Prognostic impact of surgery and radiofrequency ablation on single nodular HCC ⩽5 cm: Cohort study based on serum HCC markers

Ueno, Masaki; Hayami, Shinya; Shigekawa, Yoshinobu; Kawai, Manabu; Hirono, Seiko; Okada, Ken-ichi; Tamai, Hideyuki; Shingaki, Naoki; Mori, Yoshiyuki; Ichinose, Masakazu; Yamaue, Hiroki

doi:10.1016/j.jhep.2015.07.013

Cited by 59 publications

(45 citation statements)

References 44 publications

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“…In contrast, the less-invasive percutaneous RFA is a standardized and widely used treatment method, which has equal efficacy to liver resection in terms of localized control (7). However, RFA monotherapy may increase the risk of relapse in cases where the HCC is comparatively large, when it exists near the surface of the liver or near vessels that are hard to treat due to the risk of coagulation necrosis (8). A variety of methods, including imaging support such as Real-Time Virtual Sonography (9), have been devised in the past to counteract these difficulties.…”

Section: Introductionmentioning

confidence: 99%

Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma

et al. 2017

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Abstract. Percutaneous radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) is an effective, standard therapy against small hepatocellular carcinoma (HCC). However, there is debate regarding the effectiveness of RFA combined with TACE (RFA/TACE) compared with RFA alone. These two approaches were compared for the treatment of early HCC. The present study examined 83 HCC tumors in 83 patients treated with RFA between April 2007 and August 2014 at three medical institutions. All HCCs were single hypervascular tumors, with a median diameter of 16 mm (range, 6-30 mm). The overall survival (OS) rate of all patients (n=83) was 97.5% at 1 year, 82.8% at 3 years and 48.6% at 5 years, and the local recurrence rate of all patients was 14.3% at 1 year, 32.3% at 3 years and 36.5% at 5 years. The tumor-free survival (TFS) rate of all patients was 95.1% at 1 year, 56.3% at 3 years and 23.4% at 5 years. Compared with RFA alone, RFA/TACE significantly improved OS (P<0.001), intrahepatic distant recurrence (IDR; P=0.038) and TFS (P=0.010). A univariate analysis of prognostic indicators revealed that age <70 years (P=0.008), aspartate transaminase <40 IU/l (P=0.003), alanine aminotransferase <40 IU/l (P=0.006) and platelet count >10x10 4 /µl (P=0.05) were associated with a high survival rate. Multivariate analysis identified RFA/TACE [hazard ratio (HR), 0.108; P=0.001] as an independent prognostic indicator. RFA/TACE was identified as the only independent indicator of IDR (HR: 0.467; P=0.042) and TFS (HR: 0.452; P=0.012). RFA/TACE improved OS rate, IDR and TFS compared with RFA alone. The data suggested that RFA/TACE should be considered for the treatment of single hypervascular HCC.

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Section: Introductionmentioning

confidence: 99%

Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma

et al. 2017

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“…The Wakayama group14 recently reported the utility of positive conditions of tumor markers for treatment selection of patients with HCC (Table 1). A total of 296 patients with solitary HCC of ≤5 cm and presenting Child–Pugh grade A (136 HR and 160 RFA) were analyzed.…”

Section: Selection Of Hr or Rfa For Hcc Patients By Assessment Of Thementioning

confidence: 99%

“…Three studies have reported on the expression number of positive tumor markers and histological HCC malignancy 10,12,14. We presented the data from patients with HCC who met the Milan criteria in the Kumamoto cohort12 and from patients with solitary HCC ≤5 cm in diameter in the Wakayama cohort 14.…”

Section: Number Of Positive Tumor Markers and Histological Malignancymentioning

confidence: 99%

“…We presented the data from patients with HCC who met the Milan criteria in the Kumamoto cohort12 and from patients with solitary HCC ≤5 cm in diameter in the Wakayama cohort 14. Positive data from the Kumamoto cohort is depicted in Fig.…”

