Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma

Tiong, Leong Ung; Maddern, Guy J.

doi:10.1002/bjs.7669

Cited by 240 publications

(175 citation statements)

References 94 publications

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“…Both systematic reviews 37 and recent publications 38 have highlighted the fact that resection produces better results than RFA especially in small HCC. However, the advantage of RFA is the lack of post-procedure adhesions which may result from surgery which provides greater technical ease in explantation during salvage transplantation.…”

Section: Resection Versus Ablationmentioning

confidence: 99%

Resection for Hepatocellular Carcinoma

Ramesh

2014

Journal of Clinical and Experimental Hepatology

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Hepatocellular Carcinoma (HCC) continues to present major challenges in management, which is further complicated by the presence of associated chronic liver disease. Key issues in surgical resection of HCC include the site, size, and number of lesions, the severity of the chronic liver disease, and the size of the functional liver remnant. De novo HCC in the absence of chronic liver disease can be treated by major liver resection with little risk of postoperative liver failure. Liver resection can also be used a bridge to liver transplantation as it affords the possibility of determining the pathologic grade of the tumortumor and its invasiveness, and thereby the prognosis. This review summarizes the current treatment approaches to surgical resection for HCC. ( J CLIN EXP HEPATOL 2014;4:S90-S96) R ecommendations for treatment of HCC should be based on randomized controlled trials or meta analyses, rather than by non randomized clinical trials or observational studies. However, there is a paucity of robust evidence regarding the treatment of HCC. Interventions have not been thoroughly tested against each other. Hence the strength of evidence for most interventions is less than desirable. Therefore treatment decisions must be taken by a multi-disciplinary group which comprises hepatologists, surgeons, radiologists, interventional radiologists, pathologists, nurses, palliative care physicians, patient education specialists, and pharmacists. Treatment decisions must be made in a tumortumor board meeting.In India, the problem is compounded by the fact that the country is large, and there is considerable variation in the expertise and technology available for the treatment of HCC. It is inconceivable that HCC shall be treated only in a few centers with state-of-the art services. While treatment guidelines must therefore be treated with caution, the right of every patient with HCC to standardized care has placed a huge burden on healthcare systems to deliver for these patients. Although prevention of HBV related cancer is still the priority, yet, treatment of the established HCC is also necessity.The radical treatment options are: No randomized data is available at this time comparing these three approaches. Hence existing guidelines are dependent on cure rates with these treatment approaches. HEPATOCELLULAR CARCINOMA IN THE ABSENCE OF LIVER DISEASEHCC in background of healthy liver (without cirrhosis or chronic hepatitis) may occur occasionally.1 There are two types: a) the classical sporadic variety, and b) the fibrolamellar variant. The fibrolamellar variant is characteristic in the female preponderance, absence of AFP elevation, and in the presence of lymph node involvement. These tumors present only as mass lesions and at an advanced stage. Despite this advanced stage at presentation, resection can be done as the healthy liver has a normal ability to regenerate. Survival following resection is over 50% at 5 years. 2 HEPATOCELLULAR CARCINOMA IN THE PRESENCE OF LIVER DISEASEResection for HCC has several advantages: ...

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Section: Resection Versus Ablationmentioning

confidence: 99%

Resection for Hepatocellular Carcinoma

Ramesh

2014

Journal of Clinical and Experimental Hepatology

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“…A major drawback of RFA is the high rate of tumor recurrence after the therapeutic procedure, which affects the patient survival and is the main reason why RFA is considered to be inferior to surgical resection in cases of resectable lesions [5]. In the aforementioned study from Korea, Kim et al demonstrated the 5 and 10 year cumulative local tumor recurrence rates to be 27.0 % and 36.9 % respectively, with 5 and 10 year cumulative intrahepatic distant and extrahepatic recurrence rates of 73.1 %/ 88.5 % and 19.1 %/ 38.2 % respectively [2].…”

Section: Editorialmentioning

confidence: 99%

Does Radiofrequency Ablation Stimulate a Higher Malignant Potential of Hepatocellular Carcinoma?

