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Cabibbo G, Daniele B, Borzio M, Casadei-Gardini A, Cillo U, Colli A, Conforti M, Dadduzio V, Dionisi F, Farinati F, Gardini I, Giannini EG, Golfieri R, Guido M, Mega A, Minozzi S, Piscaglia F, Rimassa L, Romanini L, Pecorelli A, Sacco R, Scorsetti M, Viganò L, Vitale A, Trevisani F. Multidisciplinary Treatment of Hepatocellular Carcinoma in 2023: Italian practice Treatment Guidelines of the Italian Association for the Study of the Liver (AISF), Italian Association of Medical Oncology (AIOM), Italian Association of Hepato-Bilio-Pancreatic Surgery (AICEP), Italian Association of Hospital Gastroenterologists (AIGO), Italian Association of Radiology and Clinical Oncology (AIRO), Italian Society of Pathological Anatomy and Diagnostic Cytology (SIAPeC-IAP), Italian Society of Surgery (SIC), Italian Society of Gastroenterology (SIGE), Italian Society of Medical and Interventional Radiology (SIRM), Italian Organ Transplant Society (SITO), and Association of Patients with Hepatitis and Liver Disease (EpaC) - Part I - Surgical treatments. Dig Liver Dis 2024; 56:223-234. [PMID: 38030455 DOI: 10.1016/j.dld.2023.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/07/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
Worldwide, hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death. The remarkable improvements in treating HCC achieved in the last years have increased the complexity of HCC management. Following the need to have updated guidelines on the multidisciplinary treatment management of HCC, the Italian Scientific Societies involved in the management of this cancer have promoted the drafting of a new dedicated document. This document was drawn up according to the GRADE methodology needed to produce guidelines based on evidence. Here is presented the first part of guidelines, focused on the multidisciplinary tumor board of experts and surgical treatments of HCC.
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Affiliation(s)
- Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties PROMISE, University of Palermo, Italy; Gastroenterology Unit, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy.
| | - Bruno Daniele
- Oncology Unit, Ospedale del Mare, ASL Napoli 1 Centro, Napoli, Italy
| | - Mauro Borzio
- Centro Diagnostico Italiano (CDI), Milano, Italy
| | - Andrea Casadei-Gardini
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Umberto Cillo
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, 35128 Padua, Italy
| | - Agostino Colli
- Dipartimento di Medicina Trasfusionale ed Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Vincenzo Dadduzio
- Medical Oncology Unit, "Mons. A.R.Dimiccoli" Hospital, Barletta, ASL BT, Italy
| | - Francesco Dionisi
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute - Rome, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, 35128 Padova, Italy
| | - Ivan Gardini
- EpaC Onlus, Italian Liver Patient Association, Turin, Italy
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rita Golfieri
- Alma Mater Studiorum" Bologna University, Bologna, Italy; Radiology Unit Madre Fortunata Toniolo Private Hospital, coordinator of Radiology centers Medipass Bologna, Bologna, Italy
| | - Maria Guido
- Department of Medicine, University of Padova, Padova- Italy
| | - Andrea Mega
- Department of Gastronterology, Regional Hospital Bolzano, Italy
| | - Silvia Minozzi
- Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milano, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Laura Romanini
- Radiology Unit, Ospedale di Cremona, ASST Cremona, Cremona, Italy
| | - Anna Pecorelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rodolfo Sacco
- Gastroenterology and Endoscopy Unit, Department of Surgical and Medical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luca Viganò
- Hepatobiliary Unit, Department of Minimally Invasive General & Oncologic Surgery, Humanitas Gavazzeni University Hospital, Viale M. Gavazzeni 21, 24125 Bergamo, Italy; Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090 Milan, Italy
| | - Alessandro Vitale
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, 35128 Padua, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
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Abdelmalak J, Strasser SI, Ngu N, Dennis C, Sinclair M, Majumdar A, Collins K, Bateman K, Dev A, Abasszade JH, Valaydon Z, Saitta D, Gazelakis K, Byers S, Holmes J, Thompson AJ, Pandiaraja D, Bollipo S, Sharma S, Joseph M, Nicoll A, Batt N, Sawhney R, Tang MJ, Lubel J, Riordan S, Hannah N, Haridy J, Sood S, Lam E, Greenhill E, Majeed A, Kemp W, Zalcberg J, Roberts SK. Improved Survival Outcomes with Surgical Resection Compared to Ablative Therapy in Early-Stage HCC: A Large, Real-World, Propensity-Matched, Multi-Centre, Australian Cohort Study. Cancers (Basel) 2023; 15:5741. [PMID: 38136287 PMCID: PMC10742146 DOI: 10.3390/cancers15245741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
