Early intrahepatic recurrence of hepatocellular carcinoma after hepatectomy treated with re-hepatectomy, ablation or chemoembolization: A prospective cohort study

Meta-analysis of determinants of survival following treatment of recurrent hepatocellular carcinoma

“…Some studies offered multiple treatment modalities but chose to report only a given treatment subgroup; four studies looked at RH alone. Centres offering ablation reported mostly RFA only; however, three studies used both RFA and ethanol ablation, combining these into a single ablation group. Additional ablation techniques, such as holminum and microwave coagulation, were reported in single studies.…”

“…15 Korea 217 RH 18⋅0 9 2 3 5 9 9 Ablation 82⋅0 9 0 ⋅0 3 ⋅8 5 9 ⋅0 Wang et al 7 China 629 RH 20⋅3 3 6 ⋅4 9 TACE 53⋅9 4 6 ⋅5 Ablation 25⋅8 6 0 ⋅2 Chan et al 16 China 179 RH 16⋅2 9 0 4 7 Ablation 25⋅1 8 9 7 Ho et al 8 Taiwan 22 China 110 RH 40⋅0 9 3 9 Ablation 60⋅0 9 1 Kubo et al 27 China 51 RH 100 100 6 Shah et al 11 Canada 8 OS RH versus supportive: HR 0⋅14 (0⋅06, 0⋅34)* Ablation versus supportive: HR 0⋅1 (0⋅03, 0⋅29)* TACE versus supportive: HR 0⋅33 (0⋅19, 0⋅58)* Umeda et al 19 OS RH versus TACE: HR 0⋅07 (0⋅02, 0⋅24) ‡ Ablation versus TACE: HR 0⋅17 (0⋅06, 0⋅44) ‡ Shah et al 11 OS Supportive versus any potentially curative treatment: HR 3⋅9 (2⋅1, 7⋅2)* Lee et al 26 OS TACE versus RH: HR 0⋅98 (n.a. )* Time to recurrence Wang et al 7 OS ≤ 1 versus > 1 year: HR 1⋅59 (1⋅19, 2⋅14) † Huang et al 17 OS ≤ 18 versus > 18 months: HR 2⋅19 (1⋅07, 4⋅47) Shah et al 11 OS ≤ 1 versus > 1 year: HR 6⋅8 (3⋅3, 14⋅0)* Choi et al 10 OS ≤ 1 versus > 1 year: RR 6⋅75 (2⋅14, 21⋅29) ‡ Sun et al 23 OS ≤ 3 versus > 3 years: RR 4⋅57 (1⋅06, 19⋅61)* Huang et al 17 DFS ≤ 18 versus > 18 months: HR 2⋅32 (1⋅35, 3⋅98) † No. of recurrent tumours Wang et al 7 OS Multiple versus single: HR 1⋅32 (1⋅03, 1⋅70)* Umeda et al 19 OS ≥ 3 versus < 3: HR 3⋅78 (1⋅69, 8⋅58)* Kawano et al 20 OS Multiple versus single: HR 1⋅50 (1⋅16, 1⋅96) † Song et al 15 DFS Multiple versus single: HR 2⋅78 (1⋅54, 5⋅03) ‡ Tumour size…”

“…In the event of recurrence of HCC, a number of treatment options may be considered. These consist most commonly of repeat hepatectomy (RH), radiofrequency ablation (RFA) or transarterial chemoembolization (TACE). The exact selection criteria determining treatment modality may vary between centres, although there are broad indications for each.…”

The Evolving Role of Local Treatments for HCC in the Third Millennium

“…Moreover, an aggressive treatment of HCC with liver resection, TACE, and RFA is necessary for down-staging and is able to qualify patients for transplant (51). Later in 2015, in a prospective study Wang and colleagues reported that in patients treated for recurrence after curative hemi-hepatectomy, the repeat hepatectomy group had significantly better overall survival and RTDS than the RFA group, and that of the RFA group was significantly better than that of the TACE group (36).…”

“…Overall survival in patients with MVI was also significantly higher in the TACE-treated group versus that treated with surgery/RFA (p=0.01). Wang and colleagues published a prospective study in 2015 comparing surgery, RFA and TACE in patients who developed intrahepatic tumor recurrence after partial hepatectomy (36 (38). The inclusion criteria were age of 18 years or more; ECOG performance status 0-2; serum total bilirubin less than 2 mg/l; ability to undergo angiography.…”