Survival Rates Are Comparable After Radiofrequency Ablation or Surgery in Patients With Small Hepatocellular Carcinomas

Hung, Hung–Hsu; Chiou, Yi–You; Hsia, Cheng Yuan; Su, Chien–Wei; Chou, Yi–Hong; Chiang, Jen–Huey; Kao, Wei Yu; Huo, Teh–Ia; Huang, Yi Hsiang; Su, Yiwei; H, Lin; Lee, Shou–Dong; Wu, Jaw–Ching

doi:10.1016/j.cgh.2010.08.018

Cited by 149 publications

(126 citation statements)

References 35 publications

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“…This was consistent with the results from previous studies in which patient factors (such as age and performance status) [24, 25], tumor factors (size and number of tumors, vascular invasion, serum AFP level) [26, 27], field factors in the background liver (grade of hepatic inflammation, degree of steatosis, stage of fibrosis, portal hypertension, viral replication) [28-33], and treatment modalities determined the outcomes of HCC patients [9, 34, 35]. …”

Section: Discussionmentioning

confidence: 99%

The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade

Fang

Kao

et al. 2018

Liver Cancer

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Background/Aims: Whether single large hepatocellular carcinoma (SLHCC) is classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B is still controversial. We aimed to compare the clinical manifestations, treatment modalities, and prognoses among patients with SLHCC and those in BCLC stage A and B. Methods: We enrolled 2,285 treatment-naive hepatocellular carcinoma (HCC) patients with BCLC stage A or B from October 2007 to December 2015. Factors in terms of prognoses were analyzed by multivariate analysis. Results: We enrolled 1,210, 466, and 609 patients in a BCLC-A, SLHCC, and BCLC-B group, respectively. After a median follow-up duration of 21.2 months, 898 patients had died. The cumulative 5-year survival rates were 57.0, 42.6, and 27.3% for patients in the BCLC-A, SLHCC, and BCLC-B groups, respectively, which were significantly different (p < 0.001). Multivariate analysis indicated that the following independent risk factors were associated with poor prognosis: age > 65 years, alkaline phosphatase > 100 U/L, creatinine > 1.0 mg/dL, alpha-fetoprotein > 20 mg/mL, noncurative treatment, albumin-bilirubin (ALBI) grade, and HCC staging. Subgroup analysis also confirmed that patients in the SLHCC group had a survival rate intermediate to those in the BCLC-A and BCLC-B groups. However, for patients in the SLHCC group and with ALBI grade 1, outcomes were close to those in the BCLC-A group, especially in the setting of curative treatment. For those with ALBI grades 2 or 3, the prognoses were similar to those of the SLHCC and BCLC-B groups. Conclusion: Patients in the SLHCC group had an overall survival rate intermediate to those of the BCLC-A and BCLC-B groups. It is suggested that the SLHCC group could be classified as occupying a different stage from the BCLC stages A and B. The ALBI grade could help to stratify SLHCC into a different prognostic group. However, the results need to be validated externally in other regions of the world.

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Section: Discussionmentioning

confidence: 99%

The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade

Fang

Kao

et al. 2018

Liver Cancer

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“…Therefore, the 2012 EASL HCC guidelines (and some reports) advocate that RFA is also an option in patients with very early stage (BCLC-0) HCC or BCLC-A-grade resectable HCC that is not suitable for resection. Some randomized or cohort studies, including some studies from Taiwan (with or without propensity score matching), reported that RFA achieved a good 5-year survival rate for very early stage operable HCC, and provided a survival rate for very early stage or early-stage HCC that was comparable to that seen with resection [10,17,18,63,65,66] with comparable recurrence rates for very early stage HCC [17] (table 2).…”