The optimal treatment approach in very-early and early-stage hepatocellular carcinoma (HCC) is not precisely defined, and there is ambiguity in the literature around the comparative efficacy of surgical resection versus ablation as curative therapies for limited disease. We performed this real-world propensity-matched, multi-centre cohort study to assess for differences in survival outcomes between those undergoing resection and those receiving ablation. Patients with Barcelona Clinic Liver Cancer (BCLC) 0/A HCC first diagnosed between 1 January 2016 and 31 December 2020 who received ablation or resection as initial treatment were included in the study. A total of 450 patients were included in the study from 10 major liver centres including two transplant centres. Following propensity score matching using key covariates, 156 patients were available for analysis with 78 in each group. Patients who underwent resection had significantly improved overall survival (log-rank test p = 0.023) and local recurrence-free survival (log rank test p = 0.027) compared to those who received ablation. Based on real-world data, our study supports the use of surgical resection in preference to ablation as first-line curative therapy in appropriately selected BCLC 0/A HCC patients.
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Affiliation(s)
- Jonathan Abdelmalak
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
| | - Simone I. Strasser
- Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; (S.I.S.); (N.N.); (C.D.)
| | - Natalie Ngu
- Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; (S.I.S.); (N.N.); (C.D.)
| | - Claude Dennis
- Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; (S.I.S.); (N.N.); (C.D.)
| | - Marie Sinclair
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Avik Majumdar
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Kate Collins
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Katherine Bateman
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Anouk Dev
- Department of Gastroenterology, Monash Health, Clayton, VIC 3168, Australia; (A.D.); (J.H.A.)
| | - Joshua H. Abasszade
- Department of Gastroenterology, Monash Health, Clayton, VIC 3168, Australia; (A.D.); (J.H.A.)
| | - Zina Valaydon
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Daniel Saitta
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Kathryn Gazelakis
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Susan Byers
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Jacinta Holmes
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (J.H.); (A.J.T.); (D.P.)
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Parkville, VIC 3052, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (J.H.); (A.J.T.); (D.P.)
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Parkville, VIC 3052, Australia
| | - Dhivya Pandiaraja
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (J.H.); (A.J.T.); (D.P.)
| | - Steven Bollipo
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; (S.B.); (S.S.); (M.J.)
| | - Suresh Sharma
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; (S.B.); (S.S.); (M.J.)
| | - Merlyn Joseph
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; (S.B.); (S.S.); (M.J.)
| | - Amanda Nicoll
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia; (A.N.); (N.B.); (R.S.)
- Department of Medicine, Eastern Health Clinical School, Box Hill, VIC 3128, Australia
| | - Nicholas Batt
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia; (A.N.); (N.B.); (R.S.)
| | - Rohit Sawhney
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia; (A.N.); (N.B.); (R.S.)
- Department of Medicine, Eastern Health Clinical School, Box Hill, VIC 3128, Australia
| | - Myo J. Tang
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
| | - John Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
| | - Stephen Riordan
- Department of Gastroenterology, Prince of Wales Hospital, Randwick, NSW 2031, Australia;
| | - Nicholas Hannah
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia; (N.H.); (J.H.); (S.S.)
| | - James Haridy
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia; (N.H.); (J.H.); (S.S.)
| | - Siddharth Sood
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia; (N.H.); (J.H.); (S.S.)
