Clinical features of hemodialysis patients treated for hepatocellular carcinoma: Comparison between resection and radiofrequency ablation

Abstract

There is no consensus regarding which therapeutic option is better and/or safer for treating hemodialysis (HD) patients with hepatocellular carcinoma (HCC). The present study compared surgical resection (Hx) and radiofrequency ablation (RFA) with regard to therapeutic efficacy in HD patients with HCC. Of 108 HD patients with naïve HCC treated at 15 institutions between 1988 and 2014 enrolled in the present study, 58 fulfilled the up-to-7 criteria [7 as the sum of the size of the largest tumor (cm) and the number of tumors] and were treated with Hx (n=23) or RFA (n=35); their clinical features, complications and prognosis were assessed. The frequency of hepatitis C virus was higher in the RFA group compared with that in the Hx group (P=0.002), whereas there were no differences between the groups with regard to the average time from the first HD (P=0.953), tumor-nodes-metastasis (TNM) stage (Union for International Cancer Control 7th edition) (P=0.588), TNM stage (Liver Cancer Study Group of Japan 5th edition) (P=0.095), Child-Pugh classification (P=0.094), and Japan Integrated Scoring system (P=0.489). There were no significant differences in overall survival (OS) and disease-free survival (DFS) rates between the Hx and RFA groups [1-, 3- and 5-year OS rates: 81.7, 55.6 and 43.3% vs. 89.9, 67.1 and 56.3%, respectively (P=0.454); 1-, 3- and 5-year DFS rates: 71.1, 30.5 and 18.3% vs. 63.8, 31.6 and 21.1%, respectively (P=0.911)] Complications were observed in 4 patients (11.4%) in the RFA group (2 with subcapsular hemorrhage, 1 with intraperitoneal bleeding and 1 with tardive intrahepatic hematoma) and in 4 patients (17.4%) in the Hx group (2 with postoperative infection, 1 with liver failure and 1 with pleural effusion) (P=0.700). In conclusion, Hx and RFA have a similar therapeutic efficacy in HD patients with naïve HCC who fulfilled the up-to-7 criteria.

A systematic review and meta-analysis of radio frequency ablation and routine resection in the treatment of small hepatocellular carcinoma

“…The basic principle of operation is that heating current stimulation lesions causes focal cell degeneration necrosis. The operation temperature is influenced by factors such as liver blood circulation, tissue density, and local temperature, which can cause lesions that are difficult to control and can prevent the expected effect from being reached (27). In addition, liver tumor lesions have complex three-dimensional structures, and the cross-distribution of internal blood vessels and branch bile ducts can affect the field of RFA and easily lead to cancer cell residues.…”

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

“…Few original studies or systematic reviews have discussed whether pre-existing renal dysfunction before RFA is related to treatment outcomes, although much more evidence indicating treatment outcomes in patients with ESRD on dialysis receiving RFA for HCC have been emerging. To examine the efficacy and safety of RFA in treating HCC in patients with HD, a study enrolled 108 HD patients with naïve HCC at 15 institutions between 1988 and 2014[ 194 ]. Fifty-eight patients with appropriate indications treated with either hepatectomy ( n = 23) or RFA ( n = 35) were compared with respect to their clinical features, complications, and prognosis.…”