Radiofrequency ablation vs. surgery for perivascular hepatocellular carcinoma: Propensity score analyses of long-term outcomes
Sunyoung Lee
, Tae Wook Kang 'Correspondence information about the author Tae Wook KangEmail the author Tae Wook KangEmail the author Tae Wook Kang
, Dong Ik Cha
, Kyoung Doo Song
, Min Woo Lee
, Hyunchul Rhim
, Hyo Keun Lim
, Dong Hyun Sinn
, Jong Man Kim
, Kyunga Kim
•Surgery provided better PFS and OS compared to RFA for small periportal HCCs.
•There was significant interaction between treatment and vessel types for outcomes.
•Evaluating type of peritumoral vessel may determine treatment strategy for HCCs.
Background & Aims The therapeutic outcomes of surgical resection (SR) or radiofrequency ablation (RFA) for perivascular hepatocellular carcinoma (HCC) have not been compared. The aim of this study was to compare SR with RFA as first-line treatment in patients with perivascular HCC and to evaluate the long-term outcomes of both therapies.
Methods This retrospective study was approved by the institutional review board. The requirement for informed consent was waived. Between January 2006 and December 2010, a total of 283 consecutive patients with small perivascular HCCs (≤3 cm, Barcelona Clinic Liver Cancer stage 0 or A) underwent SR (n = 182) or RFA (n = 101) as a first-line treatment. The progression-free survival (PFS) and overall survival (OS) rates were compared by propensity score matching. Subgroup analysis of these outcomes was conducted according to the type of hepatic vessels.
Results The median follow-up was 7.8 years. Matching yielded 62 pairs of patients. In the two matched groups, the PFS rates at 5 and 10 years were 58.0% and 17.8%, respectively, in the SR group, and 25.4% and 14.1%, respectively, in the RFA group (p <0.001). The corresponding OS rates at 5 and 10 years were 93.5% and 91.9% in the SR group and 82.3% and 74.1% in the RFA group, respectively (p <0.001). In contrast to those in patients with perivenous HCCs, subgroup analysis indicated that extrahepatic recurrence and OS were significantly different according to the treatment modality in patients with periportal HCCs (p = 0.004 and p <0.001, respectively).
Conclusions In patients with small perivascular HCCs, SR provided better long-term tumor control and OS than RFA, particularly for periportal tumors.
Lay summary Surgical resection and radiofrequency ablation are both treatment options for perivascular hepatocellular carcinoma. We compared outcomes in patients treated with either method. Surgical resection provided better long-term tumor control and overall survival than radiofrequency ablation for patients with a small perivascular hepatocellular carcinoma (≤3 cm) as a first-line treatment, particularly for periportal tumors. The location of the tumor and the type of peritumoral hepatic vessels need to be considered when choosing between surgical resection and radiofrequency ablation for small HCCs.
射频消融与围手术治疗血管周围肝细胞癌：长期结果的倾向评分分析
Sunyoung李
，Tae Wook Kang'关于作者的通信信息Tae Wook KangEmail作者Tae Wook KangEmail作者Tae Wook Kang
Dong Ik Cha
，Kyoung Doo Song
，Min Woo Lee
，Hyunchul Rhim
，Hyo Keun Lim
Dong Hyun Sinn
Jong Man Kim
，Kyunga Kim
PlumX指标
DOI：https：//doi.org/10.1016/j.jhep.2018.02.026 |
