Advertisement

Safety and Efficacy of Radiofrequency Ablation for Solitary Hepatocellular Carcinoma (3–5 cm): a Propensity Score Matching Cohort Study

  • Qing-wang Ye
  • Shu-jie Pang
  • Ning Yang
  • Hai-bin Zhang
  • Yong Fu
  • Bin LinEmail author
  • Guang-shun YangEmail author
Article
  • 26 Downloads

Abstract

Background

We aim to investigate the safety and efficacy of radiofrequency ablation in the treatment of solitary hepatocellular carcinoma (3–5 cm) in comparison with surgical resection.

Methods

Included in this study were 388 patients with primary and solitary hepatocellular carcinoma, of whom 196 patients underwent surgical resection and the other 192 patients received radiofrequency ablation. Clinicopathological characteristics, prognosis, post-treatment complications, hospital stay, and financial expenditures between the two groups were compared retrospectively.

Results

The result of propensity score matching and subgroup analysis showed that the 1-, 3-, and 5-year overall survival and disease-free survival were comparable in patients with tumors of 3–4 cm in diameter between surgical resection and radiofrequency ablation groups. However, when the tumor size exceeded 4 cm in diameter, surgical resection exhibited a superior long-term prognosis compared with radiofrequency ablation. Nevertheless, hepatectomy was associated with high occurrences of postoperative complications, long hospital stay, and high hospitalization cost as compared with radiofrequency ablation. Further analysis of the relationship between tumor size and pathological features of hepatocellular carcinoma showed that tumors larger than 4 cm were positively correlated with a high rate of microvascular invasion and satellite nodule formation.

Conclusion

For solitary hepatocellular carcinoma of 3–4 cm in diameter, radiofrequency ablation could achieve a comparable prognosis with a low incidence of post-treatment complications and low hospitalization costs, while surgical resection is recommended for solitary hepatocellular carcinoma tumors of 4–5 cm in diameter when long-term prognosis is considered.

Keywords

Hepatocellular carcinoma Radiofrequency ablation Prognosis Hepatectomy 

Notes

Acknowledgements

Thanks for Dr. Xu Lin’s help (an intervention radiologist) in the description of RFA.

Contributions

Guang-shun Yang, Qing-wang Ye, and Shu-jie Pang designed the project. Qing-wang Ye and Shu-jie Pang wrote the manuscript with Guang-shun Yang. Guang-shun Yang and Lin Bin provided revisions of the manuscript; Yang Ning, Hai-bin Zhang, Fu Yong, and Guang-shunYang collected and assembled the data; Qing-wang Ye, Shu-jie Pang, Lin Bin, and Guang-shun Yang analyzed the data and interpreted results; and all authors have given their final approval for the manuscript.

Financial Support

This study was supported by the General Program of Shanghai Municipal Commission of Health and Family Planning (No. 201440445) and the National Nature Science Foundation of China (No. 81372355).

Compliance with Ethical Standards

Ethics Approval and Consent to Participate

This study complied with the ethical guidelines of the Declaration of Helsinki and was approved by our Ethics Committee of the hospital. Informed consent was obtained from all patients before treatment for their data to be used in this study.

Conflict of Interest

The authors declare that there are no competing interests.

Supplementary material

11605_2019_4229_Fig4_ESM.png (256 kb)
ESM 1

Flow-diagram for screening of patients enrolled in this study (PNG 255 kb)

11605_2019_4229_MOESM1_ESM.tif (2.6 mb)
High resolution image (TIF 2625 kb)
11605_2019_4229_MOESM2_ESM.docx (22 kb)
ESM 2 (DOCX 22 kb)

