Long-term outcomes of ablation, liver resection, and liver transplant as first-line treatment for solitary HCC of 3 cm or less using an intention-to-treat analysis: A retrospective cohort study

Ivanics, Tommy; Rajendran, Luckshi; Abreu, Phillipe; Claasen, Marco; Shwaartz, Chaya; Patel, Madhukar S.; Choi, W.J.; Doyle, Adam; Muaddi, Hala; McGilvray, Ian D.; Selzner, Markus; Beecroft, R.; Kachura, John R.; Bhat, Mamatha; Selzner, Nazia; Ghanekar, Anand; Cattral, Mark S.; Sayed, Blayne A.; Reichman, Trevor; Lilly, Leslie

doi:10.1016/j.amsu.2022.103645

Cited by 6 publications

(7 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Radiofrequency ablation and liver resection are crucial clinical therapies for hepatocellular carcinoma. However, there remains considerable controversy regarding which of these methods offers better prospects for prolonging patient life [23,24]. This study encompasses a total of 11 documents with a high level of evidence and low selection bias, representing medium to highquality literature.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Radiofrequency Ablation versus Liver Resection in the Treatment of Early-stage Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

Xu,

Hu,

Huang

2024

Ann Ital Chir

View full text Add to dashboard Cite

Objective: To systematically evaluate the efficacy and safety of radiofrequency ablation and liver resection in the therapeutic management of early-stage hepatocellular carcinoma. Method: We conducted a comprehensive search of domestic and foreign databases including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang to retrieve literature on radiofrequency ablation and liver resection for the treatment of early hepatocellular carcinoma. The retrieved literature underwent thorough screening, and relevant data were extracted. Following the evaluation of the literature's quality, Meta-analysis was performed using RevMan 5.4 software. Results: In this study, a total of 11 documents were selected, comprising 1334 patients with hepatocellular carcinoma. Meta-analysis results indicated that there was no statistically significant difference in the 1-year overall survival rate [Relative risk (RR) = 1.01, 95% confidence intervals (CI) (0.98; 1.04)] and the 3-year overall survival rate [RR = 0.95, 95% CI (0.90; 1.01)] between the radiofrequency ablation and liver resection groups (p > 0.05). Similarly, there was no statistically significant difference in the 1-year disease-free survival rate [RR = 0.94, 95% CI (0.87; 1.01)] between the two groups. However, the 3-year disease-free survival rate [RR = 0.84, 95% CI (0.74; 0.96)] of patients in the radiofrequency ablation group was significantly lower than that in the hepatectomy group (p < 0.05). Notably, the incidence of complications [RR = 0.42, 95% CI (0.33; 0.55)] was significantly lower in the radiofrequency ablation group compared to the hepatectomy group. Conversely, the local recurrence rate [RR = 1.45, 95% CI (1.22; 1.73)] was significantly higher in the radiofrequency ablation group compared to the hepatectomy group (p < 0.05). Conclusion: During the treatment of hepatocellular carcinoma, hepatectomy demonstrates superior clinical efficacy compared to radiofrequency ablation, particularly in its ability to control tumor recurrence. However, radiofrequency ablation presents with fewer complications and a higher level of safety. These findings can serve as a valuable foundation for clinicians when selecting the most suitable treatment approaches for liver cancer.

show abstract

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Radiofrequency Ablation versus Liver Resection in the Treatment of Early-stage Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

Xu,

Hu,

Huang

2024

Ann Ital Chir

View full text Add to dashboard Cite

show abstract

“…With a median follow-up of 8.4 years (IQR 3.7–12.9), the OS plateaued at 71.6% and the DFS was 75.0% at 10-year follow-up among patients with HCC <3 cm after LT in a study by Ivanics et al. 37 Multiple studies have shown lower mortality and recurrence risks of patients undergoing transplant compared to resection at 5 years with comparable complication risks. 38 , 39 However, small retrospective cohort studies have suggested similar outcomes, based on national averages, for patients who undergo LT and patients with early-stage HCC and Child-Pugh A cirrhosis who were denied LT for non-tumour reasons.…”

Section: Liver Transplantationmentioning

confidence: 99%

Optimal treatment for small HCC (<3 cm): Resection, liver transplantation, or locoregional therapy?

