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Rasic G, de Geus SWL, Beaulieu-Jones B, Kasumova GG, Kent TS, Ng SC, McAneny D, Tseng JF, Sachs TE. A nationwide propensity score analysis comparing ablation and resection for hepatocellular carcinoma. J Surg Oncol 2023; 127:1125-1134. [PMID: 36905338 DOI: 10.1002/jso.27232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Studies have reported ambiguous results regarding the efficacy of ablation for early-stage hepatocellular carcinoma (HCC). Our study compared outcomes of ablation versus resection for HCC ≤50 mm to identify tumor sizes that would most benefit from ablation in terms of long-term survival. METHODS The National Cancer Database was queried for patients with stage I and II HCC ≤50 mm who underwent ablation or resection (2004-2018). Three cohorts were created based on tumor size: ≤20, 21-30, and 31-50 mm. A propensity score-matched survival analysis was performed using the Kaplan-Meier method. RESULTS In total, 36.47% (n = 4263) and 63.53% (n = 7425) of patients underwent resection and ablation, respectively. After matching, resection was associated with a significant survival benefit compared to ablation (3-year survival: 78.13% vs. 67.64%; p < 0.0001) in patients with HCC of ≤20 mm. The impact of resection was even more striking among patients with HCC of 21-30 mm (3-year survival: 77.88% vs. 60.53%; p < 0.0001) and 31-50 mm (3-year survival: 67.21% vs. 48.55%; p < 0.0001). CONCLUSIONS While resection offers a survival benefit over ablation in the treatment of early-stage HCC ≤50 mm, ablation may provide a feasible bridging strategy in patients awaiting transplantation.
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Affiliation(s)
- Gordana Rasic
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Susanna W L de Geus
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brendin Beaulieu-Jones
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Gyulnara G Kasumova
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sing Chau Ng
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - David McAneny
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Le M, Nelson R, Lee W, Wiatrek R, Singh G, Garcia-Aguilar J, Kim J. An Appraisal of Radiofrequency Ablation and Surgical Resection for Hepatocellular Carcinoma: Results from the Surveillance, Epidemiology, and End Results Registry. Am Surg 2020. [DOI: 10.1177/000313481207801018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer death worldwide, but only a small percentage of patients are eligible for curative surgical intervention. Over the past decade, radio-frequency ablation (RFA) has been increasingly shown to offer long-term survival benefits. Our study objective was to compare outcomes of patients with HCC who underwent surgical resection with those who received RFA. Using the Surveillance, Epidemiology, and End Results registry, we identified 1209 (21%) and 4595 (79%) patients with HCC who received RFA and surgical resection, respectively, between the years 1988 and 2008. When comparing the groups, patients undergoing RFA were older (years, 62.6 vs 58.7; P < 0.001) and had smaller tumors (less than 5 cm; 84.4 vs 61.2%; P < 0.001), yet patients who underwent surgical resection had improved survival over patients undergoing RFA (median survival, 5 vs 3 years, respectively; P < 0.001). Univariate and multivariate analysis verified the superiority of surgical resection over ablation (hazard ratio [HR], 0.6; 95% confidence interval [CI], 0.60 to 0.80; P < 0.001 and HR, 0.57; 95% CI, 0.52 to 0.63; P < 0.001, respectively). In summary, our investigation demonstrates that surgical resection provides durable long-term survival for surgical candidates with HCC; however, RFA remains an appropriate alternative therapy that also provides long-term survival in select patients.
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Affiliation(s)
- Maithao Le
- Division of Surgical Oncology, Department of Surgery, Duarte, California
| | - Rebecca Nelson
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Wendy Lee
- Division of Surgical Oncology, Department of Surgery, Duarte, California
| | - Rebecca Wiatrek
- Division of Surgical Oncology, Department of Surgery, Duarte, California
| | - Gagandeep Singh
- Division of Surgical Oncology, Department of Surgery, Duarte, California
| | | | - Joseph Kim
- Division of Surgical Oncology, Department of Surgery, Duarte, California
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Donner DB, Nakakura EK, Venook AP, Lenz HJ, Zhang W, Hwang J, Bergsland EK, Lin MH, Toriguchi K, Antonia RJ, Warren RS. High thymidylate synthase gene expression predicts poor outcome after resection of hepatocellular carcinoma. PLoS One 2019; 14:e0219469. [PMID: 31291332 PMCID: PMC6620013 DOI: 10.1371/journal.pone.0219469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/24/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction Prognosis after resection of hepatocellular carcinoma (HCC) is highly variable. Compared to clinicopathologic factors, the use of molecular markers to predict outcome has not been well studied. We investigated the prognostic importance of thymidylate synthase (TS) gene expression and polymorphisms in patients after resection of HCC. Methods Patients who underwent complete resection of HCC for whom tissue was available were identified. TS gene expression level and polymorphisms were determined in HCC specimens. Prognostic factors were evaluated using Kaplan-Meier curves and Cox proportional hazard models. Results The study included 67 patients. In univariate analysis, variables that negatively influenced survival included TNM stage, microvascular invasion, and high TS expression. For the high TS expression group, median survival was 54 months and 5-year actuarial survival was 47%. For the low TS expression group, median survival was not reached and the 5-year actuarial survival was 91%. In multivariate analysis, only high TS expression remained an independent predictor of poor survival (HR = 10.77, 95% CI 1.36–84.91; P = 0.02). TS gene polymorphisms were not associated with TS expression or overall survival. Conclusions High TS expression predicts poor outcome after resection of HCC. Molecular markers might be robust predictors of patient outcome after resection of HCC.