| | - Eileen Lam
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Elysia Greenhill
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
| | - John Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
- Department of Medical Oncology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Stuart K. Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
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Zhang Y, Qin Y, Dong P, Ning H, Wang G. Liver resection, radiofrequency ablation, and radiofrequency ablation combined with transcatheter arterial chemoembolization for very-early- and early-stage hepatocellular carcinoma: A systematic review and Bayesian network meta-analysis for comparison of efficacy. Front Oncol 2022; 12:991944. [PMID: 36387091 PMCID: PMC9650158 DOI: 10.3389/fonc.2022.991944] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/07/2022] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE To compare the efficacy of liver resection (LR), radiofrequency ablation (RFA), and radiofrequency ablation combined with transcatheter arterial chemoembolization (RFA+TACE) in the treatment of very-early- and early-stage hepatocellular carcinoma (HCC). METHODS We systemically searched the PubMed, Embase, and Cochrane Library databases. Randomized controlled trials (RCTs) and observational analyses with propensity score-matched cohort analyses (PSMs) comparing any two of the three treatments were included in this study. The primary result was overall survival (OS) and the secondary result was recurrence-free survival (RFS), which were analyzed by calculating the hazard ratio (HR) and 95% confidence intervals (CI). RESULTS A total of 25 studies (4249 patients), including 10 RCTs and 15 PSM observational studies, met the inclusion criteria. Although there was no significant difference between LR and RFA in terms of one-year OS, though LR showed superior performance for three- and five-year OS (at three years, HR: 0.74, 95% CI: 0.56-0.96; at five years, HR: 0.73, 95% CI: 0.55-0.94). In addition, significantly higher rates of RFS at one-, three- and five-year follow-up were found for LR than for RFA alone (at one year, HR: 0.68, 95% CI: 0.51-0.92; at three years, HR: 0.67, 95% CI: 0.55-0.81; at five years, HR: 0.61, 95% CI: 0.48-0.78). The combination of RFA+TACE was superior to RFA alone based on one-year RFS (HR: 0.57, 95% CI: 0.34-0.96), while there were no significant differences in OS at one, three, and five years, and in RFS at three and five years. CONCLUSIONS For very-early- and early-stage HCC, this systematic review and network meta-analysis showed that the efficacy of LR is superior to that of RFA alone, regardless of whether the evaluation is based on either OS or RFS. The advantages of RFA+TACE compared to RFA alone are limited, and further studies are needed to determine whether combination therapy is necessary, i.e., results in significantly improved outcomes. SYSTEMATIC REVIEW REGISTRATION The study was registered with http://www.crd.york.ac.uk/PROSPERO, identifier: CRD42022299269.
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Affiliation(s)
- Yunlong Zhang
- School of Medical Imaging, Weifang Medical University, Weifang, China
- Department of Medical Imaging Center, Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China
| | - Yunlong Qin
- School of Medical Imaging, Weifang Medical University, Weifang, China
- Department of Medical Imaging Center, Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China
| | - Peng Dong
- School of Medical Imaging, Weifang Medical University, Weifang, China
- Department of Medical Imaging Center, Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China
| | - Houfa Ning
- School of Medical Imaging, Weifang Medical University, Weifang, China
- Department of Medical Imaging Center, Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China
| | - Guangzhi Wang
- School of Medical Imaging, Weifang Medical University, Weifang, China
- Department of Medical Imaging Center, Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China
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Ward EM, Sherif AE, O'Neill S, Hughes M, Ireland H, Wigmore SJ, Adair A. Clinical Outcomes of Ablation Compared with Resection for Single Hepatocellular Carcinoma Lesions, as a Primary Treatment or Bridging to Liver Transplantation: A Retrospective Comparative Study. Ann Transplant 2021; 26:e931980. [PMID: 34326301 PMCID: PMC8330445 DOI: 10.12659/aot.931980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Ablative therapies (AT) are widely utilized as bridging treatment for liver transplantation (LT) candidates with hepatocellular carcinoma (HCC) who are on the transplant waiting list to minimize dropout rate. We aimed to investigate whether AT could be considered a primary treatment modality for LT candidates with single, small HCC lesions. Material/Methods We retrospectively investigated the outcomes of patients with AT for single HCC lesions as primary treatment or bridging to LT between 2010 and 2017, compared with surgical resection (SR) during the same time period as control. Univariate and multivariate survival analyses were performed. Matched analysis, after propensity score matching (PSM), was performed to minimize the selection bias confounding effect on outcomes. Results Of 162 patients identified, 92 received AT and 70 had SR. PSM identified 38 paired matches in each group. Overall survival (OS) and disease-free survival (DFS) before matching showed comparable outcomes for each treatment after 1, 3, and 5 years. Multivariate analysis using Cox regression models adjusting the study confounders showed lesion size (>30 mm), not treatment received, was associated with worse DFS (hazard ratio, 2.21 [95% confidence interval, 1.14–4.28]). In the matched groups, OS and DFS were equivalent and consistent with the whole-cohort survival outcomes. Explant histopathology of patients having AT as a bridge to LT showed complete pathological response in 85.7% of patients. Conclusions This study supports the use of AT with curative intent for single ≤3-cm HCCs, particularly in LT candidates, with salvage transplantation kept as a backup in case of recurrence.
