Yuemin Feng1, Hao Wu1, Daniel Q Huang2, Chenghui Xu1, Hang Zheng1, Mayumi Maeda3, Xinya Zhao4, Le Wang5, Feng Xiao1,6, Huanran Lv7, Tiantian Liu1, Jianni Qi8, Jie Li9, Ning Zhong10, Chuanxi Wang11, Hong Feng11, Bo Liang12, Wanhua Ren9, Chengyong Qin1, Mindie H Nguyen3, Qiang Zhu13. 1. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China. 2. Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore. 3. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA. 4. Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China. 5. Department of Geriatrics, Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China. 6. Department of Gastroenterology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, Shandong Province, China. 7. Department of Gastroenterology, Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, China. 8. Department of Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China. 9. Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China. 10. Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China. 11. Department of Cancer Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China. 12. Department of Ultrasonic Intervention, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China. 13. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China. zhuqiang@sdu.edu.cn.
Abstract
OBJECTIVES: Recurrence rate is up to 70% at 5 years for hepatocellular carcinoma (HCC) after initial resection, but the management of recurrent HCC remains unclear. To compare the efficacy and safety of radiofrequency ablation (RFA) and repeat resection as the first-line treatment in recurrent HCC. METHODS: This multicenter retrospective study analyzed 290 patients who underwent RFA (n = 199) or repeat resection (n = 91) between January 2006 and December 2016 for locally recurrent HCC (≤ 5 cm) following primary resection. We compared the overall survival (OS), progression-free survival (PFS), and complications between the two treatment groups for the total cohort and the propensity score matched (PSM) cohort. RESULTS: The 1-, 3-, and 5-year OS (90.7%, 69.04%, 55.6% vs. 87.7%, 62.9%, 38.1%, p = 0.11) and PFS (56.5%, 27.9%, 14.6% vs. 50.2%, 21.9%, 19.2%, p = 0.80) were similar in the RFA group and the repeat resection group. However, RFA was superior to repeat resection in complication rate and hospital stay (p ≤ 0.001). We observed similar findings in the PSM cohort of 48 pairs of patients and when OS and PFS were measured from the time of the primary resection. The OS of the RFA group was significantly better than repeat resection group among those with 2 or 3 recurrent tumor nodules in both the total cohort (p = 0.009) and the PSM cohort (p = 0.018). CONCLUSION: RFA has the same efficacy as repeat resection in recurrent HCC patients, but with fewer complications. RFA is more efficient and safer than repeat resection in patients with 2 or 3 recurrent tumor nodules. KEY POINTS: • Recurrence rate is up to 70% at 5 years for hepatocellular carcinoma (HCC) after initial resection. • RFA has the same efficacy as repeat resection in recurrent HCC patients, but with fewer complications. • RFA may be preferred for those with 2 or 3 recurrent HCC nodules.
OBJECTIVES: Recurrence rate is up to 70% at 5 years for hepatocellular carcinoma (HCC) after initial resection, but the management of recurrent HCC remains unclear. To compare the efficacy and safety of radiofrequency ablation (RFA) and repeat resection as the first-line treatment in recurrent HCC. METHODS: This multicenter retrospective study analyzed 290 patients who underwent RFA (n = 199) or repeat resection (n = 91) between January 2006 and December 2016 for locally recurrent HCC (≤ 5 cm) following primary resection. We compared the overall survival (OS), progression-free survival (PFS), and complications between the two treatment groups for the total cohort and the propensity score matched (PSM) cohort. RESULTS: The 1-, 3-, and 5-year OS (90.7%, 69.04%, 55.6% vs. 87.7%, 62.9%, 38.1%, p = 0.11) and PFS (56.5%, 27.9%, 14.6% vs. 50.2%, 21.9%, 19.2%, p = 0.80) were similar in the RFA group and the repeat resection group. However, RFA was superior to repeat resection in complication rate and hospital stay (p ≤ 0.001). We observed similar findings in the PSM cohort of 48 pairs of patients and when OS and PFS were measured from the time of the primary resection. The OS of the RFA group was significantly better than repeat resection group among those with 2 or 3 recurrent tumor nodules in both the total cohort (p = 0.009) and the PSM cohort (p = 0.018). CONCLUSION: RFA has the same efficacy as repeat resection in recurrent HCC patients, but with fewer complications. RFA is more efficient and safer than repeat resection in patients with 2 or 3 recurrent tumor nodules. KEY POINTS: • Recurrence rate is up to 70% at 5 years for hepatocellular carcinoma (HCC) after initial resection. • RFA has the same efficacy as repeat resection in recurrent HCC patients, but with fewer complications. • RFA may be preferred for those with 2 or 3 recurrent HCC nodules.