Shilei Bai1,2, Pinghua Yang3, Zhihao Xie1, Jun Li1, Zhengqing Lei1,4, Yong Xia1, Guojun Qian5, Baohua Zhang6, Timothy M Pawlik7, Wan Yee Lau1,8, Feng Shen9. 1. Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital and National Center for Liver Cancer, Second Military Medical University, Shanghai, China. 2. Department of Hepatic Surgery II, the Eastern Hepatobiliary Surgery Hospital and National Center for Liver Cancer, Second Military Medical University, Shanghai, China. 3. Department of Biliary Surgery IV, the Eastern Hepatobiliary Surgery Hospital and National Center for Liver Cancer, Second Military Medical University, Shanghai, China. 4. Department of General Surgery, the Affiliated Zhongda Hospital, Southeast University, Nanjing, China. 5. Department of Ultrasound Interventional Therapy, the Eastern Hepatobiliary Surgery Hospital and National Center for Liver Cancer, Second Military Medical University, Shanghai, China. 6. Department of Biliary Surgery IV, the Eastern Hepatobiliary Surgery Hospital and National Center for Liver Cancer, Second Military Medical University, Shanghai, China. zhangbaohuaehbh@163.com. 7. Department of Surgery, the Wexner Medical Center, Ohio State University, Columbus, OH, USA. 8. Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong SAR, China. 9. Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital and National Center for Liver Cancer, Second Military Medical University, Shanghai, China. shenfengehbh@sina.com.
Abstract
OBJECTIVES: The aim of this study was to examine prognostic differences between liver resection (LR) and percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma (HCC) based on preoperative predicted microvascular invasion (MVI) risk. METHODS: Data on consecutive patients who underwent LR (n = 1344) or PRFA (n = 853) for hepatitis B virus-related HCC within the Milan criteria (MC) were analyzed. A preoperative nomogram was used to estimate MVI risk. Overall survival (OS), time to recurrence, and patterns of recurrence were compared using propensity score matching. RESULTS: The concordance indices of the nomogram to predict MVI were 0.813 and 0.781 among LR patients with HCC within the MC or ≤ 3 cm, respectively. LR and PRFA resulted in similar 5-year recurrence and OS for patients with nomogram-predicted low-risk of MVI. LR provided better 5-year recurrence and OS versus PRFA for patients with high-risk of MVI (71.6% vs. 80.7%, p = 0.013; 47.9% vs. 34.0%, p = 0.002, for HCC within the MC; 62.3% vs. 78.8%, p = 0.020; 63.6% vs. 38.3%, p = 0.015, for HCC ≤ 3 cm). Among high-risk patients, LR was associated with lower recurrence and improved OS compared with PRFA, on multivariate analysis [hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.63-0.97, and HR 0.68, 95% CI 0.52-0.88, for HCC within the MC; HR 0.51, 95% CI 0.32-0.81, and HR 0.47, 95% CI 0.26-0.84, for HCC ≤ 3 cm], and resulted in less early and local recurrence than PRFA (42.4% vs. 54.8%, p = 0.007, and 31.2% vs. 46.1%, p = 0.007, for HCC within the MC; 27.9% vs. 50.8%, p = 0.016, and 15.6% vs. 39.5%, p = 0.046, for HCC ≤ 3 cm). CONCLUSIONS: LR was oncologically superior over PRFA for early HCC patients with predicted high-risk of MVI. LR was associated with better local disease control than PRFA in these patients.
OBJECTIVES: The aim of this study was to examine prognostic differences between liver resection (LR) and percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma (HCC) based on preoperative predicted microvascular invasion (MVI) risk. METHODS: Data on consecutive patients who underwent LR (n = 1344) or PRFA (n = 853) for hepatitis B virus-related HCC within the Milan criteria (MC) were analyzed. A preoperative nomogram was used to estimate MVI risk. Overall survival (OS), time to recurrence, and patterns of recurrence were compared using propensity score matching. RESULTS: The concordance indices of the nomogram to predict MVI were 0.813 and 0.781 among LR patients with HCC within the MC or ≤ 3 cm, respectively. LR and PRFA resulted in similar 5-year recurrence and OS for patients with nomogram-predicted low-risk of MVI. LR provided better 5-year recurrence and OS versus PRFA for patients with high-risk of MVI (71.6% vs. 80.7%, p = 0.013; 47.9% vs. 34.0%, p = 0.002, for HCC within the MC; 62.3% vs. 78.8%, p = 0.020; 63.6% vs. 38.3%, p = 0.015, for HCC ≤ 3 cm). Among high-risk patients, LR was associated with lower recurrence and improved OS compared with PRFA, on multivariate analysis [hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.63-0.97, and HR 0.68, 95% CI 0.52-0.88, for HCC within the MC; HR 0.51, 95% CI 0.32-0.81, and HR 0.47, 95% CI 0.26-0.84, for HCC ≤ 3 cm], and resulted in less early and local recurrence than PRFA (42.4% vs. 54.8%, p = 0.007, and 31.2% vs. 46.1%, p = 0.007, for HCC within the MC; 27.9% vs. 50.8%, p = 0.016, and 15.6% vs. 39.5%, p = 0.046, for HCC ≤ 3 cm). CONCLUSIONS: LR was oncologically superior over PRFA for early HCC patients with predicted high-risk of MVI. LR was associated with better local disease control than PRFA in these patients.
Authors: Jorge A Marrero; Laura M Kulik; Claude B Sirlin; Andrew X Zhu; Richard S Finn; Michael M Abecassis; Lewis R Roberts; Julie K Heimbach Journal: Hepatology Date: 2018-08 Impact factor: 17.425
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Authors: Maurizio Pompili; Antonio Saviano; Nicoletta de Matthaeis; Alessandro Cucchetti; Francesco Ardito; Bruno Federico; Franco Brunello; Antonio D Pinna; Antonio Giorgio; Stefano M Giulini; Ilario De Sio; Guido Torzilli; Fabio Fornari; Lorenzo Capussotti; Alfredo Guglielmi; Fabio Piscaglia; Luca Aldrighetti; Eugenio Caturelli; Fulvio Calise; Gennaro Nuzzo; Gian Ludovico Rapaccini; Felice Giuliante Journal: J Hepatol Date: 2013-03-22 Impact factor: 25.083