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Affiliation(s)
- Elizabeth M Ward
- Department of Hepato-Pancreato-Biliary (HPB)/Transplant Surgery, The University of Edinburgh Clinical Surgery, Edinburgh, United Kingdom
| | - Ahmed Elshawadfy Sherif
- Department of Hepato-Pancreato-Biliary (HPB)/Transplant Surgery, The University of Edinburgh Clinical Surgery, Edinburgh, United Kingdom.,Department of Hepato-Pancreato-Biliary (HPB) Surgery, National Liver Institute, Menoufia University, Shibin Elkom, Egypt
| | - Stephen O'Neill
- Department of Transplant Surgery, Belfast City Hospital, Belfast, United Kingdom
| | - Michael Hughes
- Department of Hepato-Pancreato-Biliary (HPB)/Transplant Surgery, The University of Edinburgh Clinical Surgery, Edinburgh, United Kingdom
| | - Hamish Ireland
- Department of Interventional Radiology, Vascular Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Stephen J Wigmore
- Department of Hepato-Pancreato-Biliary (HPB)/Transplant Surgery, The University of Edinburgh Clinical Surgery, Edinburgh, United Kingdom
| | - Anya Adair
- Department of Hepato-Pancreato-Biliary (HPB)/Transplant Surgery, The University of Edinburgh Clinical Surgery, Edinburgh, United Kingdom
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Shin SW, Ahn KS, Kim SW, Kim TS, Kim YH, Kang KJ. Liver Resection Versus Local Ablation Therapies for Hepatocellular Carcinoma Within the Milan Criteria: A Systematic Review and Meta-analysis. Ann Surg 2021; 273:656-666. [PMID: 33074898 DOI: 10.1097/sla.0000000000004350] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare the oncologic outcomes of liver resection (LR) and local ablation therapies for HCC. SUMMARY OF BACKGROUND DATA Although several studies have compared LR and local ablation therapies, the optimal treatment of choice for HCC within the Milan criteria remains controversial. METHODS We systemically searched the MEDLINE, Embase, and Cochrane Library databases for randomized control trials (RCTs) and matched nonrandomized trials (NRTs) that compared LR and local ablation therapies for HCC within the Milan criteria. The primary outcome was overall survival (OS). Secondary outcomes were recurrence free survival (RFS) and recurrence pattern. RESULTS A total of 7 RCTs and 18 matched NRTs, involving 2865 patients in the LR group and 2764 patients in the local ablation therapy group [RFA, MWA, RFA plus trans-arterial chemoembolization (TACE)], were included. Although there was no significant difference in OS between LR and RFA, LR showed a significantly better 5-year RFS than RFA in the analysis of RCTs (hazards ratio: 0.75; 95% confidence interval: 0.62-0.92; P = 0.006). The RFA group showed a significantly higher local recurrence than the LR group in both analyses of RCTs and NRTs. Additionally, the LR group showed better OS and RFS than the MWA or RFA plus TACE groups. CONCLUSION Our meta-analysis showed that LR was superior to RFA in terms of RFS and incidence of local recurrence. Moreover, LR showed better oncologic outcomes than MWA or RFA plus TACE.
