Ann Surg Treat Res.  2020 Oct;99(4):238-246. 10.4174/astr.2020.99.4.238.

Comparison of outcome between liver resection, radiofrequency ablation, and transarterial therapy for multiple small hepatocellular carcinoma within the Milan criteria

• Oh JH
• Sinn DH
• Choi GS
• Kim JM
• Joh JW
• Kang TW
• Hyun D
• Kang W
• Gwak GY
• Paik YH
• Lee JH
• Koh KC
• Paik SW
• Choi MS

• KMID: 2506655
• DOI: http://doi.org/10.4174/astr.2020.99.4.238

Abstract

Purpose
Although surgical resection is usually considered for a single tumor, several reports have suggested that resection can be considered for multiple tumors. The objective of this study was to determine whether resection could provide better long-term outcome for patients with multiple hepatocellular carcinomas (HCCs) within Milan criteria.
Methods
A total of 276 patients with multiple HCCs within Milan criteria with liver function preserved who underwent resection, radiofrequency ablation (RFA), or transarterial chemoembolization (TACE) between 2009 and 2013 were analyzed. Propensity-score (PS) matching was conducted.
Results
Five-year overall survival (OS) and recurrence-free survival (RFS) were better in the resection group than that in the RFA or TACE group. Patients who underwent resection had more preserved liver function and different tumor characteristics compared to those received RFA or TACE. With similar baseline characteristics generated in the PS model, there was no difference in 5-year OS among 3 groups (79.5% vs. 72.3% or 62.0%, P = 0.232), but the 5-year RFS was better for patients who received resection than those who received RFA or TACE (51.9% vs. 22.0% or 0.0%, P < 0.001). Although the major complication rate was slightly higher than RFA or TACE, there was no significant difference between the 3 groups before and after PS matching.
Conclusion
Resection was associated with better RFS than RFA or TACE and showed comparable OS in multiple HCC patients within the Milan criteria, but at a cost of slightly increased risk of complication. Resection can be considered as a first-line option if selected appropriately.

Keyword

Chemoembolization; Hepatectomy; Hepatocellular carcinoma; Propensity score; Radiofrequency ablation

Figure

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  Fig. 1 Flowchart for participants' enrollment (overall cohort). HCC, hepatocellular carcinoma; RFA, radiofrequency ablation; TACE, transarterial chemoembolization.

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  Fig. 2 (A) Overall survival (OS) by initial treatment modality in overall cohort. (B) OS by initial treatment modality in propensity-score matching cohort. RFA, radiofrequency ablation; TACE, transarterial chemoembolization.

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  Fig. 3 (A) Recurrence-free survival (RFS) by initial treatment modality in overall cohort. (B) RFS by initial treatment modality in propensity-score matching cohort. RFA, radiofrequency ablation; TACE, transarterial chemoembolization.

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