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Affiliation(s)
- David B. Donner
- Department of Surgery, The University of California San Francisco, San Francisco, California, United States of America
- The Helen Diller Family Comprehensive Cancer Center, The University of California San Francisco, San Francisco, California, United States of America
- * E-mail: (DD); (EN)
| | - Eric K. Nakakura
- Department of Surgery, The University of California San Francisco, San Francisco, California, United States of America
- The Helen Diller Family Comprehensive Cancer Center, The University of California San Francisco, San Francisco, California, United States of America
- * E-mail: (DD); (EN)
| | - Alan P. Venook
- The Helen Diller Family Comprehensive Cancer Center, The University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, The University of California San Francisco, San Francisco, California, United States of America
| | - Heinz-Josef Lenz
- Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, California, United States of America
| | - Wu Zhang
- Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, California, United States of America
| | - Jimee Hwang
- The Helen Diller Family Comprehensive Cancer Center, The University of California San Francisco, San Francisco, California, United States of America
- Biostatistics Core Facility, The University of California San Francisco, San Francisco, California, United States of America
| | - Emily K. Bergsland
- The Helen Diller Family Comprehensive Cancer Center, The University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, The University of California San Francisco, San Francisco, California, United States of America
| | - Meng Hsun Lin
- Department of Surgery, The University of California San Francisco, San Francisco, California, United States of America
- The Helen Diller Family Comprehensive Cancer Center, The University of California San Francisco, San Francisco, California, United States of America
| | - Kan Toriguchi
- Department of Surgery, The University of California San Francisco, San Francisco, California, United States of America
- The Helen Diller Family Comprehensive Cancer Center, The University of California San Francisco, San Francisco, California, United States of America
| | - Ricardo J. Antonia
- Department of Surgery, The University of California San Francisco, San Francisco, California, United States of America
- The Helen Diller Family Comprehensive Cancer Center, The University of California San Francisco, San Francisco, California, United States of America
| | - Robert S. Warren
- Department of Surgery, The University of California San Francisco, San Francisco, California, United States of America
- The Helen Diller Family Comprehensive Cancer Center, The University of California San Francisco, San Francisco, California, United States of America
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Taefi A, Abrishami A, Nasseri-Moghaddam S, Eghtesad B, Sherman M. Surgical resection versus liver transplant for patients with hepatocellular carcinoma. Cochrane Database Syst Rev 2013:CD006935. [PMID: 23813393 DOI: 10.1002/14651858.cd006935.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hepatocellular carcinoma is a major worldwide health problem, involving more than half a million new patients yearly, with a different incidence in different parts of the world. Hepatocellular carcinoma develops in about 80% of cirrhotic patients, and cirrhosis is considered the strongest predisposing factor for it. Surgical resection and liver transplantation are conventional treatment modalities that can offer long-term survival for patients with hepatocellular carcinoma. OBJECTIVES To assess the benefits and harms of surgical resection compared with those of liver transplantation in patients with hepatocellular carcinoma. SEARCH METHODS We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded (SCI-EXPANDED) at ISI Web of Science (last search February 2013). We also searched the abstracts from annual meetings of the American Society of Clinical Oncology, the American Association for the Study of Liver Diseases (AASLD), and the European Association for the Study of the Liver (EASL), provided through The Cochrane Hepato-Biliary Group until February 2013. SELECTION CRITERIA Randomised clinical trials comparing surgical resection and hepatic transplantation. DATA COLLECTION AND ANALYSIS The search strategies were run and two authors individually evaluated whether the retrieved studies fulfilled the inclusion criteria. MAIN RESULTS No randomised clinical trials comparing surgical resection and liver transplantation as the major methods of treating hepatocellular carcinoma were found. AUTHORS' CONCLUSIONS There are no randomised clinical trials comparing surgical resection and liver transplantation for hepatocellular carcinoma treatment.
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Affiliation(s)
- Amir Taefi
- Department of Internal Medicine, Medstar Washington Hospital Center,Washington, DC, USA.
