Kenichi Takayasu1, Shigeki Arii2, Michiie Sakamoto3, Yutaka Matsuyama4, Masatoshi Kudo5, Shuichi Kaneko6, Osamu Nakashima7, Masumi Kadoya8, Namiki Izumi9, Tadatoshi Takayama10, Yonson Ku11, Takashi Kumada12, Shoji Kubo13, Takashi Kokudo14, Yasuhiro Hagiwara4, Norihiro Kokudo15. 1. Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan. 2. Department of Hepato-Biliary-Pancreatic Surgery, Hamamatsu Rosai Hospital, Japan Labor Health and Welfare Organization, Hamamatsu, Japan. 3. Department of Pathology, Keio University School of Medicine, Tokyo, Japan. 4. Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan. 5. Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Sayama, Japan. 6. Department of Gastroenterology, Kanazawa University School of Medical Science, Kanazawa, Japan. 7. Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan. 8. Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan. 9. Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan. 10. Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan. 11. Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. 12. Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan. 13. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. 14. Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 15. National Center for Global Health and Medicine, Tokyo, Japan.
Abstract
BACKGROUND AND AIMS: Small hypovascular hepatocellular carcinoma (HCC) ≤2 cm is biologically less aggressive than hypervascular one, however, the optimal treatment is still undetermined. The efficacy of surgical resection (SR), radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) was evaluated. METHODS: The 853 (SR, 176; RFA, 491; PEI, 186) patients were enrolled who met Child-Pugh A/B, single hypovascular HCC ≤2 cm pathologically proven, available tumour differentiation and absence of macrovascular invasion and extrahepatic metastasis. Overall and recurrence-free survivals were compared in original and a propensity score weighted pseudo-population with 732 patients. RESULTS: The median follow-up time and tumour size were 2.8 years and 1.47 cm respectively. In original population, multivariate Cox regression showed no significant difference for overall survival among three groups. In pseudo-population, Cox regression also revealed no significant difference for overall survival among them, although SR (HR, 0.56; 95% CI, 0.36-0.86) and RFA (HR, 0.75; 95% CI, 0.57-1.00) groups had significantly lower recurrence than PEI group. The overall survival rates at 3 and 5 years for the SR, RFA and PEI groups were 94%/70%, 90%/75% and 94%/73% respectively. Corresponding recurrence-free survival rates were 64%/54%, 59%/41% 48%/33% respectively. Subgroup analysis revealed no significant survival benefit of SR compared with non-SR. No treatment-related death occurred. CONCLUSIONS: For patients with single hypovascular HCC ≤2 cm, no significant difference for overall survival was first identified among 3 treatment groups. The SR or RFA could be recommended, and PEI would be alternative to RFA.
BACKGROUND AND AIMS: Small hypovascular hepatocellular carcinoma (HCC) ≤2 cm is biologically less aggressive than hypervascular one, however, the optimal treatment is still undetermined. The efficacy of surgical resection (SR), radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) was evaluated. METHODS: The 853 (SR, 176; RFA, 491; PEI, 186) patients were enrolled who met Child-Pugh A/B, single hypovascular HCC ≤2 cm pathologically proven, available tumour differentiation and absence of macrovascular invasion and extrahepatic metastasis. Overall and recurrence-free survivals were compared in original and a propensity score weighted pseudo-population with 732 patients. RESULTS: The median follow-up time and tumour size were 2.8 years and 1.47 cm respectively. In original population, multivariate Cox regression showed no significant difference for overall survival among three groups. In pseudo-population, Cox regression also revealed no significant difference for overall survival among them, although SR (HR, 0.56; 95% CI, 0.36-0.86) and RFA (HR, 0.75; 95% CI, 0.57-1.00) groups had significantly lower recurrence than PEI group. The overall survival rates at 3 and 5 years for the SR, RFA and PEI groups were 94%/70%, 90%/75% and 94%/73% respectively. Corresponding recurrence-free survival rates were 64%/54%, 59%/41% 48%/33% respectively. Subgroup analysis revealed no significant survival benefit of SR compared with non-SR. No treatment-related death occurred. CONCLUSIONS: For patients with single hypovascular HCC ≤2 cm, no significant difference for overall survival was first identified among 3 treatment groups. The SR or RFA could be recommended, and PEI would be alternative to RFA.