Single Hepatocellular Carcinoma approached by curative-intent treatment: A propensity score analysis comparing radiofrequency ablation and liver resection

Sandro, Stefano Di; Benuzzi, Laura; Lauterio, Andrea; Botta, Francesca; Carlis, Riccardo De; Najjar, Marc; Centonze, Leonardo; Danieli, Maria Giovanna; Pezzoli, Isabella; Rampoldi, Antonio; Bagnardi, Vincenzo; Carlis, Luciano De

doi:10.1016/j.ejso.2019.04.023

Cited by 25 publications

(16 citation statements)

References 30 publications

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“…Tumors were defined as "subcapsular" when localized below the Glissonian layer, located at <1 cm in depth from the liver surface and associated with a liver surface bulge, without an exophytic growth [4].…”

Section: Variables and Definitionsmentioning

confidence: 99%

“…Therefore, the correct approach for single tumors up to 3 cm is debatable, since multiple options are currently available. Evidence in the literature suggests that LR or RFA can provide comparable results for patients with single, small HCC and well-compensated liver disease, although recent reports show an advantage for LR over percutaneous ablation (PA) in terms of recurrence-free survival with comparable post-procedure morbidities [4]. However, whether or not ablation can achieve a similar outcome as LR for tumors within the 3-cm range remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Robotic Liver Resection Versus Percutaneous Ablation for Early HCC: Short- and Long-Term Results

Magistri

Catellani

Frassoni

et al. 2020

Cancers

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Background: The correct approach for early hepatocellular carcinoma (HCC) is debatable, since multiple options are currently available. Percutaneous ablation (PA) is associated in some series to reduced morbidity compared to liver resection (LR); therefore, minimally invasive surgery may play a significant role in this setting. Methods: All consecutive patients treated by robotic liver resection (RLR) or PA between January 2014 and October 2019 for a newly diagnosed single HCC, less than 3 cm in size (very early/early stages according to the Barcelona Clinic Liver Cancer (BCLC)) on chronic liver disease or liver cirrhosis, were enrolled in this retrospective study. The aim of this study was to compare short- and long-term outcomes to define the best approach in this specific cohort. Results: 60 patients fulfilled the inclusion criteria: 24 RLR and 36 PA. The two populations were homogeneous in terms of baseline characteristics. There were no statistically significant differences regarding the incidence of postoperative morbidity (RLR 38% vs. PA 19%, p = 0.15). The cumulative incidence of recurrence (CIR) was significantly higher in patients who underwent PA, with the one, two, and three years of CIR being 42%, 69%, and 73% in the PA group and 17%, 27%, and 27% in the RLR group, respectively. Conclusions: RLR provides a significantly higher potential of cure and tumor-related free survival in cases of newly diagnosed single HCCs smaller than 3 cm. Therefore, it can be considered as a first-line approach for the treatment of patients with those characteristics in high-volume centers with extensive experience in the field of hepatobiliary surgery and minimally invasive approaches.

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Section: Variables and Definitionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Robotic Liver Resection Versus Percutaneous Ablation for Early HCC: Short- and Long-Term Results

Magistri

Catellani

Frassoni

et al. 2020

Cancers

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“…In recent years, some studies have shown that RFA can be used for subcapsular HCC [ 10 , 14 ]. And there was a study that proved RFA could be as effective as liver resection [ 15 ]. But whether repeat hepatectomy or RFA is an optimal treatment for patients with subcapsular RHCC remains unknown when preoperative disease status is eligible for both repeat hepatectomy and RFA.…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency ablation versus repeat hepatectomy in the treatment of recurrent hepatocellular carcinoma in subcapsular location: a retrospective cohort study