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5
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Abdo AA, Hassanain M, AlJumah A, Al Olayan A, Sanai FM, Alsuhaibani HA, Abdulkareem H, Abdallah K, AlMuaikeel M, Al Saghier M, Babatin M, Kabbani M, Bazarbashi S, Metrakos P, Bruix J. Saudi guidelines for the diagnosis and management of hepatocellular carcinoma: technical review and practice guidelines. Ann Saudi Med 2012; 32:174-99. [PMID: 22366832 PMCID: PMC6086640 DOI: 10.5144/0256-4947.2012.174] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Recognizing the significant prevalence of hepatocellular carcinoma (HCC) in Saudi Arabia, and the difficulties often faced in early and accurate diagnoses, evidence-based management, and the need for appropriate referral of HCC patients, the Saudi Association for the Study of Liver diseases and Transplantation (SASLT) formed a multi-disciplinary task force to evaluate and update the previously published guidelines by the Saudi Gastroenterology Association. These guidelines were later reviewed, adopted and endorsed by the Saudi Oncology Society (SOS) as its official HCC guidelines as well. The committee assigned to revise the Saudi HCC guidelines was composed of hepatologists, oncologists, liver surgeons, transplant surgeons, and interventional radiologists. Two members of the task force served as guidelines editors. A wide based search on all published reports on all aspects of the epidemiology, natural history, risk factors, diagnosis, and management of HCC was performed. All available literature was critically examined and available evidence was then classified according to its strength. The whole document and the recommendations were then discussed in detail by members and consensus was obtained. All recommendations in these guidelines were based on the best available evidence, but were tailored to the patients treated in Saudi Arabia. We hope that these guidelines will improve HCC patient care and enhance the multidisciplinary care needed for these patients.
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Affiliation(s)
- Ayman A Abdo
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Palesty JA, Al-Kasspooles M, Gibbs JF. Patient selection for surgical management of primary and metastatic liver cancers: current perspectives. Semin Intervent Radiol 2011; 23:13-20. [PMID: 21326716 DOI: 10.1055/s-2006-939837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The surgical management of liver malignancies remains a mainstay in the treatment of such patients, and has benefited from dramatic advancements over the last two decades. Improvements in surgical technique, better understanding of hepatic anatomy, and improvement in anesthesiological supportive care has resulted in a decline in perioperative morbidity and operative mortality. Proper patient selection for surgical and nonsurgical treatment currently employs a multidisciplinary approach in our institution. This review will focus on the surgical treatment options for both primary and secondary liver cancers.
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Affiliation(s)
- J Alexander Palesty
- Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, New York
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7
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A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg 2010; 252:903-12. [PMID: 21107100 DOI: 10.1097/sla.0b013e3181efc656] [Citation(s) in RCA: 601] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the long-term outcomes of surgical resection and radiofrequency ablation for the treatment of small hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA Radiofrequency ablation (RFA) is a promising, emerging therapy for small HCC. Whether it is as effective as surgical resection (RES) for long-term outcomes is still indefinite. METHODS Two hundred thirty HCC patients who met the Milan criteria and were suitable to be treated by either RES or RFA entered into a randomized controlled trial. The patients were regularly followed up after treatment for 5 years (except for those who died). The primary end point was overall survival; the secondary end points were recurrence-free survival, overall recurrence, and early-stage recurrence. RESULTS The 1-, 2-, 3-, 4- and 5-year overall survival rates for the RFA group and the RES group were 86.96%, 76.52%, 69.57%, 66.09%, 54.78% and 98.26%, 96.52%, 92.17%, 82.60%, 75.65%, respectively. The corresponding recurrence-free survival rates for the 2 groups were 81.74%, 59.13%, 46.08%, 33.91%, 28.69% and 85.22%, 73.92%, 60.87%, 54.78%, 51.30%, respectively. Overall survival and recurrence-free survival were significantly lower in the RFA group than in the RES group (P = 0.001 and P = 0.017). The 1-, 2-, 3-, 4-, and 5-year overall recurrence rates were 16.52%, 38.26%, 49.57%, 59.13%, and 63.48% for the RFA group and 12.17%, 22.60%, 33.91%, 39.13%, and 41.74% for the RES group. The overall recurrence was higher in the RFA group than in the RES group (P = 0.024). CONCLUSIONS Surgical resection may provide better survival and lower recurrence rates than RFA for patients with HCC to the Milan criteria.
