Comparative study of percutaneous radiofrequency ablation and hepatic resection for small, poorly differentiated hepatocellular carcinomas

Abstract

As hepatic resection has greater efficacy than RFA in the treatment of poorly differentiated HCC, even in cases with a small tumor size, we recommend its use for this malignancy.

Predictive factors of pathological vascular invasion in hepatocellular carcinoma within 3 cm and three nodules without radiological vascular invasion

“…In addition, there were no recognizable local recurrences that could be clearly attributed to the residual tumor at the treatment site. All the patients in this study were treated with hepatic resection, and if they had been treated with local ablation therapy, the prognosis for pathological vascular invasion positive patients might have been poorer than those reported for negative patients . Several previous studies have reported the negative impact of pathological vascular invasion in HCC patients treated with surgical resection .…”

“…Poorly differentiated HCC is reported to be correlated with microvascular invasion or satellite lesions, even though it is quite difficult to regard pathological tumor differentiation as a routine preoperative task. Besides, the outcome for small but poorly differentiated HCC treated with ablation therapy is reportedly much worse than for patients undergoing hepatic resection . We previously reported that the preoperatively‐evaluable contrast‐to‐noise ratio T 2 ‐weighted MRI was a predictive factor for poor differentiation .…”

Comparative effectiveness of first‐line radiofrequency ablation versus surgical resection and transplantation for patients with early hepatocellular carcinoma

“…A recently published study from Japan compared RFA with RXN in patients with small, poorly differentiated tumors: the maximum tumor size was 2 cm in the RFA group and 2.5 cm in the RXN group. RFA for these small tumors was found to be significantly inferior, demonstrating a cumulative 5‐year survival rate of 32.7%, whereas RXN yielded a survival rate of 67.5%; the recurrence‐free survival rate also was found to be significantly lower in the RFA group . Furthermore, a Japanese nationwide survey of 12,968 patients with tumors measuring <3 cm found significantly lower odds of death and disease recurrence in patients who underwent RXN compared with those who underwent RFA .…”

“…Outcomes were analyzed for patients with tumors measuring ≤20 mm, 21 to 30 mm, 31 to 50 mm, or 31 to 35 mm. The 20‐mm cutoff value was chosen on the basis of studies demonstrating longer survival and lower disease recurrence with RXN compared with RFA in patients with early‐stage HCC measuring <20 mm . The 30‐mm cutoff value was derived from published reports (including the current American Hepato‐Pancreato‐Biliary Association consensus statement) recommending RFA for tumors measuring <30 mm .…”

“…Although RFA can be successful as first‐line therapy, the maximum HCC tumor size for which RFA is safe and effective remains highly controversial; size cutoff values of 20 mm, 30 mm, and 50 mm have been proposed . Some authors have proposed a 20‐mm cutoff value based on studies demonstrating that RXN results in longer survival than RFA in patients with poorly differentiated HCC measuring <20 mm . A 30‐mm cutoff value has been suggested by several authors and currently is recommended by the American Hepato‐Pancreato‐Biliary Association and in the BCLC staging algorithm .…”