References

  1. 1.
    Torre LA, Bray F, Siegel RL, et al. Global Cancer Statistics, 2012. CA-Cancer J Clin. 2015;65(2):87–108.CrossRefGoogle Scholar
  2. 2.
    Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018;391(10127):1301–14.CrossRefGoogle Scholar
  3. 3.
    Bruix J, Gores GJ, Mazzaferro V. Hepatocellular carcinoma: clinical frontiers and perspectives. Gut. 2014;63(5):844–55.CrossRefGoogle Scholar
  4. 4.
    Tanaka M, Katayama F, Kato H, et al. Hepatitis B and C Virus Infection and Hepatocellular Carcinoma in China: A Review of Epidemiology and Control Measures. J Epidemiol. 2011;21(6):401–16.CrossRefGoogle Scholar
  5. 5.
    McGlynn KA, Petrick JL, London WT. Global Epidemiology of Hepatocellular Carcinoma An Emphasis on Demographic and Regional Variability. Clinics in liver disease. 2015;19(2):223–238.CrossRefGoogle Scholar
  6. 6.
    Tian QJ, Jia JD. Hepatitis B virus genotypes: epidemiological and clinical relevance in Asia. Hepatology International. 2016;10(6):854–60.CrossRefGoogle Scholar
  7. 7.
    Bruix J, Reig M, Sherman M. Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma. Gastroenterology. 2016;150(4):835–53.CrossRefGoogle Scholar
  8. 8.
    de Lope CR, Tremosini S, Forner A,et al. Management of HCC. Journal of hepatology. 2012;56:S75-S87.CrossRefGoogle Scholar
  9. 9.
    Lee SH, Jin YJ, Lee JW. Survival benefit of radiofrequency ablation for solitary (3-5cm) hepatocellular carcinoma: An analysis for nationwide cancer registry. Medicine. 2017;96(44):7.Google Scholar
  10. 10.
    Xu XL, Liu XD, Liang M, Luo BM. Radiofrequency Ablation versus Hepatic Resection for Small Hepatocellular Carcinoma: Systematic Review of Randomized Controlled Trials with Meta-Analysis and Trial Sequential Analysis. Radiology. 2018;287(2):461–72.CrossRefGoogle Scholar
  11. 11.
    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo Classification of Surgical Complications Five-Year Experience. Annals of Surgery. 2009;250(2):187–96.CrossRefGoogle Scholar
  12. 12.
    Guo WX, Zhai B, Lai ECH, Li N, Shi J, Lau WY, et al. Percutaneous Radiofrequency Ablation versus Partial Hepatectomy for Multicentric Small Hepatocellular Carcinomas: A Nonrandomized Comparative Study. World Journal of Surgery. 2010;34(11):2671–6.CrossRefGoogle Scholar
  13. 13.
    Kulik L, Heimbach JK, Zaiem F, et al. Therapies for patients with hepatocellular carcinoma awaiting liver transplantation: A systematic review and meta-analysis. Hepatology. 2018;67(1):381–400.CrossRefGoogle Scholar
  14. 14.
    Lu H, Lu L, Zhang F,et al. Living donor liver transplantation: where do we stand and where are we going? Hepatobiliary Surgery and Nutrition. 2016;5(2):141–4.Google Scholar
  15. 15.
    Chen SL, Peng ZW, Lin MX, et al. Combined percutaneous radiofrequency ablation and ethanol injection versus hepatic resection for 2.1-5.0 cm solitary hepatocellular carcinoma: a retrospective comparative multicentre study. Eur Radiol. 2018;28(9):3651–60.CrossRefGoogle Scholar
  16. 16.
    Peng ZW, Lin XJ, Zhang YJ, et al. Radiofrequency Ablation versus Hepatic Resection for the Treatment of Hepatocellular Carcinomas 2 cm or Smaller: A Retrospective Comparative Study. Radiology. 2012;262(3):1022–33.CrossRefGoogle Scholar
  17. 17.
    Lupo L, Panzera P, Giannelli G, et al. Single hepatocellular carcinoma ranging from 3 to 5 cm: radiofrequency ablation or resection? HPB : the official journal of the International Hepato Pancreato Biliary Association. 2007;9(6):429–34.CrossRefGoogle Scholar
  18. 18.
    Banerjee S, Wang DS, Kim HJ, et al. A Computed Tomography Radiogenomic Biomarker Predicts Microvascular Invasion and Clinical Outcomes in Hepatocellular Carcinoma. Hepatology. 2015;62(3):792–800.CrossRefGoogle Scholar
  19. 19.
    Sumie S, Kuromatsu R, Okuda K, et al. Microvascular invasion in patients with hepatocellular carcinoma and its predictable clinicopathological factors. Annals of Surgical Oncology. 2008;15(5):1375–82.CrossRefGoogle Scholar
  20. 20.
    Finn RS, Zhu AX, Farah W, et al. Therapies for advanced stage hepatocellular carcinoma with macrovascular invasion or metastatic disease: A systematic review and meta-analysis. Hepatology. 2018;67(1):422–35.CrossRefGoogle Scholar
  21. 21.
    Kaibori M, Ishizaki M, Matsui K, Kwon AH. Predictors of Microvascular Invasion Before Hepatectomy for Hepatocellular Carcinoma. Journal of Surgical Oncology. 2010;102(5):462–8.CrossRefGoogle Scholar
  22. 22.
    Roayaie S, Blume IN, Thung SN, et al. A System of Classifying Microvascular Invasion to Predict Outcome After Resection in Patients With Hepatocellular Carcinoma. Gastroenterology. 2009;137(3):850–5.CrossRefGoogle Scholar
  23. 23.
    Cucchetti A, Piscaglia F, Grigioni AD, et al. Preoperative prediction of hepatocellular carcinoma tumour grade and micro-vascular invasion by means of artificial neural network: A pilot study. Journal of hepatology. 2010;52(6):880–8.CrossRefGoogle Scholar
  24. 24.
    Hwang S, Lee YJ, Kim KH, et al. The Impact of Tumor Size on Long-Term Survival Outcomes After Resection of Solitary Hepatocellular Carcinoma: Single-Institution Experience with 2558 Patients. J Gastrointest Surg. 2015;19(7):1281–90.CrossRefGoogle Scholar
  25. 25.
    McHugh PP, Gilbert J, Vera S,et al. Alpha-fetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma. Hpb. 2010;12(1):56–61CrossRefGoogle Scholar
  26. 26.
    Huang G, Lau WY, Zhou WP, et al. Prediction of Hepatocellular Carcinoma Recurrence in Patients With Low Hepatitis B Virus DNA Levels and High Preoperative Hepatitis B Surface Antigen Levels. Jama Surgery. 2014;149(6):519–27.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of Hepatic Surgery, Shanghai Eastern Hepatobiliary Surgery HospitalSecond Military Medical UniversityShanghaiChina
  2. 2.Department of Hepatic SurgerySuqian People’s Hospital of Nanjing Drum-Tower Hospital GroupSuqianChina

Personalised recommendations