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8
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Molinari M, Helton S. Hepatic resection versus radiofrequency ablation for hepatocellular carcinoma in cirrhotic individuals not candidates for liver transplantation: a Markov model decision analysis. Am J Surg 2009; 198:396-406. [PMID: 19520354 DOI: 10.1016/j.amjsurg.2009.01.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 01/05/2009] [Accepted: 01/05/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Several observational studies have suggested that radiofrequency ablation (RFA) may have survival benefits similar to hepatic resection (HR) in cirrhotic patients affected by hepatocellular carcinoma (HCC) are not candidates for liver transplantation. A small randomized controlled trial confirmed these findings, although underpowered to detect a significant difference at 5-year interval. METHODS A Markov model was created to simulate a randomized trial comparing the quality of life-adjusted survival for individuals undergoing HR versus RFA for HCCs less than 5 cm in diameter. RESULTS HR was the best therapeutic option with 5.33 (standard deviation +/-.42) versus 3.91 (standard deviation +/-.38) quality-adjusted life years except for in individuals older than 75 years of age (P = .02, log rank test). One-way sensitivity analysis showed that RFA was the preferred strategy if the perioperative mortality of HR was more than 30%, if the percentage of patients with negative margins was less than 60%, and if RFA could be performed at least 60% of the time for recurrent disease after a previous ablation. The quality of life associated with both procedures did not influence the results of this model. CONCLUSIONS HR provided better quality of life-adjusted survival as ablation therapy was associated with increased risk of local recurrent disease requiring multiple sessions. For older individuals, RFA appears to be the best therapeutic option. If the probability of ablation for recurrent disease is equal in the 2 arms, survival benefits of RFA is similar to HR.
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Affiliation(s)
- Michele Molinari
- Department of Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Rm 6-254 Victoria Building, Victoria General Hospital, Halifax, NS, Canada.
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9
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Ohmoto K, Yoshioka N, Tomiyama Y, Shibata N, Kawase T, Yoshida K, Kuboki M, Yamamoto S. Comparison of therapeutic effects between radiofrequency ablation and percutaneous microwave coagulation therapy for small hepatocellular carcinomas. J Gastroenterol Hepatol 2009; 24:223-7. [PMID: 18823439 DOI: 10.1111/j.1440-1746.2008.05596.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although thermal ablation therapies have gained fairly wide acceptance as an effective treatment for small hepatocellular carcinoma (HCC), there have been only a few clinical studies comparing the response to radiofrequency ablation (RFA) and percutaneous microwave coagulation therapy (PMCT). We evaluated the therapeutic efficacy and safety of these two procedures for the treatment of small HCC measuring < or = 2 cm in diameter. METHODS Thirty-four patients who had 37 nodules were treated by RFA and were compared with 49 patients (56 nodules) who underwent PMCT. Treatment was repeated until complete tumor necrosis was confirmed by contrast computed tomography (CT) scanning. The therapeutic efficacy and complications were retrospectively compared between the two procedures. RESULTS (i) There were significantly fewer treatment sessions (P < 0.001) in the RFA group than in the PMCT group, but the necrotic area was significantly larger (P < 0.001) in the former group. (ii) The local recurrence rate was significantly lower (P = 0.031) after RFA than after PMCT, although the ectopic recurrence rate showed no significant difference. (iii) The cumulative survival rate was significantly higher (P = 0.018) after RFA than after PMCT. (iv) The incidence of pain and fever after treatment was significantly higher in the PMCT group. Bile duct injury, pleural effusion, and ascites were also significantly more common in the PMCT group. CONCLUSIONS RFA is more useful than PMCT for the treatment of small HCC because it is minimally invasive and achieves a low local recurrence rate, high survival rate, and extensive necrosis after only a few treatment sessions.
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Affiliation(s)
- Kenji Ohmoto
- Division of Hepatology, Department of Medicine, Kawasaki Medical School, Kurashiki, Japan.
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Boctor EM, Choti MA, Burdette EC, Webster Iii RJ. Three-dimensional ultrasound-guided robotic needle placement: an experimental evaluation. Int J Med Robot 2008; 4:180-91. [PMID: 18433079 DOI: 10.1002/rcs.184] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical use of image-guided needle placement robots has lagged behind laboratory-demonstrated robotic capability. Bridging this gap requires reliable and easy-to-use robotic systems. METHODS Our system for image-guided needle placement requires only simple, low-cost components and minimal, entirely off-line calibration. It rapidly aligns needles to planned entry paths using 3D ultrasound (US) reconstructed from freehand 2D scans. We compare system accuracy against clinical standard manual needle placement. RESULTS The US-guided robotic system is significantly more accurate than single manual insertions. When several manual withdrawals and reinsertions are allowed, accuracy becomes equivalent. In ex vivo experiments, robotic repeatability was 1.56 mm, compared to 3.19 and 4.63 mm for two sets of manual insertions. In an in vivo experiment with heartbeat and respiratory effects, robotic system accuracy was 5.5 mm. CONCLUSIONS A 3D US-guided robot can eliminate error bias and reduce invasiveness (the number of insertions required) compared to manual needle insertion. Remaining future challenges include target motion compensation.
