Radiofrequency Ablation Versus Resection for Liver Tumours: An Evidence-Based Approach to Retrospective Comparative Studies

Abstract

Multiple factors determine outcomes following treatment of liver tumours. Small or solitary lesions seem the most appropriate ones to study as this reduces the number of confounding variables, but even in these cases HR confers a better OS and DFS than RFA for both CRM and HCC. If our data are confirmed it will be important to examine other factors influencing the response.

Elevated neutrophil to lymphocyte ratio might predict poor prognosis for colorectal liver metastasis after percutaneous radiofrequency ablation

“…Some clinico-pathological features, such as patient age, primary tumour stage, DFI, CEA level, tumour size, tumour number and tumour location, have been recognised as adverse prognostic factors for patients with CRLM after RFA [2,3]. In the current study, besides the clinico-pathologic factors including primary tumour stage, DFI and extrahepatic metastasis, Figure 2.…”

“…However, only 15-20% of patients with CRLM are eligible for hepatic resection [1,2]. Radiofrequency ablation (RFA) has been considered to be one of the most effective alternative treatments for those patients without surgical prospects, with a 5-year survival rate of 14-55%, which is comparable to that after hepatic resection [2][3][4][5]. However, both intra-and extra-hepatic tumour recurrence rates remain as high as 60-68% [2,3].…”

“…Besides recognised adverse prognostic factors such as patient age, primary tumour stage, disease-free interval (DFI), carcinoembryonic antigen (CEA) level, tumour size, and tumour number [2,3], there is increasing evidence that the presence of systemic inflammation correlates with poorer cancer-specific survival in certain cancers [6].…”

Multimodal management of colorectal liver metastases and the effect on regeneration and outcome after liver resection

“…Overall, liver resection has been reported to be superior to RFA in terms of 3-and 5-year overall survival rates, as well as 5-year disease-free survival, even for small (less than 4 cm) or solitary lesions [37,38]. In addition, liver resection seems to be more effective than RFA in terms of quality-adjusted life years (QALY) [39].…”

Curable Metastatic Colorectal Cancer

“…Mortality estimates are from 0% to 2% and major complications from 6% to 9% [20]. However, hepatic resection has consistently shown a survival and local recurrence advantage over RFA in most of these studies [20,21]. Due to possible confounding issues of patient selection and technical limitations and variability of RFA, it is difficult to ascertain the cause for these differences and makes interpretation somewhat difficult when lacking a randomized controlled trial [22].…”