Johannes Uhlig1,2, Cortlandt M Sellers1, Stacey M Stein3,4, Hyun S Kim5,6,7. 1. Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA. 2. Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Göttingen, Germany. 3. Division of Medical Oncology, Department of Medicine, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA. 4. Yale Cancer Center, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA. 5. Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA. kevin.kim@yale.edu. 6. Division of Medical Oncology, Department of Medicine, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA. kevin.kim@yale.edu. 7. Yale Cancer Center, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA. kevin.kim@yale.edu.
Abstract
PURPOSE: To compare utilization and effectiveness of radiofrequency ablation (RFA) and surgical resection for hepatocellular carcinoma (HCC). METHODS: The 2004-2015 United States National Cancer Database was queried for HCC patients treated by RFA and surgical resection. Patients were 1:1 propensity score matched. Duration of hospital stay, unplanned readmission rates, and overall survival (OS) were compared in the matched cohort via multivariable regression models. RESULTS: Eighteen thousand two hundred ninety-six patients were included (RFA, n = 8211; surgical resection, n = 10,085). RFA was more likely in young male whites with high degree of hepatic fibrosis, high bilirubin levels, high INR, and multifocal HCC; resection was more likely in those with private insurance, high income, high cancer grade and stage, and larger HCC. RFA rates varied between 32.3% (East South Central) and 58.5% (New England). Post-treatment outcomes were superior for RFA versus resection regarding duration of hospital stay (median 1 vs. 5d, p < 0.001), 30-day unplanned hospital readmission rates (3.1% vs. 4.5%, p < 0.001), and 30-/90-day mortality (0% vs. 4.6%/8%, p < 0.001). Overall survival was comparable for RFA and resection for severe hepatic fibrosis/cirrhosis (5-year OS 37.3% vs. 39.4%, p = 0.07), for patients > 65 years old (5-year OS 21.9% vs. 26.5%, p = 0.47), and for HCC < 15 mm (5-year OS 49.7% vs. 52.3%, p = 0.78). OS in the full cohort was superior for surgical resection (5-year OS 29.9% vs. 45.7%, p < 0.01). CONCLUSION: RFA for HCC shows substantial variation by geography, socioeconomic factors, liver function, and tumor extent. RFA offers superior post-treatment outcomes versus surgical resection and may be an alternative for older patients with cirrhosis and/or small HCC. KEY POINTS: • Duration of hospital stay, unplanned readmissions, and 30-/90-day mortality are lower for RFA versus surgical resection. • RFA and surgical resection show similar survival in severe hepatic fibrosis. • In HCC < 15 mm, RFA and surgical resection yield similar survival.
PURPOSE: To compare utilization and effectiveness of radiofrequency ablation (RFA) and surgical resection for hepatocellular carcinoma (HCC). METHODS: The 2004-2015 United States National Cancer Database was queried for HCC patients treated by RFA and surgical resection. Patients were 1:1 propensity score matched. Duration of hospital stay, unplanned readmission rates, and overall survival (OS) were compared in the matched cohort via multivariable regression models. RESULTS: Eighteen thousand two hundred ninety-six patients were included (RFA, n = 8211; surgical resection, n = 10,085). RFA was more likely in young male whites with high degree of hepatic fibrosis, high bilirubin levels, high INR, and multifocal HCC; resection was more likely in those with private insurance, high income, high cancer grade and stage, and larger HCC. RFA rates varied between 32.3% (East South Central) and 58.5% (New England). Post-treatment outcomes were superior for RFA versus resection regarding duration of hospital stay (median 1 vs. 5d, p < 0.001), 30-day unplanned hospital readmission rates (3.1% vs. 4.5%, p < 0.001), and 30-/90-day mortality (0% vs. 4.6%/8%, p < 0.001). Overall survival was comparable for RFA and resection for severe hepatic fibrosis/cirrhosis (5-year OS 37.3% vs. 39.4%, p = 0.07), for patients > 65 years old (5-year OS 21.9% vs. 26.5%, p = 0.47), and for HCC < 15 mm (5-year OS 49.7% vs. 52.3%, p = 0.78). OS in the full cohort was superior for surgical resection (5-year OS 29.9% vs. 45.7%, p < 0.01). CONCLUSION: RFA for HCC shows substantial variation by geography, socioeconomic factors, liver function, and tumor extent. RFA offers superior post-treatment outcomes versus surgical resection and may be an alternative for older patients with cirrhosis and/or small HCC. KEY POINTS: • Duration of hospital stay, unplanned readmissions, and 30-/90-day mortality are lower for RFA versus surgical resection. • RFA and surgical resection show similar survival in severe hepatic fibrosis. • In HCC < 15 mm, RFA and surgical resection yield similar survival.
Authors: Tito Livraghi; Luigi Solbiati; M Franca Meloni; G Scott Gazelle; Elkan F Halpern; S Nahum Goldberg Journal: Radiology Date: 2003-02 Impact factor: 11.105
Authors: James E Everhart; Elizabeth C Wright; Zachary D Goodman; Jules L Dienstag; John C Hoefs; David E Kleiner; Marc G Ghany; A Scott Mills; S Russell Nash; Sugantha Govindarajan; Thomas E Rogers; Joel K Greenson; Elizabeth M Brunt; Herbert L Bonkovsky; Chihiro Morishima; Heather J Litman Journal: Hepatology Date: 2010-02 Impact factor: 17.425
Authors: Adriano Carneiro da Costa; Mikael Sodergren; Kumar Jayant; Fernando Santa Cruz; Duncan Spalding; Madhava Pai; Nagy Habib Journal: World J Gastroenterol Date: 2020-05-07 Impact factor: 5.742
Authors: Antonia Grimm; Moritz Winkelmann; Jakob Weiß; Georg Gohla; Gunnar Blumenstock; Konstantin Nikolaou; Stephan Clasen; Rüdiger Hoffmann Journal: Eur Radiol Exp Date: 2019-09-23