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Affiliation(s)
- Emad M Boctor
- Department of Radiology, Johns Hopkins Medical Institute, Baltimore, MD, USA
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Trends in local therapy for hepatocellular carcinoma and survival outcomes in the US population. Am J Surg 2008; 195:829-36. [PMID: 18436176 DOI: 10.1016/j.amjsurg.2007.10.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 10/11/2007] [Accepted: 10/12/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatocellular cancer (HCC) frequently presents with limitations to resection. We investigated survival outcomes after various local HCC therapies in US patients. DATA SOURCES Relationships between local HCC therapy modality and overall survival (OS) were analyzed from the Surveillance, Epidemiology and End Results (SEER) 1973-2003 database. Of 46,065 patients with primary hepatobiliary malignancy, 5,317 individuals with HCC had sufficient surgical data. The median age was 65 (range 0-105), and 73% of patients were male. The median tumor size was 6 cm (.2-30). There were single lesions (52%), multiple lesions (28%), and extrahepatic disease (20%). Mortality at 30 days was 8.4% (resection), 3.3% (transplantation), 3.2% (ablation), or 31% (no local therapy, P <.0001). Actuarial 5-year survival was 67% after transplantation, 35% after resection, 20% after ablation, and 3% for no or incomplete local therapy (P <.0001). Multivariate prognosticators were surgical modality, disease extent, grade (all at P <.0001), tumor size (P = .01), vascular invasion (P = .02), and age (P = .045). Compared to resection, risk ratios were .56 (transplantation) and 1.53 (ablation). CONCLUSIONS Long-term HCC survival can be observed after all 3 treatment approaches but is best after transplantation and resection, although likely biased through confounding patient selection variables. Preferred HCC treatment should be individualized based on morbidity and long-term OS prospects.
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12
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Takahashi S, Kudo M, Chung H, Inoue T, Ishikawa E, Kitai S, Tatsumi C, Ueda T, Minami Y, Ueshima K, Haji S. Initial treatment response is essential to improve survival in patients with hepatocellular carcinoma who underwent curative radiofrequency ablation therapy. Oncology 2007; 72 Suppl 1:98-103. [PMID: 18087189 DOI: 10.1159/000111714] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study was undertaken to assess the outcome of potentially curative radiofrequency ablation (RFA) therapy for early-stage hepatocellular carcinoma (HCC) in patients with Child-Pugh stage A cirrhosis. METHODS This study retrospectively evaluated clinical outcomes in a cohort of 171 Child-Pugh stage A cirrhotic patients who received RFA for naïve HCC within the Milan criteria. The median follow-up period was 36.7 months. RESULTS Cumulative survival rates estimated by the Kaplan-Meier method for all patients were 98.8, 91.1 and 76.8% at 1, 3 and 5 years, respectively. Cumulative probabilities of local tumor recurrence at 1, 2 and 3 years were 9.0, 14.1 and 17.7%, respectively. Cumulative survival rates in patients without local tumor recurrence were 96.6, 94.6 and 84.4% at 1, 3 and 5 years, respectively, compared with patients with local tumor recurrence (96.6, 74.8 and 42.1% at 1, 3 and 5 years, respectively; p = 0.0002). Cox regression analysis showed that low serum albumin (p = 0.009, RR 3.04, CI 1.32-6.98), high range of PIVKA-II (prothrombin induced by vitamin K absence or agonist II) (p = 0.025, RR 2.57, CI 1.13-5.89), with multiple (less than 3) nodules (p = 0.021, RR 2.61, CI 1.15-5.91), and with local tumor recurrence (p = 0.004, RR 3.62, CI 1.51-8.69) were significant risk factors for death. CONCLUSION Initial complete response of curative RFA therapy in patients with Child-Pugh stage A cirrhosis and early-stage HCC is associated with improved survival. Therefore, clinicians should aim to achieve complete ablation of all detectable HCC nodules with adequate safety margins.
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Affiliation(s)
- Shunsuke Takahashi
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan
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Jakobs TF, Hoffmann RT, Poepperl G, Schmitz A, Lutz J, Koch W, Tatsch K, Lubiensky A, Reiser MF, Helmberger T. Mid-term results in otherwise treatment refractory primary or secondary liver confined tumours treated with selective internal radiation therapy (SIRT) using 90Yttrium resin-microspheres. Eur Radiol 2006; 17:1320-30. [PMID: 17149621 DOI: 10.1007/s00330-006-0508-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Revised: 09/15/2006] [Accepted: 10/12/2006] [Indexed: 10/23/2022]
Abstract
The purpose was to determine the response and survival and to analyse the feasibility of single-session, whole-liver SIRT in patients with non-resectable, otherwise non-responding liver cancer. Thirty-nine patients qualified for SIRT. Eighteen patients suffered from colorectal-cancer metastases (CRC), breast-cancer metastases (MBC, 7), HCC (5) and other tumours (9). Response was assessed by tumour-markers and CT-imaging. At 2-4, 5-7 and 8-9 months follow-up in 3/17, 5/15 and 5/10 of CRC-patients CEA-levels were higher than before. In the MBC group 1-3 and 4-6 months after SIRT tumour-marker-levels were higher in 2/6 and 3/3 patients, respectively. In all HCC-patients AFP-levels dropped 1-3 months after SIRT. Using RECIST, in the CRC-group progressive liver disease (PD) was found in 4/17, 2/12, 2/10 and 2/5 patients at 2-4, 5-8, 9-10 and 12-14 months follow-up. Concerning MBC, after 3 months 7/7 patients presented with stable-disease (SD) or partial-response (PR). At 5-6 months, 1/5 patients showed PD. All HCC-patients showed SD/PR at 2-3 months with no PD at 5-8 months. In the mixed-group 5/6 patients presented with SD/PR at 3-4 months and with SD in 2/3 patients at 5-6 months. The median time-to-PD was 6.5, 8.5 and 8 months for the CRC-, MBC- and mixed-group, respectively. SIRT is a promising, liver-targeted approach for patients with otherwise treatment-refractory liver tumours.
