Long term effect of percutaneous radiofrequency ablation and repeated hepatectomy in treatment of advanced recurrent liver cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHENG Huanli , ZHONG Furui , ZHANG Hao , ZHANG Mengyu , HE Kai ,  XIA Xianming

Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

XIA Xianming, Email: xxmlzyxy@163.com

Keywords：

hepatocellular carcinoma; tumor recurrence; radiofrequency ablation; repeated hepatectomy; propensity score matching

DOI：

10.7507/1007-9424.202005001

Video：

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Objective To compare clinical effect of percutaneous radiofrequency ablation (RFA) and open repeated hepatectomy (ORH) in treatment of liver cancer with late recurrence (recurrence time >12 months) and single tumor diameter ≤5 cm.Methods The patients with advanced intrahepatic recurrence after first operation for liver cancer in this hospital from January 2013 to December 2019 were retrospectively collected, who were treated with ORH (ORH group) or percutaneous RFA (RFA group) and met the inclusion criteria. The overall survival rate and disease-free survival rate of the two groups were compared after 1∶1 matching by propensity score matching (PSM), while the factors affecting survival were stratified.Results A total of 244 patients with recurrent liver cancer were collected, including 134 patients in the ORH group, 110 patients in the RFA group. The patients in the two groups were matched with 1∶1 by PSM, 90 patients in each group. The median overall survival time of the ORH group and the RFA group was 54 months and 45 months, respectively. There were no significant differences in the curves of cumulative overall survival and cumulative disease-free survival between the two groups (P=0.221, P=0.199). The incidence of severe complications in the ORH group was higher than that in the RFA group (10.00% versus 2.22%, P=0.029). A further subgroup analysis showed that the overall survival time of the ORH group was longer than that of the RFA group when the diameter of recurrent liver cancer was 3 to 5 cm (P=0.035), which had no significant differences for the patients with AFP (>400 μg/L or ≤400 μg/L), tumors number (single or multiple), and tumor diameter ≤3 cm between the two groups (P>0.05).Conclusions Percutaneous RFA is effective and safe in treatment of advanced recurrent liver cancer, its overall survival and disease-free survival are similar to ORH treatment. However, when diameter of recurrent tumor is3–5 cm, ORH treatment has a advantage in prolonging survival time of patients.

Citation： CHENG Huanli, ZHONG Furui, ZHANG Hao, ZHANG Mengyu, HE Kai, XIA Xianming. Long term effect of percutaneous radiofrequency ablation and repeated hepatectomy in treatment of advanced recurrent liver cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(2): 224-229. doi: 10.7507/1007-9424.202005001 Copy