et al. 2021

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Background Repeat hepatectomy and radiofrequency ablation (RFA) are widely used to treat early recurrent hepatocellular carcinoma (RHCC) located in the subcapsular region, but the optimal treatment strategy remains to be controversial. Methods A total of 126 RHCC patients in the subcapsular location after initial radical hepatectomy were included in this study between Dec 2014 and Jan 2018. These patients were divided into the RFA group (46 cases) and the repeat hepatectomy group (80 cases). The primary endpoints include repeat recurrence-free survival (rRFS) and overall survival (OS), and the secondary endpoint was complications. The propensity-score matching (PSM) was conducted to minimize the bias. Complications were evaluated using the Clavien-Dindo classification, and severe complications were defined as classification of complications of ≥grade 3. Results There were no significant differences in the incidence of severe complications were observed between RFA group and repeat hepatectomy group in rRFS and OS both before (1-, 2-, and 3-year rRFS rates were 65.2%, 47.5%, and 33.3% vs 72.5%, 51.2%, and 39.2%, respectively, P = 0.48; 1-, 2-, and 3-year OS rates were 93.5%, 80.2%, and 67.9% vs 93.7%, 75.8%, and 64.2%, respectively, P = 0.92) and after PSM (1-, 2-, and 3-year rRFS rates were 68.6%, 51.0%, and 34.0% vs 71.4%, 42.9%, and 32.3%, respectively, P = 0.78; 1-, 2-, and 3-year OS rates were 94.3%, 82.9%, and 71.4% vs 88.6%, 73.8%, and 59.0%, respectively, P = 0.36). Moreover, no significant differences in the incidence of severe complications were observed between the RFA group and repeat hepatectomy group. Conclusion Both repeat hepatectomy and RFA are shown to be effective and safe for the treatment of RHCC located in the subcapsular region.

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“…There are several non-surgical therapeutic options available to treat HCC such as chemoembolization, radiofrequency ablation, or radiation therapy. However, liver resection and liver transplantation remain the main curative therapy options [ 4 , 5 , 6 ]. Concerning systemic treatment options, there are several therapies approved for advanced HCC patients, including the multikinase inhibitors sorafenib, regorafenib, lenvatinib, carbozantinib; the anti-angiogenic antibody ramucirumab; the immune checkpoint inhibitors nivolumab and pembrolizumab; and the combination therapies atezolizumab (anti-PD-L1) + bevacizumab (anti-VEGFA), and nivolumab (anti-PD-1) + ipilimumab (anti-CTLA4) [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

The Endless Sources of Hepatocellular Carcinoma Heterogeneity

Bárcena‐Varela

Lujambio

2021

Cancers

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Hepatocellular carcinoma (HCC) represents a global health problem. The incidence keeps increasing and current therapeutic options confer limited benefits to the patients. Tumor heterogeneity plays a central role in this context, limiting the availability of predictive biomarkers and complicating the criteria used to choose the most suitable therapeutic option. HCC heterogeneity occurs at different levels: within the population (inter-patient heterogeneity) and within tumors from the same patient (intra-patient and intra-tumor heterogeneity). Experts in the field have made many efforts to classify the patients based on clinicopathological characteristics and molecular signatures; however, there is still much work ahead to be able to integrate the extra-tumor heterogeneity that emerges from the complexity of the tumor microenvironment, which plays a critical role in the pathogenesis of the disease and therapy responses. In this review, we summarize tumor intrinsic and extrinsic sources of heterogeneity of the most common etiologies of HCC and summarize the most recent discoveries regarding the evolutionary trajectory of liver cancer cells and the influence of tumor-extrinsic factors such as the microbiome and the host immune system. We further highlight the potential of novel high-throughput methodologies to contribute to a better understanding of this devastating disease and to the improvement of the clinical management of patients.

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Single Hepatocellular Carcinoma approached by curative-intent treatment: A propensity score analysis comparing radiofrequency ablation and liver resection

Cited by 25 publications

References 30 publications

Robotic Liver Resection Versus Percutaneous Ablation for Early HCC: Short- and Long-Term Results

Robotic Liver Resection Versus Percutaneous Ablation for Early HCC: Short- and Long-Term Results

Radiofrequency ablation versus repeat hepatectomy in the treatment of recurrent hepatocellular carcinoma in subcapsular location: a retrospective cohort study

The Endless Sources of Hepatocellular Carcinoma Heterogeneity

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