Wu¹,

Lokken²,

Mehta³

2023

JHEP Reports

View full text Add to dashboard Cite

“…For transplantable patients, the initial approach of liver resection for HCC, followed by salvage transplantation in cases of intrahepatic tumour recurrence, has demonstrated favourable long-term survival and conserves liver grafts. [15][16][17][18][19][20] Previously, we reported preliminary data suggesting the feasibility of a similar approach for patients treated with percutaneous RFA. 21 However, our study included a small patient cohort and a short follow-up period, and primarily employed monopolar RFA, which inherently had limitations in treating larger HCC 21 .…”

Section: Introductionmentioning

confidence: 99%

“…A key limitation is the shortage of available organs, necessitating an adapted management strategy for HCC to maximise the long‐term benefits of transplantation. For transplantable patients, the initial approach of liver resection for HCC, followed by salvage transplantation in cases of intrahepatic tumour recurrence, has demonstrated favourable long‐term survival and conserves liver grafts 15–20 …”

Section: Introductionmentioning

confidence: 99%

Upfront multi‐bipolar radiofrequency ablation for HCC in transplant‐eligible cirrhotic patients with salvage transplantation in case of recurrence

Boros,

Sutter,

Cauchy

et al. 2024

Liver International

View full text Add to dashboard Cite

IntroductionWe aim to assess the long‐term outcomes of percutaneous multi‐bipolar radiofrequency (mbpRFA) as the first treatment for hepatocellular carcinoma (HCC) in transplant‐eligible cirrhotic patients, followed by salvage transplantation for intrahepatic distant tumour recurrence or liver failure.Materials and MethodsWe included transplant‐eligible patients with cirrhosis and a first diagnosis of HCC within Milan criteria treated by upfront mbp RFA. Transplantability was defined by age <70 years, social support, absence of significant comorbidities, no active alcohol use and no recent extrahepatic cancer. Baseline variables were correlated with outcomes using the Kaplan‐Meier and Cox models.ResultsAmong 435 patients with HCC, 172 were considered as transplantable with HCCs >2 cm (53%), uninodular (87%) and AFP >100 ng/mL (13%). Median overall survival was 87 months, with 75% of patients alive at 3 years, 61% at 5 years and 43% at 10 years. Age (p = .003) and MELD>10 (p = .01) were associated with the risk of death. Recurrence occurred in 118 patients within Milan criteria in 81% of cases. Local recurrence was observed in 24.5% of cases at 10 years and distant recurrence rates were observed in 69% at 10 years. After local recurrence, 69% of patients were still alive at 10 years. At the first tumour recurrence, 75 patients (65%) were considered transplantable. Forty‐one patients underwent transplantation, mainly for distant intrahepatic tumour recurrence. The overall 5‐year survival post‐transplantation was 72%, with a tumour recurrence of 2.4%.ConclusionUpfront multi‐bipolar RFA for a first diagnosis of early HCC on cirrhosis coupled with salvage liver transplantation had a favourable intention‐to‐treat long‐term prognosis, allowing for spare grafts.

show abstract

Long-term outcomes of ablation, liver resection, and liver transplant as first-line treatment for solitary HCC of 3 cm or less using an intention-to-treat analysis: A retrospective cohort study

Cited by 6 publications

References 39 publications

Effectiveness and Safety of Radiofrequency Ablation versus Liver Resection in the Treatment of Early-stage Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

Effectiveness and Safety of Radiofrequency Ablation versus Liver Resection in the Treatment of Early-stage Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

Optimal treatment for small HCC (<3 cm): Resection, liver transplantation, or locoregional therapy?

Upfront multi‐bipolar radiofrequency ablation for HCC in transplant‐eligible cirrhotic patients with salvage transplantation in case of recurrence

Contact Info

Product

Resources

About