1.	李超. 中国癌症流行的国际比较. 中国肿瘤, 2016, 25(6): 409-414.
2.	中国抗癌协会肝癌专业委员会, 中国抗癌协会临床肿瘤学协作委员会, 中华医学会肝病学分会肝癌学. 原发性肝癌规范化诊治专家共识. 临床肿瘤学杂志, 2009, 14(3): 259-269.
3.	Shi J, Sun Q, Wang Y, et al. Comparison of microwave ablation and surgical resection for treatment of hepatocellular carcinomas conforming to Milan criteria. J Gastroenterol Hepatol, 2014, 29(7): 1500-1507.
4.	Bruix J, Sherman M. American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology, 2011, 53(3): 1020-1022.
5.	中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版). 临床肝胆病杂志, 2020, 36(2): 277-292.
6.	中国医师协会器官移植医师分会, 中华医学会器官移植学分会. 中国肝癌肝移植临床实践指南(2018版). 临床肝胆病杂志, 2019, 35(2): 275-280.
7.	Lu LH, Mei J, Kan A, et al. Treatment optimization for recurrent hepatocellular carcinoma: Repeat hepatic resection versus radiofrequency ablation. Cancer Med, 2020, 9(9): 2997-3005.
8.	李雪梅, 王博方, 马延龄. 复发肝癌的诊断与治疗. 中华肝脏外科手术学电子杂志, 2020, 9(2): 116-122.
9.	Chen X, Chen Y, Li Q, et al. Radiofrequency ablation versus surgical resection for intrahepatic hepatocellular carcinoma recurrence: a meta-analysis. J Surg Res, 2015, 195(1): 166-174.
10.	Lee DH, Lee JM, Lee JY, et al. Radiofrequency ablation for intrahepatic recurrent hepatocellular carcinoma: long-term results and prognostic factors in 168 patients with cirrhosis. Cardiovasc Intervent Radiol, 2014, 37(3): 705-715.
11.	Choi D, Lim HK, Rhim H, et al. Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy: long-term results and prognostic factors. Ann Surg Oncol, 2007, 14(8): 2319-2329.
12.	Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis, 2010, 30(1): 52-60.
13.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
14.	侯帅, 樊琳琳. 非手术治疗原发性肝癌研究进展. 实用肝脏病杂志, 2016, 19(2): 249-252.
15.	Mazzaferro V, Lencioni R, Majno P. Early hepatocellular carcinoma on the procrustean bed of ablation, resection, and transplantation. Semin Liver Dis, 2014, 34(4): 415-426.
16.	Huang ZM, Li W, Li S, et al. Cytokine-induced killer cells in combination with transcatheter arterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma patients. J Immunother, 2013, 36(5): 287-293.
17.	Chen H, Wu MC, Luo XJ, et al. An analysis of prospective outcome of re-resection for recurrent live cancer and extrahepatic metastases, a follow-up of 267 cases. Chin-Ger J Clin Onco, 2003, 2(1): 2-9.
18.	Liang HH, Chen MS, Peng ZW, et al. Percutaneous radiofrequency ablation versus repeat hepatectomy for recurrent hepatocellular carcinoma: a retrospective study. Ann Surg Oncol, 2008, 15(12): 3484-3493.
19.	Takahashi H, Mizuta T, Kawazoe S, et al. Efficacy and safety of radiofrequency ablation for elderly hepatocellular carcinoma patients. Hepatol Res, 2010, 40(10): 997-1005.
20.	Lau WY, Leung TW, Yu SC, et al. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg, 2003, 237(2): 171-179.
21.	Zhang X, Li C, Wen T, et al. Appropriate treatment strategies for intrahepatic recurrence after curative resection of hepatocellular carcinoma initially within the Milan criteria: according to the recurrence pattern. Eur J Gastroenterol Hepatol, 2015, 27(8): 933-940.
22.	Eisele RM, Chopra SS, Lock JF, et al. Treatment of recurrent hepatocellular carcinoma confined to the liver with repeated resection and radiofrequency ablation: a single center experience. Technol Health Care, 2013, 21(1): 9-18.
23.	Hasegawa K, Aoki T, Ishizawa T, et al. Comparison of the therapeutic outcomes between surgical resection and percutaneous ablation for small hepatocellular carcinoma. Ann Surg Oncol, 2014, 21(Suppl 3): S348-S355.
24.	中国抗癌协会肿瘤介入学专业委员会, 上海市抗癌协会实体肿瘤聚焦诊疗专业委员会. 影像导引肝脏恶性肿瘤多模态消融治疗技术专家共识. 临床肝胆病杂志, 2018, 34(10): 2098-2102.
25.	Wang Q, Blank S, Fiel MI, et al. The severity of liver fibrosis influences the prognostic value of inflammation-based scores in hepatitis B-associated hepatocellular carcinoma. Ann Surg Oncol, 2015, 22(Suppl 3): S1125-S1132.
26.	安松林, 荣维淇, 王黎明. 甲胎蛋白阴性和甲胎蛋白阳性肝细胞癌临床病理特征及R0切除后生存分析. 中华肿瘤杂志, 2015, 37(4): 308-311.
27.	Bertrand J, Caillol F, Borentain P, et al. Percutaneous hepatic radiofrequency for hepatocellular carcinoma: results and outcome of 46 patients. Hepat Med, 2015, 7: 21-27.
28.	Chen MH, Yang W, Yan K, et al. Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients–mathematic model, overlapping mode, and electrode placement process. Radiology, 2004, 232(1): 260-271.