Kinoshita

Nishino²,

Tajiri³

2014

JGPLD

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EditorialRadiofrequency ablation (RFA) is an established treatment for BCLC 0-A hepatocellular carcinoma (HCC) associated with minimal invasiveness and a high rate of curability [1]. Recent large scale, long-term follow-up study from Korea demonstrated the 5 and 10 year overall survival rates in 1,305 patients with early HCC treated with RFA to be 59.7 % and 32.3 % respectively [2].However, to date, it remains under debate which is superior, surgical resection or RFA, with respect to the overall survival and recurrence rates in patients with early HCC [3,4]. A major drawback of RFA is the high rate of tumor recurrence after the therapeutic procedure, which affects the patient survival and is the main reason why RFA is considered to be inferior to surgical resection in cases of resectable lesions [5]. In the aforementioned study from Korea, Kim et al. demonstrated the 5 and 10 year cumulative local tumor recurrence rates to be 27.0 % and 36.9 % respectively, with 5 and 10 year cumulative intrahepatic distant and extrahepatic recurrence rates of 73.1 %/ 88.5 % and 19.1 %/ 38.2 % respectively [2].The presence of an insufficiently ablated margin, in addition to a large tumor size, is a major risk factor for tumor recurrence after RFA. Lee et al. reported that an insufficiently ablated margin is an independent factor predicting early diffuse recurrence (three or more new lesions of intrahepatic recurrence within one year after the initial RFA procedure) [6]. Some investigators have reported early and serious recurrence of HCC after RFA, leading to poor survival outcomes [7,8]. These reports suggest the phenotypic and functional alteration of HCC cells after RFA.More recently, in vol. 58 issue 5 of Hepatology, Yoshida et al. demonstrated that sublethal heat treatment of HCC cells endows these cells with a higher proliferative and carcinogenic potential in both in vitro and in vivo studies [9]. The authors exposed three human HCC cell lines (HEPG2, HuH7 and HEP3B) to 37˚C, 45˚C, 50˚C and 55˚C for 10 minutes, simulating the marginal zone of RFA treatment. They subsequently analyzed the degree of cell proliferation, parameters of the epithelial-mesenchymal transition (EMT) and the level of activation of mitogen-activated protein kinases 5-12 days after treatment. Although all HCC cells died following exposure to a temperature of 55˚C, 65-85 % of the HCC cells survived exposure to temperature of 48-50˚C, thus exhibiting distinct morphological changes, such as the appearance of spindle-like cells, and expressing the progenitor marker, CD133, the cholangiocyte markers, CK7 and CK19, and the EMT-related transcription factor, Snail, on day 5 after heat exposure. The HCC cells exposed to 50˚C showed enhanced proliferation and activation of Src homology and collagen (Shc), a central player in malignant transformation. Moreover, in order to evaluate how far heat treatment can indue more aggressive (EMT-like) tumor growth in vivo, the authors transplanted heat-exposed HEPG2 cells into nude mice. The heat-exposed HEPG2 cells impla...

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“…The algorithm of the National Comprehensive Cancer Network guideline states that RFA is categorized as locoregional therapy, and tumors ≤3 cm are optimally treated with RFA [3]. Recent developments in RFA technology have made it possible to necrotize a large volume of tissue (≥3 cm in diameter) [4,5]. RFA was reported to be relatively safe, with a mortality rate of 0.3% [6].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Repair of Diaphragmatic Perforation with Colonic Herniation Following Hepatic Radiofrequency Ablation: A Case Report

Yamamoto¹,

Sugiura²,

Okamura³

et al. 2017

J Clin Case Rep

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Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma

Abstract: RFA provides a valuable treatment option for patients with unresectable HCC. It improves survival in those previously considered to have advanced disease. As progress continues to be made, RFA is gradually being used to treat resectable HCC.

Cited by 240 publications

References 94 publications

Resection for Hepatocellular Carcinoma

Resection for Hepatocellular Carcinoma

Does Radiofrequency Ablation Stimulate a Higher Malignant Potential of Hepatocellular Carcinoma?

Laparoscopic Repair of Diaphragmatic Perforation with Colonic Herniation Following Hepatic Radiofrequency Ablation: A Case Report

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