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Affiliation(s)
- Tobias F Jakobs
- Department of Clinical Radiology, University of Munich, Grosshadern Campus, Marchioninistrasse 15, 81377, Munich, Germany.
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Choi D, Lim HK, Rhim H, Kim YS, Lee WJ, Paik SW, Koh KC, Lee JH, Choi MS, Yoo BC. Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long-term results and prognostic factors in a large single-institution series. Eur Radiol 2006; 17:684-92. [PMID: 17093964 DOI: 10.1007/s00330-006-0461-5] [Citation(s) in RCA: 265] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2006] [Revised: 08/02/2006] [Accepted: 08/25/2006] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to evaluate the long-term survival results and complications of percutaneous radiofrequency ablation (RFA) in patients with early-stage hepatocellular carcinoma (HCC). Between April 1999 and May 2005, 570 patients with 674 early-stage HCCs underwent percutaneous RFA as a first-line treatment option in a single institution. We evaluated the effectiveness rates, local tumor progression rates, survival rates, and complications. We also assessed the prognostic values of survival rates by using Cox proportional hazard models. The primary technique effectiveness rate was 96.7% (652 of 674). The cumulative rates of local tumor progression at 1, 2, and 3 years were 8.1%, 10.9%, and 11.8%, respectively. The cumulative survival rates at 1, 2, 3, 4, and 5 years were 95.2%, 82.9%, 69.5%, 60.8%, and 58.0%, respectively. Patients with Child-Pugh class A cirrhosis, of younger age (<or=58 years), or having lower AFP level (<or=100 microg/L) demonstrated better survival results (P < 0.05). A total of 11 major complications (1.9% per treatment) were found during the follow-up period. There was no procedure-related death. Percutaneous RFA can be used successfully as a first-line treatment modality for early-stage HCCs. Child-Pugh class, age, and AFP level before RFA were significant prognostic predictors of long-term survival.
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Affiliation(s)
- Dongil Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul, 135-710, South Korea
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15
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Stucchi AF, Aarons CB, Becker JM. Surgical approaches to cancer in patients who have inflammatory bowel disease. Gastroenterol Clin North Am 2006; 35:641-73. [PMID: 16952745 DOI: 10.1016/j.gtc.2006.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IBD clearly increases the risk for GI malignancies, especially CRC. The absolute number of patients that develops such malignancies is low compared with the overall cancer rate; however, younger age of onset, higher relative risk, unique clinical presentations, and problems with early diagnosis make this a serious complication of IBD. With the exception of patients with comorbid complications, such as primary sclerosing cholangitis, the prognosis is no worse for CRCs that arise as the result of IBD compared with those that arise sporadically. The prognosis remains poor for small bowel adenocarcinomas in patients who have CD, primarily because of their advanced stage at detection. Diligent surveillance is essential for early detection and treatment of IBD-related CRCs in patients with unresected colons, long-standing or extensive disease, and in those who have early-onset CD, although pundits still question whether it significantly affects prognosis and survival. Better surveillance techniques for small bowel dysplasia or malignancy in patients who have CD is needed, especially given the poor prognosis of these patients when advanced cancers are detected. Depending on the presentation and disease diagnosis, patients have several surgical treatment options and can expect good outcomes for all. When the appropriate surgical technique is used in patients who have colon or rectal cancer, along with adjuvant chemotherapy when appropriate, prognosis and function is good; however, the experience of the surgeon can affect the prognosis for IBD-related GI cancers. Surgical therapy is based not only on general oncologic principles, but also on the surgery that is appropriate for the IBD diagnosis. Resection of the mesentery and lymphadenectomy should be performed according to oncologic principles. Postoperative survival for IBD-related CRC is good, and diligent surveillance and follow-up are critical to the patient's overall prognosis.
