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Radiofrequency ablation versus repeat resection for recurrent hepatocellular carcinoma (≤ 5 cm) after initial curative resection

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Recurrence rate is up to 70% at 5 years for hepatocellular carcinoma (HCC) after initial resection, but the management of recurrent HCC remains unclear. To compare the efficacy and safety of radiofrequency ablation (RFA) and repeat resection as the first-line treatment in recurrent HCC.

Methods

This multicenter retrospective study analyzed 290 patients who underwent RFA (n = 199) or repeat resection (n = 91) between January 2006 and December 2016 for locally recurrent HCC (≤ 5 cm) following primary resection. We compared the overall survival (OS), progression-free survival (PFS), and complications between the two treatment groups for the total cohort and the propensity score matched (PSM) cohort.

Results

The 1-, 3-, and 5-year OS (90.7%, 69.04%, 55.6% vs. 87.7%, 62.9%, 38.1%, p = 0.11) and PFS (56.5%, 27.9%, 14.6% vs. 50.2%, 21.9%, 19.2%, p = 0.80) were similar in the RFA group and the repeat resection group. However, RFA was superior to repeat resection in complication rate and hospital stay (p ≤ 0.001). We observed similar findings in the PSM cohort of 48 pairs of patients and when OS and PFS were measured from the time of the primary resection. The OS of the RFA group was significantly better than repeat resection group among those with 2 or 3 recurrent tumor nodules in both the total cohort (p = 0.009) and the PSM cohort (p = 0.018).

Conclusion

RFA has the same efficacy as repeat resection in recurrent HCC patients, but with fewer complications. RFA is more efficient and safer than repeat resection in patients with 2 or 3 recurrent tumor nodules.

Key Points

• Recurrence rate is up to 70% at 5 years for hepatocellular carcinoma (HCC) after initial resection.

• RFA has the same efficacy as repeat resection in recurrent HCC patients, but with fewer complications.

• RFA may be preferred for those with 2 or 3 recurrent HCC nodules.

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Abbreviations

ALT:

Alanine aminotransferase

CI:

Confidence interval

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

MELD:

Model for end-stage liver disease

MRI:

Magnetic resonance imaging

OS:

Overall survival

PFS:

Progression-free survival

PSM:

Propensity score matching

RFA:

Radiofrequency ablation

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Acknowledgments

The authors would like to thank Prof. Ying Zhang (Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States) for the revision of the draft.

Funding

This work was supported in part by the National Natural Science Foundation of China (No. 81570551; 81770607) and Key Research Project of Shandong Province (No. 2016GSF201008).

Author information

Author notes

  1. Yuemin Feng and Hao Wu contributed equally to this article.

Authors and Affiliations

  1. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China

    Yuemin Feng, Hao Wu, Chenghui Xu, Hang Zheng, Feng Xiao, Tiantian Liu, Chengyong Qin & Qiang Zhu

  2. Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore

    Daniel Q. Huang

  3. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA

    Mayumi Maeda & Mindie H. Nguyen

  4. Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China

    Xinya Zhao

  5. Department of Geriatrics, Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China

    Le Wang

  6. Department of Gastroenterology, The Second Affiliated Hospital of Shandong First Medical University, Tai’an, Shandong Province, China

    Feng Xiao

  7. Department of Gastroenterology, Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, China

    Huanran Lv

  8. Department of Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China

    Jianni Qi

  9. Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China

    Jie Li & Wanhua Ren

  10. Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China

    Ning Zhong

  11. Department of Cancer Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China

    Chuanxi Wang & Hong Feng

  12. Department of Ultrasonic Intervention, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China

    Bo Liang

Authors
  1. Yuemin Feng
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  2. Hao Wu
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  20. Mindie H. Nguyen
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Corresponding author

Correspondence to Qiang Zhu.

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Guarantor

The scientific guarantor of this publication is Prof. Qiang Zhu.

Conflict of interest

Dr. Mindie H. Nguyen has received research support from the National Cancer Institute, B.K. Kee Foundation, Gilead, Pfizer, and has served as consultant and/or advisory board member for Exact Sciences, Laboratory of Advanced Medicine, Gilead, Eisai, Bayer, Spring Bank, and Novartis.

All other authors hereby declare that there is no potential or actual personal, financial, or political interest related to this study.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• prognostic study

• multicenter study

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Feng, Y., Wu, H., Huang, D.Q. et al. Radiofrequency ablation versus repeat resection for recurrent hepatocellular carcinoma (≤ 5 cm) after initial curative resection. Eur Radiol 30, 6357–6368 (2020). https://doi.org/10.1007/s00330-020-06990-8

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  • DOI: https://doi.org/10.1007/s00330-020-06990-8

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