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Tay BWR, Huang DQ, Mark M, Thong NW, Guan Huei L, Gee LS, Cheng LH, Mei LY, Thurairajah P, Chen LJ, Ng CH, Lim WH, Tan DJH, Maureen DC, Alfred KWC, Ganpathi IS, Seng TP, Young DY. Comparable Outcomes in Early Hepatocellular Carcinomas Treated with Trans-Arterial Chemoembolization and Radiofrequency Ablation. Biomedicines 2022; 10:2361. [PMID: 36289623 PMCID: PMC9598932 DOI: 10.3390/biomedicines10102361] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022] Open
Abstract
The guidelines recommend radiofrequency ablation (RFA) for early hepatocellular carcinomas that are less than 3 cm and trans-arterial chemoembolization (TACE) for intermediate-stage tumors. Real-world patient and tumor factors commonly limit strict adherence to the guidelines. We aimed to compare the clinical outcomes for TACE and RFA in early HCC. All consecutive patients from 2010 to 2014 that were treated with locoregional therapy at our institution were enrolled. The decision for TACE or RFA was based on tumor location, stage and technical accessibility for ablation. A subgroup analysis was performed for patients with tumors less than 3 cm. A total of 168 patients underwent TACE while 56 patients underwent RFA. Patients treated with TACE and RFA had 1- and 5-year survival rates of 84.7% and 39.8% versus 91.5% and 51.5%, respectively (p = 0.28). In tumors less than 3 cm, there was no significant difference in overall survival (p = 0.69), time to progression (p = 0.55), or number of treatment sessions required (p = 0.12). Radiofrequency ablation had a significantly higher chance of a complete response (p = 0.004). In conclusion, TACE may be selectively considered for early-stage hepatocellular carcinoma in patients unsuitable for other modalities.
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Affiliation(s)
- Benjamin Wei Rong Tay
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Daniel Q. Huang
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Muthiah Mark
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Neo Wee Thong
- Department of Diagnostic Imaging, National University Health System, Singapore 119228, Singapore
| | - Lee Guan Huei
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Lim Seng Gee
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Low How Cheng
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Lee Yin Mei
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Prem Thurairajah
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Lim Jia Chen
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Cheng Han Ng
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Wen Hui Lim
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Darren Jun Hao Tan
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Da Costa Maureen
- Division of Hepatobiliary Surgery, National University Health System, Singapore 119228, Singapore
| | - Kow Wei Chieh Alfred
- Division of Hepatobiliary Surgery, National University Health System, Singapore 119228, Singapore
| | - Iyer Shridar Ganpathi
- Division of Hepatobiliary Surgery, National University Health System, Singapore 119228, Singapore
| | - Tan Poh Seng
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
| | - Dan Yock Young
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Yin School of Medicine, National University of Singapore, Singapore 119077, Singapore
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Kamarajah SK, Bundred JR, Littler P, Reeves H, Manas DM, White SA. Treatment strategies for early stage hepatocellular carcinoma: a systematic review and network meta-analysis of randomised clinical trials. HPB (Oxford) 2021; 23:495-505. [PMID: 33309569 DOI: 10.1016/j.hpb.2020.10.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several treatment strategies for early stage hepatocellular cancers (HCC) have been evaluated in randomised controlled trials (RCTs). This network meta-analysis (NMA) aimed to explore the relative effectiveness of these different approaches on their impact on overall (OS) and recurrence-free survival (RFS). METHODS A systematic review was conducted to identify RCT's reported up to 23rd January 2020. Indirect comparisons of all regimens were simultaneously compared using random-effects NMA. RESULTS Twenty-eight RCT's, involving 3,618 patients, reporting 13 different treatment strategies for early stage HCC were identified. Median follow-up, reported in 22 studies, ranged from 12-93 months. In this NMA, RFA in combination with iodine-125 was ranked first for both RFS (HR: 0.50, 95% CI: 0.19-1.31) and OS (HR: 0.41, 95% CI: 0.19-0.94). In subgroup with solitary HCC, lack of studies reporting RFS precluded reliable analysis. However, RFA in combination with iodine-125 was associated with markedly better OS (HR: 0.21, 95% CI: 0.05-0.93). CONCLUSION This NMA identified RFA in combination with iodine-125 as a treatment delivering better RFS and OS, in patients with early stage HCC, especially for those with solitary HCC. This technique warrants further evaluation in both Asia and Western regions.
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Affiliation(s)
- Sivesh K Kamarajah
- Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK; Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, Tyne and Wear, UK; Department of Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, UK.
| | - James R Bundred
- Leeds Teaching Hospitals NHS Trust Research and Innovation Department, Leeds, UK
| | - Peter Littler
- Department of Interventional Radiology, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Helen Reeves
- Newcastle University Centre for Cancer, Newcastle University Medical School, Newcastle upon Tyne, UK; Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Derek M Manas
- Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK
| | - Steven A White
- Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK; Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, Tyne and Wear, UK
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