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Affiliation(s)
- Arthur F Stucchi
- Department of Surgery, Boston University School of Medicine, Boston, MA 02118, USA
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16
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Abstract
Patients diagnosed with primary hepatic malignancies or metastases to the liver remain a difficult population to treat. A small percentage of these people can undergo surgical resection or transplantation. The remaining nonsurgical aggregate does not often benefit from conventional radiation and chemotherapy; minimally invasive means either to cure or palliate these patients are a requirement for complete cancer care. This article discusses image-guided local therapies used to treat this difficult patient population, focusing predominantly on radiofrequency ablation.
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Affiliation(s)
- Susan M Weeks
- Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, 2016 Old Clinic Building, Campus Box 7510, Chapel Hill, NC 27599-7510, USA.
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17
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Abstract
There is no worldwide consensus of an algorithm for the radical treatment of hepatocellular carcinoma (HCC). Surgical resection, liver transplantation and, recently, local ablation therapies achieve high curative rates in selected patients. However, recurrence of HCC remains a major problem. This review provides an overview of the current surgical treatment options available for patients with HCC.
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Affiliation(s)
- Lucas McCormack
- The Department of Visceral and Transplant Surgery, University Zürich, Switzerland
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18
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Ogihara M, Wong LL, Machi J. Radiofrequency ablation versus surgical resection for single nodule hepatocellular carcinoma: long-term outcomes. HPB (Oxford) 2005; 7:214-21. [PMID: 18333193 PMCID: PMC2023955 DOI: 10.1080/13651820510028846] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radiofrequency ablation (RFA) has been increasingly utilized for treatment of hepatocellular carcinoma (HCC). Long-term results of RFA, especially in comparison to surgical resection, have not been well described. METHODS Eighty-seven patients with single nodule HCC underwent surgical resection (N=47) or RFA (N=40) during a 9-year period. RFA was performed for 36 unresectable disease and 4 surgical refusals. Each group was further divided based on tumor size for analysis; Group 1: resection, <or=5 cm (N=18), Group 2: RFA, <or=5 cm (N=26), Group 3: resection, >5 cm (N=29) and Group 4: RFA, >5 cm (N=14). Follow-up ranged from 2 to 72 months (median 16 months). Patients' characteristics, local recurrences and overall and disease-free survivals were compared. RESULTS Patients who underwent RFA were older (69 versus 60, p=0.0006), had more advanced Child-Pugh class and TNM stage (p=0.0002 and p=0.016, respectively), and had smaller tumors (4.6 versus 7.4 cm, p=0.0032). Local recurrence rates were 2% for resection and 10% for RFA (p=0.12). These local and other recurrences were subsequently treated with multimodal therapies as indicated. The median overall and disease-free survivals were equivalent both between Groups 1 and 2 (49 versus 51 months, p=0.44, 36 versus 22 months, p=0.84), and Groups 3 and 4 (47 versus 463 months, p=0.94, 28 versus 20 months, p=0.67). DISCUSSION Although the groups were not truly comparable, this retrospective study suggests that RFA may offer similar long-term results to surgical resection for single nodule HCC when combined with multimodal treatments.
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Affiliation(s)
- Makoto Ogihara
- Department of Surgery, University of Hawaii School of MedicineHonolulu Hawaii
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Geschwind JFH, Salem R, Carr BI, Soulen MC, Thurston KG, Goin KA, Van Buskirk M, Roberts CA, Goin JE. Yttrium-90 microspheres for the treatment of hepatocellular carcinoma. Gastroenterology 2004; 127:S194-205. [PMID: 15508085 DOI: 10.1053/j.gastro.2004.09.034] [Citation(s) in RCA: 223] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Unresectable hepatocellular carcinoma is extremely difficult to treat. TheraSphere consists of yttrium-90 (a pure beta emitter) microspheres, which are injected into the hepatic arteries. This article reviews the safety and survival of patients with hepatocellular carcinoma who were treated with yttrium-90 microspheres. Eighty patients were selected from a database of 108 yttrium-90 microsphere-treated patients and were staged by using Child-Pugh, Okuda, and Cancer of the Liver Italian Program scoring systems. Patients were treated with local, regional, and whole-liver approaches. Survival from first treatment was analyzed with Kaplan-Meier and Cox regression methods. Adverse events and complications of treatment were coded by using the Southwest Oncology Group toxicity scoring system. Patients received liver doses ranging from 47 to 270 Gy. Thirty-two patients (40%) received more than 1 treatment. Survival correlated with pretreatment Cancer of the Liver Italian Program scores ( P = .002), as well as with the individual Cancer of the Liver Italian Program components, Child-Pugh class, alpha-fetoprotein levels, and percentage of tumor replacement. Patients classified as Okuda stage I (n = 54) and II (n = 26) had median survival durations and 1-year survival rates of 628 days and 63%, and 384 days and 51%, respectively ( P = .02). One patient died of liver failure judged as possibly related to treatment. Thus, in selected patients with hepatocellular carcinoma, yttrium-90 microsphere treatment is safe and well tolerated. On the basis of these results, a randomized controlled trial is warranted comparing yttrium-90 microsphere treatment with transarterial chemoembolization by using the Cancer of the Liver Italian Program system for prospective stratified randomization.