Section: Comparison Of Rfa With Resectionmentioning

confidence: 99%

Local Ablation for Hepatocellular Carcinoma in Taiwan

Lin

2013

Liver Cancer

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Hepatocellular carcinoma (HCC) is the second commonest cancer in Taiwan. The national surveillance program can detect HCC in its early stages, and various curative modalities (including surgical resection, orthotopic liver transplantation, and local ablation) are employed for the treatment of small HCC. Local ablation therapies are currently advocated for early-stage HCC that is unresectable because of co-morbidities, the need to preserve liver function, or refusal of resection. Among the various local ablation therapies, the most commonly used modalities include percutaneous ethanol injection and radiofrequency ablation (RFA); percutaneous acetic acid injection and microwave ablation are used less often. RFA is more commonly employed than other local ablative modalities in Taiwan because the technique is highly effective, minimally invasive, and requires fewer sessions. RFA is therefore advocated in Taiwan as the first-line curative therapy for unresectable HCC or even for resectable HCC. However, current RFA procedures are less effective against tumors that are in high-risk or difficult-to-ablate locations, are poorly visualized on ultrasonography (US), or are large. Recent advancements in RFA in Taiwan can resolve these issues by the creation of artificial ascites or pleural effusion, application of real-time virtual US assistance, use of combination therapy before RFA, or use of switching RF controllers with multiple electrodes. This review article provides updates on the clinical outcomes and advances in local ablative modalities (mostly RFA) for HCC in Taiwan.

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“…On the other hand, several observational retrospective studies do make emphasis on very early HCC and outcomes after RFA and surgical resection, however, they lack randomization and may be biased by covariate distribution [90,91] . Hung et al [90] analyzed a cohort of patients with very early HCC that included 66 patients in the RFA group and 50 in the surgical resection group.…”

Section: Liver Resection Vs Radiofrequency Ablationmentioning

confidence: 99%

“…Hung et al [90] analyzed a cohort of patients with very early HCC that included 66 patients in the RFA group and 50 in the surgical resection group. There were no statistically significant differences in terms of overall survival and recurrence but both groups were heterogeneous [90] . Peng et al [92] compared retrospectively the effects of RFA and surgical resection in patients with resectable HCC < 2 cm.…”

Section: Liver Resection Vs Radiofrequency Ablationmentioning

confidence: 99%

Management of “very early” hepatocellular carcinoma on cirrhotic patients

Sevilla

Echeverri

Charco

2014

WJH

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Due to the advances in screening of cirrhotic patients, hepatocellular carcinoma (HCC) is being diagnosed in earlier stages. For this reason the number of patients diagnosed of very early HCC (single tumors ≤ 2 cm) is continuously increasing. Once a patient has been diagnosed with this condition, treatment strategies include liver resection, local therapies or liver transplantation. The decision on which therapy should the patient undergo depends on the general patients performance status and liver disease. Anyway, even in patients with similar conditions, the best treatment offer is debatable. In this review we analyze the state of the art on the management of very early HCC on cirrhotic patients to address the best treatment strategy for this patient population.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Hepatocellular carcinoma; Very early; Liver resection; Liver transplantation; Local therapiesCore tip: Very early hepatocellular carcinoma patients are deemed too early for liver transplantation candidacy, known as the best treatment regarding long-term survival and tumor recurrence. Strategies as surgical resection and radiofrequency ablation have gained popularity. Although resection is considered as the first line of treatment, recent studies claim equal results with ablation techniques. Ablation used as a test of time in patients who remain candidates for liver transplantation is attractive. In this review we will analyze in detail the novel strategy repertoire used in the management of these patients.Sapisochin G, Fernandez de Sevilla E, Echeverri J, Charco R. Management of "very early" hepatocellular carcinoma on cirrhotic patients.

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Survival Rates Are Comparable After Radiofrequency Ablation or Surgery in Patients With Small Hepatocellular Carcinomas

Cited by 149 publications

References 35 publications

The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade

The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade

Local Ablation for Hepatocellular Carcinoma in Taiwan

Management of “very early” hepatocellular carcinoma on cirrhotic patients

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