No-touch multibipolar radiofrequency ablation vs. surgical resection for solitary hepatocellular carcinoma ranging from 2 to 5 cm

被引:101
作者
Mohkam, Kayvan [1 ]
Dumont, Paul-Noel [1 ]
Manichon, Anne-Frederique [2 ]
Jouvet, Jean-Christophe [2 ]
Boussel, Loic [2 ]
Merle, Philippe [3 ]
Ducerf, Christian [1 ]
Lesurtel, Mickael [1 ]
Rode, Agnes [2 ]
Mabrut, Jean-Yves [1 ]
机构
[1] Univ Lyon 1, Hosp Civils Lyon, Hop Croix Rousse, Dept Gen Surg & Liver Transplantat,EMR3738, Lyon, France
[2] Univ Lyon 1, Hosp Civils Lyon, Hop Croix Rousse, Dept Diagnost & Intervent Radiol, Lyon, France
[3] Univ Lyon 1, Hosp Civils Lyon, Hop Croix Rousse, Dept Hepatol, Lyon, France
关键词
Hepatocellular carcinoma; Radiofrequency; Ablation; Hepatectomy; Local neoplasm recurrence; MARGINAL STRUCTURAL MODELS; PARTIAL-HEPATECTOMY; LIVER-TRANSPLANTATION; HEPATIC RESECTION; TRIAL; RECURRENCE; MONOPOLAR; SURVIVAL; BIPOLAR; BENEFIT;
D O I
10.1016/j.jhep.2018.01.014
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background & Aims: No-touch multibipolar radiofrequency ablation (NTM-RFA) represents a novel therapy that surpasses standard RFA for hepatocellular carcinoma (HCC), but it has not been compared to surgical resection (SR). We aimed to compare the outcomes of NTM-RFA and SR for intermediate-sized HCC. Methods: Between 2012 and 2016, 141 patients with solitary HCC ranging from 2 to 5 cm were treated by NTM-RFA or SR at a single-center. The outcomes of 128 patients were compared after using inverse probability of treatment weighting (IPTW). Results: Seventy-nine patients had NTM-RFA and 62 had SR. After IPTW, the two groups were well-balanced for most baseline characteristics including tumor size, location, etiology, severity of underlying liver disease and alphafetoprotein level. Morbidity was higher (67.9% vs. 50.0%, p = 0.042) and hospital stay was longer (12 [IQR 8-13] vs. 7 [IQR 5-9] days, p <0.001) after SR. Local recurrence rates at one and three years were 5.5% and 10.0% after NTM-RFA and 1.9% and 1.9% after SR, respectively (p = 0.065). The rates of systematized recurrence (within the treated segment or in an adjacent segment within a 2 cm distance from treatment site) were higher after NTM-RFA (7.4% vs. 1.9% at one year, 27.8% vs. 3.3% at three years, p = 0.008). Most patients with recurrence were eligible for rescue treatment, resulting in similar overall survival (86.7% after NTM-RFA, 91.4% after SR at three years, p = 0.954) and disease-free survival (40.8% after NTM-RFA, 56.4% after SR at three years, p = 0.119). Conclusion: Compared to SR, NTM-RFA for solitary intermediate-sized HCC was associated with less morbidity and more systematized recurrence, while the rate of local recurrence was not significantly different. Most patients with intrahepatic recurrence remained eligible for rescue therapies, resulting in equivalent long-term oncological results after both treatments. Lay summary: Outcomes of patients treated for intermediatesized hepatocellular carcinoma by surgical resection or notouch multibipolar radiofrequency ablation were compared. No-touch multibipolar radiofrequency ablation was associated with a lower overall morbidity and a higher rate of systematized recurrence within the treated segment or in an adjacent segment within a 2 cm distance from the initial tumor site. Most patients with intrahepatic recurrence remained eligible for rescue curative therapy, enabling them to achieve similar longterm oncological results after both treatments. (C) 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:1172 / 1180
页数:9
相关论文
共 38 条
[1]   Heat Sink Phenomenon of Bipolar and Monopolar Radiofrequency Ablation Observed Using Polypropylene Tubes for Vessel Simulation [J].
