K Wang1, G Liu2, J Li1, Z Yan1, Y Xia3, X Wan4, Y Ji5, W Y Lau6, M Wu7, F Shen8. 1. Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. 2. Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Department of Interventional Radiology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. 3. Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Department of Clinical Database, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. Electronic address: xia.yong@126.com. 4. Department of Clinical Database, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. 5. Department of General Surgery, the Second Hospital of Wuxi, Wuxi, China. 6. Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China. 7. Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Department of Clinical Database, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. 8. Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Department of Clinical Database, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. Electronic address: shenfengehbh@sina.com.
Abstract
AIMS: To observe the outcomes of various treatments for patients with early intrahepatic recurrent hepatocellular carcinoma (HCC) after partial hepatectomy. METHODS: A total of 629 patients with intrahepatic recurrent HCC within Milan criteria following hepatectomy were prospectively collected between November 2004 and May 2010. Overall survival (OS) and recurrence to death survival (RTDS) were analyzed by the Kaplan-Meier method and log-rank test. Cox regression analysis was used for multivariate analyses. RESULTS: The 5-year OS and RTDS rates were 64.5%, 43.0%; 37.0%, 26.7%; 27.7% and 8.3% for patients who received re-hepatectomy (n = 128), percutaneous radiofrequency ablation (PRFA, n = 162) and transarterial chemoembolization (TACE, n = 339) (re-hepatectomy vs. TACE, P < 0.001, <0.001; vs. PRFA, P = 0.005, 0.008; PRFA vs. TACE, P < 0.001, <0.001). The independent predictors of OS and RTDS were tumor number (hazard ratio: 1.54, 95% confidence interval: 1.18-2.00; 1.57, 1.21-2.04), alpha fetoprotein >20 ng/mL (1.64, 1.24-2.17; 1.66, 1.26-2.20), presence of varices (1.69, 1.28-2.22; 1.61, 1.23-2.10) and Edmondson-Steiner grade III-IV (1.66, 1.17-2.35; 1.70, 1.20-2.40) at the initial stage; and tumor number (1.34, 1.04-1.73; 1.32, 1.03-1.70), time to recurrence (TTR) (3.46, 2.58-4.65; 1.59, 1.19-2.14) and treatment for recurrence (TACE: 3.18, 2.16-4.66; 2.95, 2.02-4.31; PRFA: 1.49, 0.97-2.29; 1.44, 0.94-2.19). CONCLUSIONS: For early intrahepatic recurrent HCC, re-hepatectomy achieved best outcome. It produced similar result as PRFA for patients with more invasive primary tumors and underlying cirrhosis/varices. TACE had worst prognosis which was only suitable for multifocal recurrence and TTR ≤1 year.
AIMS: To observe the outcomes of various treatments for patients with early intrahepatic recurrent hepatocellular carcinoma (HCC) after partial hepatectomy. METHODS: A total of 629 patients with intrahepatic recurrent HCC within Milan criteria following hepatectomy were prospectively collected between November 2004 and May 2010. Overall survival (OS) and recurrence to death survival (RTDS) were analyzed by the Kaplan-Meier method and log-rank test. Cox regression analysis was used for multivariate analyses. RESULTS: The 5-year OS and RTDS rates were 64.5%, 43.0%; 37.0%, 26.7%; 27.7% and 8.3% for patients who received re-hepatectomy (n = 128), percutaneous radiofrequency ablation (PRFA, n = 162) and transarterial chemoembolization (TACE, n = 339) (re-hepatectomy vs. TACE, P < 0.001, <0.001; vs. PRFA, P = 0.005, 0.008; PRFA vs. TACE, P < 0.001, <0.001). The independent predictors of OS and RTDS were tumor number (hazard ratio: 1.54, 95% confidence interval: 1.18-2.00; 1.57, 1.21-2.04), alpha fetoprotein >20 ng/mL (1.64, 1.24-2.17; 1.66, 1.26-2.20), presence of varices (1.69, 1.28-2.22; 1.61, 1.23-2.10) and Edmondson-Steiner grade III-IV (1.66, 1.17-2.35; 1.70, 1.20-2.40) at the initial stage; and tumor number (1.34, 1.04-1.73; 1.32, 1.03-1.70), time to recurrence (TTR) (3.46, 2.58-4.65; 1.59, 1.19-2.14) and treatment for recurrence (TACE: 3.18, 2.16-4.66; 2.95, 2.02-4.31; PRFA: 1.49, 0.97-2.29; 1.44, 0.94-2.19). CONCLUSIONS: For early intrahepatic recurrent HCC, re-hepatectomy achieved best outcome. It produced similar result as PRFA for patients with more invasive primary tumors and underlying cirrhosis/varices. TACE had worst prognosis which was only suitable for multifocal recurrence and TTR ≤1 year.
Authors: Tyler D Fields; Prejesh Philips; Charles R Scoggins; Cliff Tatum; Lawrence Kelly; Kelly M McMasters; Robert C G Martin Journal: World J Surg Date: 2017-05 Impact factor: 3.352
Authors: Kit-Fai Lee; Charing C N Chong; Anthony K W Fong; Andrew K Y Fung; Hon-Ting Lok; Yue-Sun Cheung; John Wong; Paul B S Lai Journal: Hepatobiliary Surg Nutr Date: 2018-10 Impact factor: 7.293