The Clinical Efficacy of Surgical Removal of Hepatocellular Carcinoma in Caudate Lobe in the Chinese Population: A Case-control Study

Survival outcomes after caudate lobectomy for hepatocellular carcinoma: systematic review and meta-analysis

BACKGROUND

Caudate lobectomy (CLB) remains the most effective treatment for caudate lobe hepatocellular carcinoma (CL-HCC). However, there is controversy regarding the survival after CLB. This meta-analysis aims to investigate the survival outcomes following CLB for the treatment of CL-HCC.

METHODS

In line with PRISMA and MOOSE guidelines, a search for all eligible studies was performed. The pooled estimates of survival rates and hazard ratios (HRs) with their 95% confidence intervals (CIs) were calculated using fixed- or random-effects models.

RESULTS

Sixteen studies comprising 864 patients met the inclusion criteria. The pooled estimates of 3- and 5-year overall survival (OS) rates were 62.3% and 42.9% respectively and the pooled estimate of 3- and 5-year recurrence-free survival (RFS) rates were 39.3% and 24.4% respectively. CL-HCC showed inferior OS (HR:1.39, 95% CI: 0.91-1.88, P < 0.001) and RFS (HR:1.33, 95% CI: 1.10-1.56, P < 0.001) than other sites HCC. Isolated CLB showed better OS (HR:0.9, 95% CI:0.39-1.41, p < 0.001) and RFS (HR:0.76, 95% CI: 0.03-1.5, P = 0.04) than combined CLB.

CONCLUSIONS

The survival outcomes for CL-HCC after CLB are lower compared to other sites HCC. Isolated CLB offers better survival outcomes compared to combined CLB. However, choosing isolated or combined approaches should be prioritized according to patient and tumour characteristics.

Comparison of Hepatic Resection with Percutaneous Ablation for Hepatocellular Carcinoma in the Caudate Lobe Within Milan Criteria

PURPOSE

We aimed to compare the efficacy of hepatic resection and percutaneous ablation for resectable caudate HCC within Milan criteria and to investigate the prognostic factors.

METHODS

Between August 2006 and August 2020, a total of 67 eligible patients with resectable caudate HCC within Milan criteria in three centers were retrospectively analyzed and divided into hepatic resection group (n = 46) and percutaneous ablation group (n = 21). Recurrence-free survival (RFS) and overall survival (OS) rates were compared between groups of hepatic resection and percutaneous ablation for these resectable caudate HCC patients with Kaplan-Meier curves and log-rank test. Univariable and multivariable Cox regression analyses were performed to identify the prognostic factors of RFS and OS.

RESULTS

The 1-, 3-, and 5-year OS rates were 97.6%, 83.6%, and 71.5% for the hepatic resection group, and 89.4%, 58.5%, and 48.8% for the percutaneous ablation group (P = 0.032). The corresponding RFS rates were 77.6%, 47.9%, and 42.6% for the hepatic resection group, and 40.5%, 23.2%, and 15.4% for the percutaneous ablation group (P = 0.010). According to the univariable and multivariable analyses, tumor type (first recurrence) (HR = 3.54; 95%CI, 1.49-8.37; P = 0.004) was a significant independent prognostic factor of RFS for caudate HCC patients after resection or ablation, while total bilirubin (HR = 1.02; 95%CI, 1.01-1.04; P = 0.006) and treatment strategy (HR = 5.97; 95%CI, 1.48-24.12; P = 0.012) were significant independent prognostic factors of OS.

CONCLUSIONS

Hepatic resection appears to outperform percutaneous ablation for caudate HCC patients within Milan criteria.

Multi-Institutional Retrospective Study of Radiotherapy for Hepatocellular Carcinoma in the Caudate Lobe

Background: No studies evaluating the clinical outcomes of radiotherapy (RT) for hepatocellular carcinoma (HCC) in the caudate lobe have been available to date. The purpose of this study was to evaluate the effectiveness and safety of RT for HCC in the caudate lobe.

Material and Methods: Seventy patients with HCC in the caudate lobe treated with RT from a multi-institutional database were included in this study. The median equivalent dose in 2 Gy (EQD2) was 80.0 Gy₁₀ (range, 31.3–99.3), and freedom from local progression (FFLP), progression-free survival (PFS), and overall survival (OS) rates were evaluated.

Results: The median time of follow-up was 47.9 months (range, 3.4–127), and the 5-year FFLP, PFS, and OS rates were 80.6% [95% confidence interval (CI), 70.8–91.8], 13.8% (95% CI, 7.5–25.4), and 51.3% (95% CI, 39.9–66.1), respectively. In the multivariate analysis, the radiation dose was significantly associated with the FFLP rate [hazard ratio (HR), 0.57 per 10 Gy₁₀ increase, p = 0.001], and the status of FFLP was significantly associated with OS (HR, 2.694, p = 0.014). The overall rate of ≥grade 3 adverse events was 5.7% (4 of 70), and RT-related mortality was not observed.

Conclusion: RT for HCC in the caudate lobe showed promising FFLP and OS rates with safe toxicity profiles. These findings suggest that RT may be a promising treatment option for HCC in the caudate lobe.