A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma
ABSTRACT The aim of this study was to compare the efficacy of radiofrequency ablation (RFA) with surgical resection (RES) in the treatment of small hepatocellular carcinoma (HCC).
A total of 168 patients with small HCC with nodular diameters of less than 4cm and up to two nodules were randomly divided into RES (n=84) and RFA groups (n=84). Outcomes were carefully monitored and evaluated during the 3-year follow-up period.
The 1-, 2-, and 3-year survival rates for the RES and RFA groups were 96.0%, 87.6%, 74.8% and 93.1%, 83.1%, 67.2%, respectively. The corresponding recurrence-free survival rates for the two groups were 90.6%, 76.7%, 61.1% and 86.2%, 66.6%, 49.6%, respectively. There were no statistically significant differences between the two groups in overall survival rate (p=0.342) or recurrence-free survival rate (p=0.122). Multivariate analysis demonstrated that the independent risk factors associated with survival were multiple occurrences of tumors at different hepatic locations (relative risk of 2.696; 95% CI: 1.189-6.117; p=0.018) and preoperative indocyanine green retention rate at 15min (ICG-15) (relative risk of 3.853; 95% CI: 1.647-9.015; p=0.002).
In patients with small hepatocellular carcinomas, percutaneous RFA may provide therapeutic effects similar to those of RES. However, percutaneous RFA is more likely to be incomplete for the treatment of small HCCs located at specific sites of the liver, and open or laparoscopic surgery may be the better choice.
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ABSTRACT: Whether to prefer hepatic resection or radiofrequency ablation as first line therapy for hepatocellular carcinoma is a matter of debate. To compare outcomes of resection and ablation, in the treatment of early hepatocellular carcinoma, through a decision-making analysis. Data of 388 cirrhotic patients undergoing resection and of 207 undergoing radiofrequency ablation were reviewed. Two distinct regression models were devised and used to perform sensitivity and probabilistic analyses, to overcome biases of covariate distributions. Actuarial survival curves showed no difference between resection and ablation (P=0.270) despite the fact that ablated patients were older, with worse liver function and smaller, unifocal tumours (P<0.05), suggesting a complex, non-linear relationship between clinical, tumoral variables and treatments. Sensitivity and probabilistic analyses suggested that the superiority of resection over ablation decreased at higher Model for-End stage Liver Disease scores, and that ablation provided better results for smaller tumours and higher Model for-End stage Liver Disease scores. In patients with 2-3 tumours up to 3cm, the two treatments produced opposite comparative results in relation to the Model for-End stage Liver Disease score. The superiority, or the equivalence, of resection and ablation depends on the non-linear relationship existing between treatment, tumour number, size and degree of liver dysfunction.Digestive and Liver Disease 11/2013; 46(3). DOI:10.1016/j.dld.2013.10.015 · 2.89 Impact Factor
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ABSTRACT: BACKGROUND & AIMS: Both hepatic resection and radiofrequency ablation (RFA) are considered curative treatments for hepatocellular carcinoma (HCC), but their economic impact still remains not determined. Aim of the present study was to analyze the cost-effectiveness (CE) of these two strategies in early stage HCC (Milan criteria). METHODS: As first step, a meta-analysis of the pertinent literature of the last decade was performed. Seventeen studies fulfilled the inclusion criteria: 3,996 patients underwent resection and 4,424 underwent RFA for early HCC. Data obtained from the meta-analysis were used to construct a Markov model. Costs were assessed from the health care providers perspective. A Monte-Carlo probabilistic sensitivity analysis was used to estimate outcomes with distribution samples of 1,000 patients for each treatment arm. RESULTS: In a 10 year perspective, for very early HCC (single nodule <2cm) in Child-Pugh class A patients, RFA provided similar life-expectancy and quality-adjusted life-expectancy at a lower cost than resection and was the most cost-effective therapeutic strategy. For single HCCs of 3-5cm, resection provided better life-expectancy and was more cost-effective than RFA, at a willingness-to-pay above €4,200 per quality-adjusted life-year. In the presence of two or three nodules ⩽3cm, life-expectancy and quality-adjusted life-expectancy were very similar between the two treatments, but cost-effectiveness was again in favour of RFA. CONCLUSIONS: For very early HCC and in the presence of two or three nodules ⩽3cm, RFA is more cost-effective than resection; for single larger early stage HCCs, surgical resection remains the best strategy to adopt as a result of better survival rates at an acceptable increase in cost.Journal of Hepatology 04/2013; 59(2). DOI:10.1016/j.jhep.2013.04.009 · 10.40 Impact Factor
Article: Focus.Journal of Hepatology 05/2012; 57(2):233-4. DOI:10.1016/j.jhep.2012.05.005 · 10.40 Impact Factor