Small Hepatocellular Carcinoma: Radiofrequency Ablation versus Nonanatomic Resection—Propensity Score Analyses of Long-term Outcomes

Kang, Tae Wook; Kim, Jong Man; Rhim, Hyunchul; Lee, Min Woo; Kim, Youngsun; Lim, Hyo Keun; Choi, Dongil; Song, Kyoung Doo; Kwon, Choon Hyuck David; Joh, Jae‐Won; Paik, Seung Woon; Paik, Yong Han; Ahn, Joonghyun

doi:10.1148/radiol.15141483

Cited by 137 publications

(93 citation statements)

References 40 publications

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“…Strategies for RF ablation concerning optimal electrode type and ablation technique were discussed at an RF ablation team meeting and were based on matching pre-procedural imaging findings with the results of planning US before each treatment. Our therapeutic goal for RF ablation was to achieve an ablative margin of at least 0.5 cm in the normal liver tissue surrounding the tumor, with the exception of subcapsular and perivascular tumors [25]. Procedures were finished when the hyperechoic ablation zone on the US was large enough to cover the entire tumor and the expected ablative margin.…”

Section: Methodsmentioning

confidence: 99%

Effect of oral antiviral treatment on long-term outcomes of radiofrequency ablation therapy for hepatitis B virus-related hepatocellular carcinoma

et al. 2016

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ObjectivesThis study aimed to investigate the effect of oral antiviral treatment on the prognosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after radiofrequency (RF) ablation.MethodsBetween January 2003 and December 2010, 228 patients without a history of antiviral treatment were treated with RF ablation for a single HBV-related HCC. We divided the patients into two groups, patients who received (n=125) or did not receive antiviral treatment (n=103), based on whether oral antiviral treatment was administered after RF ablation. The median duration of antiviral treatment was 60.1 months. HCC recurrence and overall survival were compared in the two groups in the full cohort and the propensity score-matched cohort.ResultsIn the matched cohort, the probability of HCC recurrence at 5 years was 43.8% for the non-antiviral treatment group and 14.7% for the antiviral treatment group (p<0.001). The probability of overall survival at 5 years was 77.2% for the non-antiviral treatment group and 93.5% for the antiviral treatment group (p=0.002). Multivariable analysis showed that risk factors for HCC recurrence included large tumor size (hazard ratio (HR)=1.30, p=0.022), HBV DNA serum level (HR=1.11, p=0.005), and serum AFP level ≥20 ng/mL (HR=1.66, p=0.005). Overall survival was associated with larger tumor size (HR=1.86, p=0.001) and Child-Pugh Class B (HR=2.13, p=0.019). Oral antiviral treatment after RF ablation was significantly associated with a lower risk of tumor recurrence and death (HR=0.33, p<0.001, and HR=0.44, p=0.004).ConclusionUse of oral antiviral treatment after curative RF ablation was associated with favorable outcomes in terms of tumor recurrence and overall survival in patients with HBV-related HCC.

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Section: Methodsmentioning

confidence: 99%

Effect of oral antiviral treatment on long-term outcomes of radiofrequency ablation therapy for hepatitis B virus-related hepatocellular carcinoma

et al. 2016

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“…Four randomized trials did not show a superiority of resection over RFA in terms of overall and progression-free survival [95-98]. Similar data were reported by some propensity score analyses [99, 100]. However, these data are not conclusive because of some methodology limitations.…”

Section: Resultsmentioning

confidence: 66%

Open Liver Resection, Laparoscopic Liver Resection, and Percutaneous Thermal Ablation for Patients with Solitary Small Hepatocellular Carcinoma (≤30 mm): Review of the Literature and Proposal for a Therapeutic Strategy

Viganò¹,

Laurenzi²,

Solbiati³

et al. 2018

Dig Surg

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Background: Patients with a single hepatocellular carcinoma (HCC) ≤3 cm and preserved liver function have the highest likelihood to be cured if treated. The most adequate treatment methods are yet a matter that is debated. Methods: We reviewed the literature about open anatomic resection (AR), laparoscopic liver resection (LLR), and percutaneous thermal ablation (PTA). Results: PTA is effective as resection for HCC < 2 cm, when they are neither subcapsular nor perivascular. PTA in HCC of 2–3 cm is under evaluation. AR with the removal of the tumor-bearing portal territory is recommended for HCC > 2 cm, except for subcapsular ones. In comparison with open surgery, LRR has better short-term outcomes and non-inferior long-term outcomes. LLR is standardized for superficial limited resections and for left-sided AR. Conclusions: According to the available evidences, the following therapeutic proposal can be advanced. Laparoscopic limited resection is the standard for any subcapsular HCC. PTA is the first-line treatment for deep-located HCC < 2 cm, except for those in contact with Glissonean pedicles. Laparoscopic AR is the standard for deep-located HCC of 2–3 cm of the left liver, while open AR is the standard for deep-located HCC of 2–3 cm in the right liver. HCC in contact with Glissonean pedicles should be scheduled for resection (open or laparoscopic) independent of their size. Liver transplantation is reserved to otherwise untreatable patients or as a salvage procedure at recurrence.

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“…Finally, the meta-analysis reported by Cho Yun Ku et al [20] showed no significant difference between the two techniques. More recently a study by Kang et al on small nodules (BCLC 0 and A) showed no difference between radiofrequency ablation and surgical excision in terms of 5-year survival [21].…”

Section: Pre-treatment Assessmentmentioning

confidence: 96%

Radiological treatment of HCC: Interventional radiology at the heart of management

Aubé

Bouvier

Lebigot

et al. 2015

Diagnostic and Interventional Imaging

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Interventional radiology is involved practically at each stage in the treatment of hepatocellular carcinoma, as recommended in the EASL-EORTC guidelines. It is even becoming more important as technological advances progress and as its long-term efficacy is assessed. Used curatively, thermoablation can obtain five-year survival rates of 40 to 70%, with a survival rate of 30% at 10years. As there are many tools available in order to be used, it requires a thorough pre-treatment assessment and discussion in a multidisciplinary team meeting. Regular patient reassessment is needed in order to be able to adjust treatment because of the complementarity of the treatments available and the course of the disease.

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Small Hepatocellular Carcinoma: Radiofrequency Ablation versus Nonanatomic Resection—Propensity Score Analyses of Long-term Outcomes

Cited by 137 publications

References 40 publications

Effect of oral antiviral treatment on long-term outcomes of radiofrequency ablation therapy for hepatitis B virus-related hepatocellular carcinoma

Effect of oral antiviral treatment on long-term outcomes of radiofrequency ablation therapy for hepatitis B virus-related hepatocellular carcinoma

Open Liver Resection, Laparoscopic Liver Resection, and Percutaneous Thermal Ablation for Patients with Solitary Small Hepatocellular Carcinoma (≤30 mm): Review of the Literature and Proposal for a Therapeutic Strategy

Radiological treatment of HCC: Interventional radiology at the heart of management

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