Radiofrequency Ablation <i>vs</i>. Cryoablation for Localized Hepatocellular Carcinoma: A Propensity-matched Population Study

Xu, J.; Noda, Christopher; Erickson, Abigail; Mokkarala, Mahati; Charalel, Resmi A.; Ramaswamy, R.; Tao, Yu; Akinwande, Olaguoke

doi:10.21873/anticanres.12997

Cited by 25 publications

(22 citation statements)

References 15 publications

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“…Among the Surgery groups, Liver Transplantation was the best treatment on the condition that there were enough liver donors. Local Destruction, such as via RFA (radio-frequency ablation) or PEI (percutaneous ethanol injection), was implicated as having a worse survival rate than other surgeries, which was also reported previously (4,15,16). However, unexpectedly, the Larger Resection sub-group (extended liver resection, e.g., hemihepatectomy or lobectomy) was not associated with better survival than Segmental Resection (including wedge resection, usually less than a hemihepatectomy or lobectomy).…”

Section: Discussionsupporting

confidence: 66%

Do Elderly Patients With Stage I–II Hepatocellular Carcinoma Benefit From More Radical Surgeries? A Population-Based Analysis

Zhang

Albahde

et al. 2020

Front. Oncol.

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Background and Aims: The best treatment modalities for elderly patients with stage I-II HCC (hepatocellular carcinoma) remain controversial in an era of a shortage of liver donors.Methods: From the SEER database (Surveillance, Epidemiology, and End Results program), 2,371 elderly patients were sampled as Cohort 1. OS (Overall Survival) and CSS (Cancer-Specific Survival) were compared between the Non-surgery and Surgery groups. A stratification analysis in a CSS Cox model was also conducted among sub-groups, and propensity score matching was performed to generate Cohort 2 (746 pairs), reducing the influences of confounders.Results: For Cohort 1, the median follow-up times of the Non-surgery and Surgery groups were 11 months (95% CI, confidence interval: 9.74-12.26) vs. 49 months (44.80-53.21) in OS, and 14 months (12.33-15.67) vs. 74 months (64.74-83.26) in CSS, respectively. In the stratification analysis, for the elderly patients (age >= 70 years), Larger Resection was associated with a higher HR (hazard ratio) than Segmental Resection: 0.30 (95% CI, confidence interval: 0.22-0.41) vs. 0.29 (0.21-0.38) in 70-74 year-olds; 0.26 (0.18-0.38) vs. 0.23 (0.16-0.32) in 75-79 year-olds; 0.32 (0.21-0.49) vs. 0.21 (0.13-0.32) in those 80+ years old. For Cohort 2, a similar result could be seen in the CSS Cox forest plot. The HRs of Larger Resection and Segmental Resection were 0.27 (0.21-0.33) and 0.25 (0.20-0.31), respectively.Conclusions: It is cautiously recommended that, when liver transplantation is not available, segmental or wedge liver resection is the better treatment choice for elderly patients with stage I-II HCC (AJCC edition 6), especially those over 70 years old, compared with other surgeries, based on the SEER data.

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Section: Discussionsupporting

confidence: 66%

Do Elderly Patients With Stage I–II Hepatocellular Carcinoma Benefit From More Radical Surgeries? A Population-Based Analysis

Zhang

Albahde

et al. 2020

Front. Oncol.

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“…Guanghua Rong et al have documented that in HCC patients who experienced percutaneous CRA, the occurrence of main obstacles and tumor seeding was as little as 6.3% and 0.78%, respectively 12. Compared to surgical resection or RFA, CRA also revealed equivalently decent results and an even greater local tumor control during the treatment of early-stage HCC 13,14. However, to date, no studies have compared MWA and CRA therapies for HCC, especially of those in high-risk locations.…”

Section: Introductionmentioning

confidence: 99%

<p>Image-Guided Percutaneous ‎Microwave Ablation Versus Cryoablation For Hepatocellular Carcinoma In High-Risk Locations: Intermediate-Term Results</p>

