonstrated that surgical resection is superior to percutaneous ablation. In nonrandomized comparative studies, hepatectomy was better than percutaneous ablation in one study [213] whereas others reported no significant difference between the two therapies [310][311][312]. Thus, it is difficult to conclude that surgical resection is the treatment of choice for resectable HCC.…”

“…Furthermore, small, arterially enhancing nodules are common in the cirrhotic liver, and majority of these nodules are benign [209][210][211]. Therefore, the most important issue remains the identification of small tumors because curative treatments can be optimally applied to improve outcome [212,213]. If left alone, these tumors can grow aggressively and invasion can occur before tumors reach the 2-cm cutoff size for small HCC [202].…”

Clinicopathologic Characteristics and Prognoses for Multicentric Occurrence and Intrahepatic Metastasis in Synchronous Multinodular Hepatocellular Carcinoma Patients

“…Many studies have reported that HCV infection is an independent factor for MO HCC and that the MO occurrence rate is higher in the presence of HCV than HBV (Arii et al, 2000;Poon et al, 2000). Maeda et al (2000) reported a higher rate of new poorly differentiated neoplasms when HBV-associated HCC recurred.…”

Longterm survival outcomes of patients undergoing treatment with radiofrequency ablation for hepatocellular carcinoma and metastatic colorectal cancer liver tumors

“…RFA particularly have emerged as a promising adjunct in the treatment of CLM and HCC in the past decade due to its safety, efficacy, and ability to provide more consistent results in local tumor control, especially in patients with limited hepatic reserve. 10,11 While there have been several studies evaluating 5-year survival in small cohorts of patients undergoing RFA as part of their treatment strategy for HCC or CLM, there are only limited data on 10-year survival, which is a time interval that we believe is equivocal with cure. 3,[12][13][14][15] In this study, we sought to determine whether long-term overall survival at 10 years is obtainable in patients, who undergo RFA as part of their treatment for primary and metastatic colorectal hepatic malignancies.…”