Roberto L Meniconi1, Shohei Komatsu2, Fabiano Perdigao1, Pierre-Yves Boëlle3, Olivier Soubrane1, Olivier Scatton4. 1. Departments of Hepato-biliary Surgery and Liver Transplantation, Hôpital Saint-Antoine, Paris, France; Université Pierre-Marie Curie, Paris VI, Paris, France. 2. Departments of Hepato-biliary Surgery and Liver Transplantation, Hôpital Saint-Antoine, Paris, France. 3. Biostatistics and Public Health, Hôpital Saint-Antoine, Paris, France; Université Pierre-Marie Curie, Paris VI, Paris, France. 4. Departments of Hepato-biliary Surgery and Liver Transplantation, Hôpital Saint-Antoine, Paris, France; Université Pierre-Marie Curie, Paris VI, Paris, France. Electronic address: olivier.scatton@sat.aphp.fr.
Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) often recurs after curative resection, and thus the optimal treatment strategy to treat recurrences remains uncertain. We analyzed the results of different options to treat recurrent HCC and emphasized the impact of pathologic patterns of the tumor at initial resection. METHODS: Between 2000 and 2014, 293 patients underwent potentially curative hepatic resection for HCC. Among them, 150 experienced a recurrence and have been treated by repeat resection (RR), radiofrequency ablation (RFA), salvage liver transplantation (SLT), transarterial chemoembolization (TACE), or conservative treatment, including systemic or targeted chemotherapy. Clinical outcomes were analyzed and compared between the treatment groups, focusing on clinical and pathologic characteristics of the tumor at initial resection. RESULTS: After a median follow-up of 26 months, the overall survival (OS) at 1, 3, and 5 years after recurrence was 62%, 48%, and 40%, respectively. Survival rates were greater in patients treated by a curative approach (RR, RFA, SLT) than those treated by TACE, with 5-year OS of >70% and 37%, respectively. Univariate analysis showed satellitosis and microvascular invasion (MVI) at initial resection as negative prognostic factors of survival after recurrence (P < .05). On multivariate analysis, type of treatment was the only independent factor associated with survival. A subgroup analysis showed that RR/RFA led to better survival outcomes than TACE for early stage intrahepatic recurrences in the absence of satellitosis or MVI on the primary resected tumor. CONCLUSION: Curative treatments of recurrent HCC improve patient survival. Satellitosis and MVI on the primary resected specimen may be used as selection criteria for the best treatment strategy for intrahepatic recurrences.
BACKGROUND:Hepatocellular carcinoma (HCC) often recurs after curative resection, and thus the optimal treatment strategy to treat recurrences remains uncertain. We analyzed the results of different options to treat recurrent HCC and emphasized the impact of pathologic patterns of the tumor at initial resection. METHODS: Between 2000 and 2014, 293 patients underwent potentially curative hepatic resection for HCC. Among them, 150 experienced a recurrence and have been treated by repeat resection (RR), radiofrequency ablation (RFA), salvage liver transplantation (SLT), transarterial chemoembolization (TACE), or conservative treatment, including systemic or targeted chemotherapy. Clinical outcomes were analyzed and compared between the treatment groups, focusing on clinical and pathologic characteristics of the tumor at initial resection. RESULTS: After a median follow-up of 26 months, the overall survival (OS) at 1, 3, and 5 years after recurrence was 62%, 48%, and 40%, respectively. Survival rates were greater in patients treated by a curative approach (RR, RFA, SLT) than those treated by TACE, with 5-year OS of >70% and 37%, respectively. Univariate analysis showed satellitosis and microvascular invasion (MVI) at initial resection as negative prognostic factors of survival after recurrence (P < .05). On multivariate analysis, type of treatment was the only independent factor associated with survival. A subgroup analysis showed that RR/RFA led to better survival outcomes than TACE for early stage intrahepatic recurrences in the absence of satellitosis or MVI on the primary resected tumor. CONCLUSION: Curative treatments of recurrent HCC improve patient survival. Satellitosis and MVI on the primary resected specimen may be used as selection criteria for the best treatment strategy for intrahepatic recurrences.
Authors: Francesco Izzo; Vincenza Granata; Roberto Grassi; Roberta Fusco; Raffaele Palaia; Paolo Delrio; Gianpaolo Carrafiello; Daniel Azoulay; Antonella Petrillo; Steven A Curley Journal: Oncologist Date: 2019-06-19