Laparoscopic ablation therapies or hepatic resection in cirrhotic patients with small hepatocellular carcinoma

Santambrogio, Roberto; Bruno, Savino; Kluger, Michael D.; Costa, M.; Salceda, Juan; Belli, Andrea; Laurent, Alexis; Barabino, Matteo; Opocher, Enrico; Azoulay, Daniel; Cherqui, Daniel

doi:10.1016/j.dld.2015.11.010

Cited by 21 publications

(16 citation statements)

References 41 publications

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“…Similar to our study, the MELD score, representing the residual liver function, was a significant factor associated with the OS in post-RFA patients ( 22 ). In addition to the Child-Pugh score, the MELD score is one of the most widespread scoring systems of liver cirrhotic patients.…”

Section: Discussionsupporting

confidence: 87%

Nomograms to Predict the Disease-free Survival and Overall Survival after Radiofrequency Ablation for Hepatocellular Carcinoma

Takuma¹,

Shota²,

Miyatake³

et al. 2018

Intern. Med.

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Objective The purpose of this study was to construct nomograms for the disease-free survival (DFS) and overall survival (OS) of post-radiofrequency ablation (RFA) patients with hepatocellular carcinoma (HCC). Furthermore, we compared the prognostic predictive ability of these nomograms for estimating per-patient outcomes with that of traditional staging systems. Methods We retrospectively enrolled 298 patients in the training set and 272 patients in the validation set who underwent RFA for HCC. The nomograms for the DFS and OS were constructed from the training set using the multivariate Cox proportional hazards model. The discriminatory accuracy of the models was compared with traditional staging systems by analyzing the Harrell's C-index. Results The DFS nomogram was developed based on the tumor size, tumor number, aspartate aminotransferase (AST), albumin, age, and α-fetoprotein. The OS nomogram was developed based on the tumor size, the model for end-stage liver disease, AST, and albumin. Our DFS and OS nomograms had good calibration and discriminatory abilities in the training set, with C-indexes of 0.640 and 0.692, respectively, that were greater than those of traditional staging systems. The C-indexes of our DFS and OS nomograms were also greater than those of traditional staging systems in the validation set, with C-indexes of 0.614 and 0.657, respectively. RFA patients were stratiﬁed into low- and high-risk groups based on the median nomogram scores. High-risk patients receiving surgical resection (SR) were associated with a better DFS and OS than those undergoing RFA. However, the DFS and OS were similar between the low-risk RFA and SR groups. Conclusion We constructed reliable and useful nomograms that accurately predict the DFS and OS after RFA for early-stage HCC patients. These graphical tools are easy to use and will assist physicians during the therapeutic decision-making process.

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Section: Discussionsupporting

confidence: 87%

Nomograms to Predict the Disease-free Survival and Overall Survival after Radiofrequency Ablation for Hepatocellular Carcinoma

Takuma¹,

Shota²,

Miyatake³

et al. 2018

Intern. Med.

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“…There have been some reports comparing the efficacy of RFA with SR in small, solitary HCC, however the results proved to be contradictory (2,4,6,7,13). In the analysis of patients with HCC measuring ≥3 cm, SR was shown to be superior to RFA with respect to OS and CSS in our study regardless of PSM, whereas several studies reported that the effect of RFA on HCC ≥3 cm was comparable to that of SR. For example, the results of a study from France including 281 patients with HCC measuring ≤5 cm have shown no survival difference between the RFA and SR group (5).…”

Section: Discussioncontrasting

confidence: 63%

Comparative Effectiveness of Radiofrequency Ablation vs. Surgical Resection for Patients With Solitary Hepatocellular Carcinoma Smaller Than 5 cm

et al. 2020

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Background: This study aims to compare survival outcome after receiving radiofrequency ablation (RFA) and surgical resection (SR) for solitary hepatocellular carcinoma (HCC) with size large as 5 cm. Methods: The SEER database was queried for patients with HCC tumors who were treated with RFA or SR between 2004 and 2015. Univariate and multivariate Cox analysis was used to assess the influence of potential variables on the patients' outcome. Additionally, propensity score matching (PSM) and multiple imputations (MI) were used as sensitivity analyses. Results: Of 1,985 cases, 934 patients received RFA treatment, while the rest underwent surgical resection. The patients in the RFA group had poorer overall survival (OS) and cancer-specific survival (CSS) than those in the SR group regardless of the tumor size before matching and MI. By using PSM analysis at a 1:1 ratio, 1,302 cases were paired and we have found that SR had a positive impact on OS and CSS of patients with tumors measuring from 3.1 to 5 cm. However, when the tumor size was <3 cm, patients undergoing SR had similar survival benefit with those after RFA. The above results were confirmed after performing PSM analysis at a 1:2 and 1:3 ratio. Conclusion: By applying several effective sensitivity analyses, we demonstrated that OS and CSS were similar between the patients with tumors smaller than 3 cm receiving RFA and SR. But SR may be a superior treatment option with better long-term outcome than RFA in patients with tumor measuring 3.1-5 cm.

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“…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 .…”

Section: Methodsmentioning

confidence: 99%

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

Kutlu

Chan

Aloia

et al. 2017

Cancer

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Although RFA frequently is used as first-line treatment of HCC tumors measuring as large as 50 mm, it is associated with worse results than RXN or TXP for tumors measuring >30 mm. To the best of the authors' knowledge, the results of the current study are the first to demonstrate that although RFA is an appropriate option for patients with HCC tumors measuring ≤30 mm, its use for tumors even slightly larger than 30 mm is associated with inferior outcomes. Cancer 2017;123:1817-1827. © 2017 American Cancer Society.

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Laparoscopic ablation therapies or hepatic resection in cirrhotic patients with small hepatocellular carcinoma

Cited by 21 publications

References 41 publications

Nomograms to Predict the Disease-free Survival and Overall Survival after Radiofrequency Ablation for Hepatocellular Carcinoma

Nomograms to Predict the Disease-free Survival and Overall Survival after Radiofrequency Ablation for Hepatocellular Carcinoma

Comparative Effectiveness of Radiofrequency Ablation vs. Surgical Resection for Patients With Solitary Hepatocellular Carcinoma Smaller Than 5 cm

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

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