Al-Alem, Ihssan ;
Pillai, Krishna ;
Akhter, Javed ;
Chua, Terence C. ;
Morris, David L. .
SURGICAL INNOVATION, 2014, 21 (03) :269-276
[2]   Prognostic factors and predictors of sorafenib benefit in patients with hepatocellular carcinoma: Analysis of two phase III studies [J].
Bruix, Jordi ;
Cheng, Ann-Lii ;
Meinhardt, Gerold ;
Nakajima, Keiko ;
De Sanctis, Yoriko ;
Llovet, Josep .
JOURNAL OF HEPATOLOGY, 2017, 67 (05) :999-1008
[3]   Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma [J].
Bruix, Jordi ;
Reig, Maria ;
Sherman, Morris .
GASTROENTEROLOGY, 2016, 150 (04) :835-853
[4]   A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma [J].
Chen, MS ;
Li, JQ ;
Zheng, Y ;
Guo, RP ;
Liang, HH ;
Zhang, YQ ;
Lin, XJ ;
Lau, WY .
ANNALS OF SURGERY, 2006, 243 (03) :321-328
[5]   Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma [J].
Cucchetti, Alessandro ;
Piscaglia, Fabio ;
Cescon, Matteo ;
Colecchia, Antonio ;
Ercolani, Giorgio ;
Bolondi, Luigi ;
Pinna, Antonio D. .
JOURNAL OF HEPATOLOGY, 2013, 59 (02) :300-307
[6]   Classification of surgical complications - A new proposal with evaluation in a cohort of 6336 patients and results of a survey [J].
Dindo, D ;
Demartines, N ;
Clavien, PA .
ANNALS OF SURGERY, 2004, 240 (02) :205-213
[7]   Liver Transplantation for Hepatocellular Carcinoma: A Model Including α-Fetoprotein Improves the Performance of Milan Criteria [J].
Duvoux, Christophe ;
Roudot-Thoraval, Francoise ;
Decaens, Thomas ;
Pessione, Fabienne ;
Badran, Hanaa ;
Piardi, Tullio ;
Francoz, Claire ;
Compagnon, Philippe ;
Vanlemmens, Claire ;
Dumortier, Jerome ;
Dharancy, Sebastien ;
Gugenheim, Jean ;
Bernard, Pierre-Henri ;
Adam, Rene ;
Radenne, Sylvie ;
Muscari, Fabrice ;
Conti, Filomena ;
Hardwigsen, Jean ;
Pageaux, Georges-Philippe ;
Chazouilleres, Olivier ;
Salame, Ephrem ;
Hilleret, Marie-Noelle ;
Lebray, Pascal ;
Abergel, Armand ;
Debette-Gratien, Marilyne ;
Kluger, Michael D. ;
Mallat, Ariane ;
Azoulay, Daniel ;
Cherqui, Daniel .
GASTROENTEROLOGY, 2012, 143 (04) :986-+
[8]  
European Assoc Study Liver, 2012, EUR J CANCER, V48, P599, DOI [10.1016/j.ejca.2011.12.021, 10.1016/j.jhep.2011.12.001]
[9]   A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma [J].
Feng, Kai ;
Yan, Jun ;
Li, Xiaowu ;
Xia, Feng ;
Ma, Kuansheng ;
Wang, Shuguang ;
Bie, Ping ;
Dong, Jiahong .
JOURNAL OF HEPATOLOGY, 2012, 57 (04) :794-802
[10]   Multipolar radiofrequency ablation of hepatic tumors: Initial experience [J].
Frericks, BB ;
Ritz, JP ;
Roggan, A ;
Wolf, KJ ;
Albrecht, T .
RADIOLOGY, 2005, 237 (03) :1056-1062