Liver resection, radiofrequency ablation treated HCC in cirrhotic patients comparably
Patients with cirrhosis and hepatocellular carcinoma experienced similar survival and tumor recurrence rates after treatment with either liver resection or radiofrequency ablation in a recent study.
In a multicenter study in Italy, researchers evaluated 544 patients with Child-Turcotte-Pugh class A cirrhosis and treatment-naive HCC of 3 cm or smaller who underwent liver resection (RES; n=246) or radiofrequency ablation (RFA; n=298). Mean follow-up occurred at 41 months for RES and 38 months for RFA recipients.
At 4 years, survival rates (74.4% of RES vs. 66.2% of RFA recipients; P=.353) and cumulative recurrence rates (56% vs. 57.1%; P=.765) were similar. Propensity score matching of 116 participants in each group did not result in significant differences in 4-year survival (68.8% for RES vs. 62.5% for RFA; P=.45) or recurrence (56.7% vs. 69.8%; P=.152). More RFA patients exhibited local tumor progression (20.5% of cases compared with one RES recipient; P<.001), while more RES recipients experienced nonlocal intrahepatic recurrence regardless of local tumor progression (42.7% vs. 34.2%; P=.001).
Major complications occurred in 4.5% of RES patients and 2% of the RFA group (P=.101), highlighted by pleural effusion, ascites and liver function failure. Two perioperative deaths (within 1 month of treatment) occurred in the RES group.
Subgroup analysis indicated that portal hypertension (PH) had no significant impact on patients’ overall 4-year survival rates (P=.146). Among patients with HCC of 2 cm or smaller, however, PH was associated with poorer survival (63% vs. 76.7% of those without PH; P=.006). This association trended toward significance when analysis was refined to the RES group (P=.054), but not RFA recipients (P=.121).
“Both RES and RFA provide excellent and comparable long-term OS and tumor recurrence rates,” the researchers concluded. “This implies that the choice between surgery and ablation should be tailored according to the individual patient’s features. Ablation could be chosen in patients with severe PH … and/or with centrally located tumors. Surgery should be preferred in patients without severe PH, with peripheral tumors or with tumors located near [the] gallbladder, main biliary ducts, bowel loops or big vessels.”