Highlights
- •Surgery provided better PFS and OS compared to RFA for small periportal HCCs.
- •There was significant interaction between treatment and vessel types for outcomes.
- •Evaluating type of peritumoral vessel may determine treatment strategy for HCCs.
Background & Aims
The therapeutic outcomes of surgical resection (SR) or radiofrequency ablation (RFA)
for perivascular hepatocellular carcinoma (HCC) have not been compared. The aim of
this study was to compare SR with RFA as first-line treatment in patients with perivascular
HCC and to evaluate the long-term outcomes of both therapies.
Methods
This retrospective study was approved by the institutional review board. The requirement
for informed consent was waived. Between January 2006 and December 2010, a total of
283 consecutive patients with small perivascular HCCs (≤3 cm, Barcelona Clinic Liver
Cancer stage 0 or A) underwent SR (n = 182) or RFA (n = 101) as a first-line treatment.
The progression-free survival (PFS) and overall survival (OS) rates were compared
by propensity score matching. Subgroup analysis of these outcomes was conducted according
to the type of hepatic vessels.
Results
The median follow-up was 7.8 years. Matching yielded 62 pairs of patients. In the
two matched groups, the PFS rates at 5 and 10 years were 58.0% and 17.8%, respectively,
in the SR group, and 25.4% and 14.1%, respectively, in the RFA group (p <0.001). The corresponding OS rates at 5 and 10 years were 93.5% and 91.9% in the
SR group and 82.3% and 74.1% in the RFA group, respectively (p <0.001). In contrast to those in patients with perivenous HCCs, subgroup analysis
indicated that extrahepatic recurrence and OS were significantly different according
to the treatment modality in patients with periportal HCCs (p = 0.004 and p <0.001, respectively).
Conclusions
In patients with small perivascular HCCs, SR provided better long-term tumor control
and OS than RFA, particularly for periportal tumors.
Lay summary
Surgical resection and radiofrequency ablation are both treatment options for perivascular
hepatocellular carcinoma. We compared outcomes in patients treated with either method.
Surgical resection provided better long-term tumor control and overall survival than
radiofrequency ablation for patients with a small perivascular hepatocellular carcinoma
(≤3 cm) as a first-line treatment, particularly for periportal tumors. The location
of the tumor and the type of peritumoral hepatic vessels need to be considered when
choosing between surgical resection and radiofrequency ablation for small HCCs.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: March 07, 2018
Accepted:
February 23,
2018
Received in revised form:
February 20,
2018
Received:
September 13,
2017
Identification
Copyright
© 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
