Prognostic Significance of Treatment Strategies for the Recurrent Hepatocellular Carcinomas After Radical Resection

Abstract

Background/Aim: The high rate of recurrence and repetitive features of hepatocellular carcinoma (HCC) require specific treatment strategies. This study aimed to evaluate the long-term outcomes of recurrent HCC focusing on clinicopathological factors. Patients and Methods: A total of 104 patients who were treated with re-hepatectomy, radiofrequency ablation (RFA) or transcatheter arterial chemoembolization for recurrent HCC were analyzed. Postrecurrent prognoses were compared between each treatment group based on the presence of adverse prognostic factors (APFs) identified. Results: In the hepatectomy group, the prognosis of patients with APFs was significantly worse compared to those without APFs. By contrast, the survival rate of patients who underwent RFA was not significantly different from those with and without APFs. Conclusion: Our results demonstrate the heterogeneity that exists in terms of the longterm survival of patients with recurrent HCC. The treatment strategy for recurrent HCC should be based on the assessment of presence of APFs to improve long-term prognosis.

Liver resection versus radiofrequency ablation for recurrent hepatocellular carcinoma: a systematic review and meta-analysis

“…The study selection process is shown in Figure 1. Ultimately, 18 studies (1 RCT, 3 propensity score matching-non RCTs [PSM-NRCTs], 14 NRCTs) compared LR with RFA for RHCC were included in our meta-analysis [10][11][12][13][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. The included studies evaluated a total of 1991 patients with recurrence of HCC; of these, 862 patients underwent LR, and 1129 patients underwent RFA.…”

“…The pooled OS was compared based on 16 studies which incorporated 1902 patients (817 patients for LR, 1085 patients for RFA) [10][11][12][13][24][25][26][27][28][30][31][32][33][34][35][36]. The pooled HR for OS demonstrated that LR had significantly better OS than RFA in recurrent HCC (HR, 0.81; 95% CI, 0.68-0.95; p < .001; I 2 ¼ 0.0%) (Figure 2(A)).…”

“…Data on DFS were available in 10 studies which incorporated 1075 patients (435 patients for LR, 640 patients for RFA) [11,12,24,26,30,[32][33][34][35][36]. The pooled HR showed no significant difference in DFS between the LR and RFA during the whole follow-up period (HR, 0.90; 95% CI, 0.76-1.07, p ¼ .217, I 2 ¼ 0.0%) (Figure 4(A)).…”

“…Sensitivity analysis was performed for all outcomes by excluding studies with sample size <20 in any treatment group [31,35], studies including extrahepatic recurrence [10,26], studies that included other radical procedures for primary HCC than surgical resection [11,26], and studies with inadequate methodological quality [28,35]. All results did not change significantly.…”

Meta-Analysis of Repeat Hepatectomy versus Radiofrequency Ablation for Recurrence of Hepatocellular Carcinoma

“…Seventeen total studies, incorporating 2597 total patients (1203 in the RHR group versus 1394 in the RFA group), were deemed eligible for inclusion in the final data analysis ( Figure 1 ) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. The majority of studies originated from East Asia (nine studies from China, three from Japan, one from Singapore, two from Taiwan and one from Korea), while one study was an international multicenter study.…”