Hu¹,

Chen

Wang³

et al. 2019

CMAR

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ObjectiveThe aims of this study were to compare the clinical outcomes between image-guided percutaneous microwave ablation (MWA) and cryoablation (CRA) in patients with hepatocellular carcinoma (HCC) in high-risk locations and to identify the prognostic factors associated with the two treatment methods.MethodsThis retrospective study was institutional review board approved. A total of 120 patients (88 men and 32 women) with one hundred and thirty-four HCC lesions in high-risk locations from April 2014 to March 2018 were reviewed. Sixty-four patients underwent MWA and 56 patients underwent CRA. Survival, recurrence and complications were compared between the two groups. Effect of changes in key outcomes (i.e., overall survival (OS), recurrence-free survival (RFS) and local tumor progression (LTP)) was statistically analyzed with the log rank test. Univariate and multivariate analysis were performed on clinicopathological variables to identify factors affecting intermediate-term outcomes.ResultsThe OS and RFS after MWA were comparable to those of CRA (P =0.141, and P=0.469, respectively). The LTP and major complication in MWA group was higher than those in CRA group (P=0.003, and P=0.039). Univariate analysis showed that age (P=0.007), tumor size (P=0.001), and Child-Turcotte-Pugh (CTP) grade (P=0.003) were risk factors for OS, and multivariate analysis results showed that older age (≥65 years) (P=0.002, HR:3.338, 95% CI:1.928–5.281), 3.0–5.0 cm in size (P<0.001, HR: 3.312, 95% CI: 1.872–4.489) and CTP grade B (P=0.001, HR:3.382, 95% CI: 1.882–5.902) were independently associated with poor OS.ConclusionCRA had comparable oncologic outcomes with MWA and could be a safe and effective treatment for HCC in high-risk locations.

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“…In a high‐quality study comparing the efficacies of cryoablation and RFA in the treatment of HCC patients with cirrhosis, tumor diameters of ≤4 cm and no more than two tumors, the rates of local tumor progression at 1, 2, and 3 years were higher in the cryoablation group than the RFA group ( p = 0.041); however, there were no significant differences in the overall survival rates at 1, 3, or 5 years between the two groups ( p = 0.747) 22 . Although, previous studies have shown that patients with unresectable liver cancer, local HCC, tumors larger than 2 cm and one or two tumors of no more than 4 cm who received cryoablation had similar survival benefits compared with those who received RFA 22–25 . The EASL guidelines classify patients with HCC more finely and recommends different treatments for different HCC patients.…”

Section: Discussionmentioning

confidence: 94%

The efficacy of radiofrequency ablation versus cryoablation in the treatment of single hepatocellular carcinoma: A population‐based study

et al. 2021

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Background Radiofrequency ablation (RFA) is an effective treatment for single hepatocellular carcinoma (HCC), but it is difficult to use against tumors in some locations and often leads to incomplete ablation as a result of the heat‐sink effect. This study was conducted to evaluate the efficacy of cryoablation compared with that of RFA in the treatment of single HCC. Methods This retrospective study was conducted based on the Surveillance, Epidemiology, and End Results (SEER) database. From 2004 to 2015, patients aged 40 to 79 diagnosed with HCC were included in the study. A propensity score matching (PSM) model was used to reduce selection biases. Results Before PSM, the median overall survival (mOS) and median cancer‐specific survival (mCSS) in the RFA group were slightly longer than those in the cryoablation group (p > 0.05). In the subgroup analysis, the mOS and mCSS of patients with tumor sizes <3, 3–5, and >5 cm who received RFA treatment were longer than those of patients given cryoablation treatment, but there was no significant difference (p > 0.05). Similar results were presented in patients at American Joint Committee on Cancer (AJCC) stages I and II. After PSM, the mOS and mCSS were slightly better in the RFA group than the cryoablation group but without significant differences. Univariate and multivariate analysis showed that cryoablation treatment was not an unfavorable factor for OS and CSS before or after PSM (p > 0.05). In the multivariable competing risk model, non‐cancer‐specific death was taken as a competing factor and cryoablation was also not unfavorable for the survival of patients before and after PSM (p > 0.05). Conclusion Cryoablation is non‐inferior to RFA therapy for single HCC patients without lymph node invasion or distant metastasis.

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Radiofrequency Ablation vs. Cryoablation for Localized Hepatocellular Carcinoma: A Propensity-matched Population Study

Cited by 25 publications

References 15 publications

Do Elderly Patients With Stage I–II Hepatocellular Carcinoma Benefit From More Radical Surgeries? A Population-Based Analysis

Do Elderly Patients With Stage I–II Hepatocellular Carcinoma Benefit From More Radical Surgeries? A Population-Based Analysis

<p>Image-Guided Percutaneous ‎Microwave Ablation Versus Cryoablation For Hepatocellular Carcinoma In High-Risk Locations: Intermediate-Term Results</p>

The efficacy of radiofrequency ablation versus cryoablation in the treatment of single hepatocellular carcinoma: A population‐based study

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