An explorative data-analysis to support the choice between hepatic resection and radiofrequency ablation in the treatment of hepatocellular carcinoma

Cucchetti, Alessandro; Piscaglia, Fabio; Cescon, Matteo; Serra, Carla; Colecchia, Antonio; Maroni, Lorenzo; Venerandi, Laura; Ercolani, Giorgio; Pinna, Antonio Daniele

doi:10.1016/j.dld.2013.10.015

Cited by 49 publications

(34 citation statements)

References 33 publications

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“…However, similar to other observational series, ablation was more frequently performed in patients with a poorer performance status, or a worse liver function, highlighting the treatment bias that occurs with therapy selection. 23,24 Thus, propensity score modelling was applied, creating treatment cohorts with similar clinicopathological variables. Despite adjusting for confounding variables, there remained a persistent survival advantage among patients receiving HR as compared with ablation, suggesting HR to be the most effective treatment modality among the two.…”

Section: Discussionmentioning

confidence: 99%

Surgical resection versus ablation for hepatocellular carcinoma ≤ 3 cm: a population-based analysis

Miura

Johnston

Tsai

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Surgical resection versus ablation for hepatocellular carcinoma ≤ 3 cm: a population-based analysis

Miura

Johnston

Tsai

et al. 2015

HPB

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“…In conclusion, as supported by a decision-making analysis performed by the same group, the superiority or equivalence of a treatment over the other is strictly dependent on the non-linear relationship among tumor number, size and liver function, with RFA to be preferred in cases of smaller tumors and impaired liver function[60]. …”

Section: Rfa Vs Liver Resection For Hccmentioning

confidence: 99%

Local ablative treatments for hepatocellular carcinoma: An updated review

Facciorusso

Serviddio

Muscatiello

2016

WJGPT

108

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Ablative treatments currently represent the first-line option for the treatment of early stage unresectable hepatocellular carcinoma (HCC). Furthermore, they are effective as bridging/downstaging therapies before orthotopic liver transplantation. Contraindications based on size, number, and location of nodules are quite variable in literature and strictly dependent on local expertise. Among ablative therapies, radiofrequency ablation (RFA) has gained a pivotal role due to its efficacy, with a reported 5-year survival rate of 40%-70%, and safety. Although survival outcomes are similar to percutaneous ethanol injection, the lower local recurrence rate stands for a wider application of RFA in hepato-oncology. Moreover, RFA seems to be even more cost-effective than liver resection for very early HCC (single nodule ≤ 2 cm) and in the presence of two or three nodules ≤ 3 cm. There is increasing evidence that combining RFA to transarterial chemoembolization may increase the therapeutic benefit in larger HCCs without increasing the major complication rate, but more robust prospective data is still needed to validate these pivotal findings. Among other thermal treatments, microwave ablation (MWA) uses high frequency electromagnetic energy to induce tissue death via coagulation necrosis. In comparison to RFA, MWA has several theoretical advantages such as a broader zone of active heating, higher temperatures within the targeted area in a shorter treatment time and the lack of heat-sink effect. The safety concerns raised on the risks of this procedure, due to the broader and less predictable necrosis areas, have been recently overcome. However, whether MWA ability to generate a larger ablation zone will translate into a survival gain remains unknown. Other treatments, such as high-intensity focused ultrasound ablation, laser ablation, and cryoablation, are less investigated but showed promising results in early HCC patients and could be a valuable therapeutic option in the next future.

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“…A systematic review of 8000 patients [14] with a current Cochrane analysis [88] reported uncertainty regarding the question of the impact of RFA versus surgery. However, a more recent meta-analysis, published after the Cochrane analysis [89], showed that there were differences in age and liver function between patients with early HCC submitted to either RFA or resection. When the analysis was corrected for these parameters, no survival differences were observed between RFA and surgery in single HCCs < 2 cm or 2 -3 HCC tumors < 3 cm, whereas surgery resulted in a longer survival in the case of single HCCs measuring 2 -5 cm [89].…”

Section: Rfa Versus Surgical Resection In Small Hccsmentioning

confidence: 99%

“…However, a more recent meta-analysis, published after the Cochrane analysis [89], showed that there were differences in age and liver function between patients with early HCC submitted to either RFA or resection. When the analysis was corrected for these parameters, no survival differences were observed between RFA and surgery in single HCCs < 2 cm or 2 -3 HCC tumors < 3 cm, whereas surgery resulted in a longer survival in the case of single HCCs measuring 2 -5 cm [89]. With RFA, survival rates have been reported to be 39.9 -68.5 % at 5 years [59, 82, 90 -93] and local tumor progression rates to be 2.4 -16.9 % [59,90,91,93].…”

Section: Rfa Versus Surgical Resection In Small Hccsmentioning

confidence: 99%

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2016

Ultraschall in Med

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An explorative data-analysis to support the choice between hepatic resection and radiofrequency ablation in the treatment of hepatocellular carcinoma

Cited by 49 publications

References 33 publications

Surgical resection versus ablation for hepatocellular carcinoma ≤ 3 cm: a population-based analysis

Surgical resection versus ablation for hepatocellular carcinoma ≤ 3 cm: a population-based analysis

Local ablative treatments for hepatocellular carcinoma: An updated review

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