A Comparison between Three-Dimensional Visualization Guided Hepatectomy and Ultrasonography Guided Radiofrequency Ablation in the Treatment of Small Hepatocellular Carcinoma within the Milan Criteria

Application of a preoperative scoring system for small liver lesions in predicting small hepatocellular carcinoma

BACKGROUND

The treatment of small hepatocellular carcinoma (SHCC) is mainly based on surgical procedures, and early treatment can significantly improve the prognosis. How to improve the diagnostic rate of SHCC in patients with small liver lesions is a challenge faced by clinical doctors. Therefore, assessing the risk of SHCC in patients with small liver lesions and taking corresponding intervention measures are crucial for prolonging patient survival.

AIM

To evaluate the application value of a preoperative scoring system for small liver lesions established based on common clinical indicators in the clinical diagnosis of SHCC.

METHODS

The clinical data of 243 patients with small liver lesions who underwent surgery at our hospital from November 2014 to December 2022 were retrospectively analyzed. Multivariate logistic regression analysis was used to screen the variables with significant differences between the two groups of patients, and the weights of the main risk factors were assigned according to the screened values. A preoperative scoring system for small liver lesions was established. Finally, receiver operating characteristic curve (ROC) analysis was performed to evaluate its efficacy in the diagnosis of SHCC.

RESULTS

Logistic regression analysis showed that four variables, including viral hepatitis, cirrhosis, preoperative AFP level elevation, and imaging diagnosis of malignant tumor, were significantly associated with the occurrence of SHCC (P < 0.05). ROC analysis showed that the accuracy of the preoperative scoring system for small liver lesions in the diagnosis of malignant tumors was 0.864, and the cut-off value was 3.5. Based on the distribution of scores and ROC analysis results of the two groups of patients, the risk of developing SHCC in patients can be graded and analyzed.

CONCLUSION

The preoperative scoring system of small liver lesions has good efficacy for early diagnosis of benign and malignant small liver lesions.

Efficacy and safety of various primary treatment strategies for very early and early hepatocellular carcinoma: a network meta-analysis

BACKGROUND

Several treatments are available for treatment of early and very early-stage Hepatocellular Carcinoma, also known as small Hepatocellular Carcinoma (SHCC). However, there is no consensus with regards to the efficacies of these methods. We aimed at identifying the most effective initial treatment strategy for SHCC through Bayesian network meta-analyses.

METHODS

Studies published between January, 2010, and February, 2021 were searched in EMBASE, Cochrane Library, PubMed and Web of science databases, and conference proceedings for trials. The included studies reported the survival outcomes of very early and early Hepatocellular Carcinoma patients subjected to radiofrequency ablation (RFA), microwave ablation (MWA), surgical resection (SR), transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), minimally invasive liver surgery (MIS), stereotactic body radiotherapy (SBRT) and cryoablation (CA). Then, data were extracted from studies that met the inclusion criteria. Patient survival data were retrieved from the published Kaplan-Meier curves and pooled. A Bayesian random-effects model was used to combine direct and indirect evidence.

RESULTS

A total of 2058 articles were retrieved and screened, from which 45 studies assessing the efficacies of 8 different treatments in 11,364 patients were selected. The included studies had high methodological quality. Recurrence free survival* (progression/recurrence/relapse/disease/tumor-free survival were combined and redefined as RFS*) and overall survival (OS) outcomes were highest in MIS-treated patients (HR 0·57, 95% confidence intervals [CI] 0·38-0·85; HR 0.48,95% CI 0.36-0.64, respectively), followed by SR-treated patients (HR 0.60, 95% CI 0.50-0.74; HR 0.62, 95% CI 0.55-0.72, respectively). TACE was highly efficacious (58.9%) at decreasing the rates of major complications. Similar findings were obtained through sensitivity analysis, and in most of the prognostic subgroups.

CONCLUSIONS

MIS and SR exhibited the highest clinical efficacies, however, they were associated with higher rates of complications. Ablation is effective in small tumors, whereas SBRT is a relatively promising treatment option for SHCC. More well-designed, large-scale randomized controlled trials should be performed to validate our findings.

Liver resection versus radiofrequency ablation for hepatitis B virus-related small hepatocellular carcinoma

Background

To compare the outcomes of liver resection (LR) with radiofrequency ablation (RFA) for patients with hepatitis B virus (HBV)-related small hepatocellular carcinoma (HCC).

Methods

A total of 122 HBV-related small HCC patients who underwent LR (n=64) or RFA (n=58) were involved in this retrospective study. Their basic clinical data, postoperative complications, survival outcomes, and prognostic factors were compared and analyzed.

Results

Patients in the LR group had more serious complications (11 versus 0) and longer postoperative hospital stays (11.3 versus 6.0 days) than those in the RFA group (all P<0.05). LR was associated with better recurrence-free survival (RFS) rates at 1, 3, and 5 years compared with RFA (90.4%, 65.9%, and 49.5% versus 79.3%, 50.3%, and 35.6%, P=0.037), but there was no significant difference in overall survival (OS) (95.2%, 78.1%, 58.6% versus 93.1%, 71.3%, 52.9%, P=0.309). Multivariate Cox analysis showed that the hepatic cirrhosis (hazard ratio [HR]: 2.13), tumor number (HR: 3.73), tumor diameter (HR: 1.92), and postoperative anti-HBV therapy (HR: 0.53) had predictive values for RFS, and the latter three (HR: 4.34, 2.30, and 0.44) were independent predictors of OS (all P<0.05).

Conclusion

LR might be considered the preferred method for patients with HBV-related small HCC, while RFA could apply to selective cases. Anti-HBV therapy after treatment was recommended.