1. 李超. 中国癌症流行的国际比较. 中国肿瘤, 2016, 25(6): 409-414.
2. 中国抗癌协会肝癌专业委员会, 中国抗癌协会临床肿瘤学协作委员会, 中华医学会肝病学分会肝癌学. 原发性肝癌规范化诊治专家共识. 临床肿瘤学杂志, 2009, 14(3): 259-269.
3. Shi J, Sun Q, Wang Y, et al. Comparison of microwave ablation and surgical resection for treatment of hepatocellular carcinomas conforming to Milan criteria. J Gastroenterol Hepatol, 2014, 29(7): 1500-1507.
4. Bruix J, Sherman M. American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology, 2011, 53(3): 1020-1022.
5. 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版). 临床肝胆病杂志, 2020, 36(2): 277-292.
6. 中国医师协会器官移植医师分会, 中华医学会器官移植学分会. 中国肝癌肝移植临床实践指南(2018版). 临床肝胆病杂志, 2019, 35(2): 275-280.
7. Lu LH, Mei J, Kan A, et al. Treatment optimization for recurrent hepatocellular carcinoma: Repeat hepatic resection versus radiofrequency ablation. Cancer Med, 2020, 9(9): 2997-3005.
8. 李雪梅, 王博方, 马延龄. 复发肝癌的诊断与治疗. 中华肝脏外科手术学电子杂志, 2020, 9(2): 116-122.
9. Chen X, Chen Y, Li Q, et al. Radiofrequency ablation versus surgical resection for intrahepatic hepatocellular carcinoma recurrence: a meta-analysis. J Surg Res, 2015, 195(1): 166-174.
10. Lee DH, Lee JM, Lee JY, et al. Radiofrequency ablation for intrahepatic recurrent hepatocellular carcinoma: long-term results and prognostic factors in 168 patients with cirrhosis. Cardiovasc Intervent Radiol, 2014, 37(3): 705-715.
11. Choi D, Lim HK, Rhim H, et al. Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy: long-term results and prognostic factors. Ann Surg Oncol, 2007, 14(8): 2319-2329.
12. Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis, 2010, 30(1): 52-60.
13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
14. 侯帅, 樊琳琳. 非手术治疗原发性肝癌研究进展. 实用肝脏病杂志, 2016, 19(2): 249-252.
15. Mazzaferro V, Lencioni R, Majno P. Early hepatocellular carcinoma on the procrustean bed of ablation, resection, and transplantation. Semin Liver Dis, 2014, 34(4): 415-426.
16. Huang ZM, Li W, Li S, et al. Cytokine-induced killer cells in combination with transcatheter arterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma patients. J Immunother, 2013, 36(5): 287-293.
17. Chen H, Wu MC, Luo XJ, et al. An analysis of prospective outcome of re-resection for recurrent live cancer and extrahepatic metastases, a follow-up of 267 cases. Chin-Ger J Clin Onco, 2003, 2(1): 2-9.
18. Liang HH, Chen MS, Peng ZW, et al. Percutaneous radiofrequency ablation versus repeat hepatectomy for recurrent hepatocellular carcinoma: a retrospective study. Ann Surg Oncol, 2008, 15(12): 3484-3493.
19. Takahashi H, Mizuta T, Kawazoe S, et al. Efficacy and safety of radiofrequency ablation for elderly hepatocellular carcinoma patients. Hepatol Res, 2010, 40(10): 997-1005.
20. Lau WY, Leung TW, Yu SC, et al. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg, 2003, 237(2): 171-179.
21. Zhang X, Li C, Wen T, et al. Appropriate treatment strategies for intrahepatic recurrence after curative resection of hepatocellular carcinoma initially within the Milan criteria: according to the recurrence pattern. Eur J Gastroenterol Hepatol, 2015, 27(8): 933-940.
22. Eisele RM, Chopra SS, Lock JF, et al. Treatment of recurrent hepatocellular carcinoma confined to the liver with repeated resection and radiofrequency ablation: a single center experience. Technol Health Care, 2013, 21(1): 9-18.
23. Hasegawa K, Aoki T, Ishizawa T, et al. Comparison of the therapeutic outcomes between surgical resection and percutaneous ablation for small hepatocellular carcinoma. Ann Surg Oncol, 2014, 21(Suppl 3): S348-S355.
24. 中国抗癌协会肿瘤介入学专业委员会, 上海市抗癌协会实体肿瘤聚焦诊疗专业委员会. 影像导引肝脏恶性肿瘤多模态消融治疗技术专家共识. 临床肝胆病杂志, 2018, 34(10): 2098-2102.
25. Wang Q, Blank S, Fiel MI, et al. The severity of liver fibrosis influences the prognostic value of inflammation-based scores in hepatitis B-associated hepatocellular carcinoma. Ann Surg Oncol, 2015, 22(Suppl 3): S1125-S1132.
26. 安松林, 荣维淇, 王黎明. 甲胎蛋白阴性和甲胎蛋白阳性肝细胞癌临床病理特征及R0切除后生存分析. 中华肿瘤杂志, 2015, 37(4): 308-311.
27. Bertrand J, Caillol F, Borentain P, et al. Percutaneous hepatic radiofrequency for hepatocellular carcinoma: results and outcome of 46 patients. Hepat Med, 2015, 7: 21-27.
28. Chen MH, Yang W, Yan K, et al. Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients–mathematic model, overlapping mode, and electrode placement process. Radiology, 2004, 232(1): 260-271.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Long term effect of percutaneous radiofrequency ablation and repeated hepatectomy in treatment of advanced recurrent liver cancer

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