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Affiliation(s)
- Jean Francois H Geschwind
- Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 545, Baltimore, Maryland 21287-4010, USA.
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20
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Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. In the United States, the incidence of HCC has increased by nearly 75% since the 1980s. The rise in HCC diagnoses in the United States has been attributed to an increased number of patients infected with viral hepatitis and better diagnostic techniques. The management of HCC begins with diagnostic confirmation, followed by accurate staging. Historically, the prognosis for patients with HCC has been poor; however, improved surveillance and radiologic imaging techniques have led to earlier detection of HCC and an increased opportunity to treat patients. Treatment options for HCC include surgical and nonsurgical modalities. Surgical therapy, by way of partial hepatectomy or orthotopic liver transplantation, is the only potentially curative treatment for HCC, but most patients are not eligible for these procedures by the time of diagnosis. Palliative options include ablative techniques, radiation, and systemic therapies. As the incidence of this malignancy continues to rise, oncology nurses, who are an integral part of the multidisciplinary team caring for these patients, must be aware of current management for HCC. This article will provide an overview of the complex management of patients with HCC in the United States.
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Affiliation(s)
- Bridget A Cahill
- Department of Medicine, Northwestern Medical Faculty Foundation, Chicago, IL, USA.
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21
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Kettenbach J, Blum M, Kilanowicz E, Schwaighofer SM, Lammer J. [Percutaneous radiofrequency ablation of liver cell carcinoma: a current overview]. Radiologe 2004; 44:330-8. [PMID: 15045198 DOI: 10.1007/s00117-004-1031-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In patients with hepatocellular carcinoma (HCC) surgical resection so far offers potential cure. Due to the frequent association with liver cirrhosis less then 30% of patients with HCC can be resected. In unresectable cases, radiofrequency ablation (RFA) offers an effective treatment alternative. Substantial improvements in the development of powerful generators (up to 250 W) combined with expandable, closed or open-perfused needle electrodes, provide coagulation necroses up to 5 cm in diameter. Most recently primary technical success rates of 85 to 100% were reported. Following RFA of HCC's (diameter up to 2,8 cm) 1-, 2-, 3 and 5-year survival was reported to be 97, 89, 71 and 48%. Low complication rates of 0-12% and a mortality of 0-1% indicate the minimal-invasive character of RFA. Basic principles, technique, indications, contraindications and limitations of percutaneous RFA will be discussed together with a presentation of own cases and a review of literature.
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Affiliation(s)
- J Kettenbach
- Klinische Abteilung für Angiographie und Interventionelle Radiologie, Allgemeines Krankenhaus der Stadt Wien, Medizinische Universität Wien.
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Vivarelli M, Guglielmi A, Ruzzenente A, Cucchetti A, Bellusci R, Cordiano C, Cavallari A. Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver. Ann Surg 2004; 240:102-7. [PMID: 15213625 PMCID: PMC1356381 DOI: 10.1097/01.sla.0000129672.51886.44] [Citation(s) in RCA: 187] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We sought to compare the experience of 2 different surgical units in the treatment of hepatocellular carcinoma (HCC) on cirrhosis with resection or percutaneous radiofrequency ablation (RFA), respectively. SUMMARY BACKGROUND DATA When allowed by the hepatic functional reserve, surgery is the therapy for HCC on cirrhosis; alternative treatments are proposed because of the high tumor recurrence rate after resection. RFA is being widely adopted to treat HCC. METHODS Over a 4-year period, 79 cirrhotics with HCC underwent resection in 1 surgical unit (group A) and another 79 had RFA at a different unit (group B). Patient selection, operative mortality, hospital stay, and 1- and 3-year overall and disease-free survival were analyzed. RESULTS Group A (surgery): mean follow-up was 28.9 +/- 17.9 months; operative mortality was 3.8%, mean hospital stay 9 days; 1- and 3-year survival were, respectively, 83 and 65%. One- and 3-year disease-free survival were 79 and 50%. Group B (RFA): mean follow-up was 15.6 +/- 11.7 months. Mean hospital stay was 1 day (range 1-8). One- and 3-year survival were 78 and 33%; 1- and 3-year disease-free survival were 60 and 20%. Overall and disease-free survival were significantly higher in group A (P = 0.002 and 0.001). The advantage of surgery was more evident for Child-Pugh class A patients and for single tumors of more than 3 cm in diameter. Results were similar in 2 groups for Child-Pugh class B patients CONCLUSIONS RFA has still to be confirmed as an alternative to surgery for potentially-resectable HCCs.
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Affiliation(s)
- Marco Vivarelli
- Department of Surgery and Transplantation, University of Bologna, S. Orsola Hospital, Bologna, Italy.
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