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Affiliation(s)
- Seong Wook Shin
- Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Zhou Y, Ding J, Qin Z, Wang Y, Zhang J, Jia K, Wang Y, Zhou H, Wang F, Jing X. Predicting the survival rate of patients with hepatocellular carcinoma after thermal ablation by nomograms. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1159. [PMID: 33241008 PMCID: PMC7576088 DOI: 10.21037/atm-20-6116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background To accurately predict the survival rate of patients with hepatocellular carcinoma (HCC) undergoing thermal ablation using nomograms taking early recurrence into account as a risk factor. Methods A total of 591 patients receiving percutaneous thermal ablation were included in this study. The overall survival (OS) and recurrence-free survival (RFS) rate was analyzed. Two prognostic nomograms with or without taking early recurrence into account as a risk factor were constructed using the independent predictors assessed by the multivariate Cox proportional hazard model. The performance of the nomograms, in terms of discrimination and calibration, was evaluated. Results The cumulative RFS and OS rates at 1-, 3- and 5-year are 82.2%, 52.5%and 38.4%, 96.6%, 83.6% and 65.5%, respectively. Multivariate analysis without considering the early recurrence shows that tumor number, α-fetoprotein (AFP) level, liver function, and GGT level are associated with OS. The early recurrence, tumor number, AFP level, and liver function are considered associated with the OS when considering early recurrence. Two different nomograms were developed from the above two results. Internal validation with 1,000 bootstrapped sample sets of the two nomograms shows the concordance indexes of 0.69 (95% CI: 0.624-0.748) for the baseline nomogram and 0.81 (95% CI: 0.754-0.857) for the early recurrence-based nomogram, with the latter significantly better in discriminating performance (Z statistics =92.19, P<0.0001). Conclusions The survival rate of patients with HCC undergoing radical thermal ablation can be reliably predicted by the nomogram presented in this study, which was developed by taking early recurrence into account.
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Affiliation(s)
- Yan Zhou
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Jianmin Ding
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Zhengyi Qin
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Yijun Wang
- Department of Hepatobiliary Surgery, Tianjin Third Central Hospital, Tianjin, China
| | - Jiayi Zhang
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Kefeng Jia
- Department of Radiology, Tianjin Third Central Hospital, Tianjin, China
| | - Yandong Wang
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Hongyu Zhou
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Fengmei Wang
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
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Fan H, Zhou C, Yan J, Meng W, Zhang W. Treatment of solitary hepatocellular carcinoma up to 2 cm: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20321. [PMID: 32501978 PMCID: PMC7306375 DOI: 10.1097/md.0000000000020321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In recent years, there has been considerable uncertainty about the optimal treatment option for very early hepatocellular carcinoma (HCC) with tumor size less than 2 cm. Therefore, we performed a systematic review and meta-analysis to evaluate the outcomes of the different treatments. METHODS This study was designed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA). PubMed, EMBASE, and Cochrane library were searched for calculating the survival rates, and the "time to event" method was used to compare the outcomes of liver resection (LR) and radiofrequency ablation (RFA). All studies focusing on the treatment of solitary HCC up to 2 cm by different techniques were included in our analysis. The Hazard ratios (HR) and 95% confidence intervals (CI) derived from multivariate and univariate analysis were utilized to assess the treatment risks. RESULTS We included 32 studies in our systematic review. The median 5-year overall survival (OS) and recurrence-free survival rate (RFS) for LR were 73% and 47%, respectively, and those for RFA were 73% and 43%, respectively. RFA was found to be associated with increased risk of mortality and recurrence compared to LR (HR = 1.61, 95% CI: 1.35-1.92, P < .0001 for OS and HR = 1.75, 95% CI: 1.56-1.96, P < .0001 for RFS). CONCLUSION Our meta-analysis demonstrated that LR is superior to RFA in the treatment of solitary HCC up to 2 cm, with reduction in mortality and recurrence risk and improved long-term outcome.
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Affiliation(s)
| | - Chenggang Zhou
- Department of general surgery, the Second People's Hospital of Lanzhou City, Gansu Province, China
| | - Jianzhou Yan
- Department of general surgery, the Second People's Hospital of Lanzhou City, Gansu Province, China
| | - Weihua Meng
- Department of general surgery, the Second People's Hospital of Lanzhou City, Gansu Province, China
| | - Wenquan Zhang
- Department of general surgery, the Second People's Hospital of Lanzhou City, Gansu Province, China
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