Transarterial chemoembolization <i>versus</i> surgery/radiofrequency ablation for recurrent hepatocellular carcinoma with or without microvascular invasion

Jin, Young–Joo; Lee, Jin Woo; Lee, Oh Hyun; Chung, Hyun Jung; Kim, Young Soo; Lee, Jung Il; Cho, Soon Gu; Jeon, Yong Sun; Lee, Kun Young; Ahn, Seung-Ik; Shin, Woo Young

doi:10.1111/jgh.12507

Cited by 45 publications

(29 citation statements)

References 29 publications

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“…They revealed that TACE provided significantly better overall survival among early (≤12 months) recurrent MVI-positive patients than surgery/RFA after curative resection for HCC (52). However, they suggested that a large-scale study is needed to confirm the results of their study.…”

Section: Locoregional Treatmentmentioning

confidence: 70%

Microvascular invasion in hepatocellular carcinoma

Ünal

İdilman

Akata³

et al. 2016

Diagn Interv Radiol

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H epatocellular carcinoma (HCC) is responsible for high incidence of cancer-related mortality worldwide (1, 2). Diagnosis of HCC is a well-known topic, and now it can be made solely by imaging findings in cirrhosis (3,4). Advances in imaging procedures and intense follow-up of high-risk patients led to increased early detection of HCC and better treatment options (5, 6). However, even in good surgical candidates, long-term survival rates remain unsatisfactory because of high recurrence (7,8). Presence of microvascular invasion (MVI) has been reported to be one of the most important risk factors related to postsurgery tumor recurrence (9-11). Presence of MVI alters the surgical procedure. MVI is a prognostic factor associated with lower survival and higher recurrence rates. Prediction of MVI may also affect locoregional treatments along with chemotherapy protocols. This review will focus on all aspects of MVI. The effect of microvascular invasion on survivalEarly tumor recurrence is linked to increased mortality rate. Lim et al. (9) reported that MVI is a more prominent tumor recurrence predictor than the Milan criteria for HCC after surgical resection. The patients who fulfill the Milan criteria should have a solitary tumor not exceeding 5 cm or three or fewer tumors with the largest not exceeding 3 cm, and no evidence of macrovascular invasion or extrahepatic metastasis (5, 9). Lim et al. (9) concluded that patients (without MVI) exceeding the Milan criteria could achieve comparable overall survival rates after surgical resection, relative to patients within the Milan criteria. However, overall survival decreased significantly with MVI, independently of the Milan criteria.In a different study, authors grouped the patients into mild (one to five invaded vessels) and severe (more than five invaded vessels) MVI groups (5). They found that the three-year recurrence-free survival rates for patients with and without MVI were 27.7% and 62.5%, respectively. They also reported that recurrence-free survival rates at two years for patients without MVI, with mild MVI, and severe MVI were 75.9%, 47.2%, and 32.7%, respectively (5). Goh et al. (12) studied patients who had surgical resection of multifocal HCC and revealed that the presence of MVI and the number of nodules (which is also a result of MVI) were more important prognostic factors than tumor size (12). They also suggested that the current American Joint Committee for Cancer TNM staging system, which uses tumor size, but not MVI, as prognostic criteria for multifocal HCC, needs to be revised (12). The indicators of microvascular invasionDespite its significance in HCC assessment, MVI can rarely be diagnosed preoperatively. However, the presence of MVI may be predicted by key radiologic findings and specific lab- We reviewed the literature and aimed to draw attention to clinicopathologic and imaging findings that may predict the presence of microvascular invasion in hepatocellular carcinoma. Imaging findings suggesting microvascular invasion are disruption of capsule...

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Section: Locoregional Treatmentmentioning

confidence: 70%

Microvascular invasion in hepatocellular carcinoma

Ünal

İdilman

Akata³

et al. 2016

Diagn Interv Radiol

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“…26 These findings are somewhat contradicted by a recently published study that found TACE superior to resection and RFA for recurrent HCC after resection in patients who were found to have microvascular invasion at the primary resection. 27 However, close inspection of this manuscript reveals that the resection/RFA group had a nearly 30% perioperative mortality for the entire cohort and a nearly 50% perioperative mortality for the group with microvascular invasion that was found to be inferior to TACE. These findings highlight the fact that surgical treatments for HCC offer benefit over other modalities only if they can be performed with minimal risk of procedure-related mortality.…”

Section: Discussionmentioning

confidence: 96%

Recurrence of Hepatocellular Cancer After Resection

et al. 2015

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“…TACE is reported to be more effective than surgery or RFA in patients with early recurrence and MVI after curative resection, staged as BCLC 0 or A (35). Despite its retrospective setting, lack of randomization and small sample size, this article contributed to the discussion on which treatment should be preferred for recurrent HCCs as a bridge to salvage transplantation.…”

Section: Discussionmentioning

confidence: 98%

“…In 2014, Jin and colleagues in their retrospective study reported the outcomes of 68 patients who underwent either TACE or surgery/RFA for recurrent HCC after an initial surgical approach (35). Cumulative overall survival rates at 1, 3, and 5 years after re-treatment were 65.1%, 27.9% and 18.6%, respectively, in the surgery/RFA group, and 91.2%, 66.1% and 30.0%, respectively, in the TACE group (p=0.23).…”

Section: Ablative Therapies: Radiofrequency Ablation (Rfa) -Percutanementioning

confidence: 99%