Section: Number Of Positive Tumor Markers and Histological Malignancymentioning

confidence: 99%

“…Highly malignant tumors have worse postoperative outcomes; however, the curability of the two treatment modalities might be different according to the grade of tumor malignancy. It has been recently reported that the expression status of positive markers can predict histological tumor malignancy 11,12,14…”

Section: Introductionmentioning

confidence: 99%

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The Number of Positive Tumor Marker Status Is Beneficial for the Selection of Therapeutic Modalities in Patients with Hepatocellular Carcinoma

Beppu¹,

Nakagawa

Nitta

et al. 2017

Journal of Clinical and Translational Hepatology

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Hepatic resection (HR) and radiofrequency ablation (RFA) are popular local therapies for early-stage hepatocellular carcinoma (HCC). Alpha-fetoprotein, Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein, and des-c-carboxy prothrombin are well-known and useful tumor markers for HCC. The positive number status of these tumor markers has recently been demonstrated as beneficial for predicting outcome for HCC patients treated with local therapy. Although the normal ranges reported have differed by institution, the positivity of tumor markers is consistent and can easily be assessed. Kumamoto and Wakayama’s group clearly demonstrated the following: 1) Regardless of the degree of tumor stage, a triple-positive tumor marker profile can predict poor outcome in HCC patients undergoing HR; 2) For RFA alone, HCC patients with double- and triple-positive status, having less than three lesions and lesions ≤3 cm in diameter show comparably insufficient outcomes; 3) For HCC patients with lesions ≤5 cm in Child–Pugh grade A, HR is preferred over RFA; 4) Microvascular invasion rates increased even in the double-positive patients, while poorly differentiated HCC was frequently observed only in the triple-positive patients; and 5) RFA with chemoembolization, anatomical liver resection, and postoperative adjuvant chemoembolization or hepatic arterial chemotherapy might improve the outcome for patients with highly malignant HCC with multiple positive tumor markers. However, the impacts of these therapies still need to be evaluated in prospective comparative studies.

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Macrovascular invasion is not an absolute contraindication for living donor liver transplantation

et al. 2016

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The indication of liver transplantation (LT) for the treatment of advanced hepatocellular carcinoma (HCC) is expanding. However, portal vein tumor thrombus (PVTT) has been still accepted as an absolute contraindication. We experienced an unexpectedly good prognosis in selected patients. Therefore, we tried to identify the prognostic factors after LT for HCC with major PVTT. Among 282 patients who underwent living donor liver transplantation (LDLT) for HCC from January 2009 to December 2013, 11 (3.9%) patients with major PVTT that was preoperatively diagnosed were investigated. The 1-, 3-, and 5-year recurrence-free survival rates were 63.6%, 45.5%, and 45.5%, respectively, and all recurrent cases showed intrahepatic and extrahepatic recurrence. The 1-, 3-, and 5-year overall survival rates were 72.7%, 63.6%, and 63.6%, respectively, and 2 patients with delayed recurrence survived approximately 5 years after LT. Main portal vein (PV) invasion (P < 0.01), high alpha-fetoprotein 3 protein induced by vitamin K absence/antagonist-II (AP) score (20,000; P < 0.01), high standardized uptake value (SUV) ratio (tumor/background liver) in positron emission tomography (2.1; P < 0.01), and a large original tumor (7 cm; P 5 0.03) were significant risk factors for recurrence. In conclusion, if the PVTT has not expanded to the main PV and the AP score is not high, we can consider LDLT as a curative treatment option.

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Prognostic impact of surgery and radiofrequency ablation on single nodular HCC ⩽5 cm: Cohort study based on serum HCC markers

Cited by 59 publications

References 44 publications

Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma

Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma

The Number of Positive Tumor Marker Status Is Beneficial for the Selection of Therapeutic Modalities in Patients with Hepatocellular Carcinoma

Macrovascular invasion is not an absolute contraindication for living donor liver transplantation

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