Hepatic resection may be best for some multifocal liver tumors

Last Updated: 2015-08-28

By Will Boggs MD

NEW YORK (Reuters Health) - Patients with multifocal hepatocellular carcinoma (HCC) who undergo hepatic resection have better relapse-free survival than do those treated with radiofrequency ablation (RFA), researchers from China report.

Hepatic resection is accepted as the first line of treatment for patients with solitary HCC, but the best treatment for patients with multifocal tumors (<=3 nodules <=3 cm each) remains unclear.

Dr. Lunan Yan and colleagues from West China Hospital of Sichuan University in Chengdu compared the short- and long-term outcomes of hepatic resection and RFA in a study of 384 consecutive patients with multifocal HCC.

Two hundred twenty-four patients underwent hepatic resection with a conventional open approach, and 160 patients had RFA using percutaneous, laparoscopic, or open methods.

There were no postoperative deaths in either group, and the rates of postoperative complications did not differ significantly.

Similarly, there were no significant differences between the resection and RFA groups in overall survival at one year (96% vs. 90.0%, respectively), three years (71.7% vs. 72.7%) or five years (36.3% vs. 37.8%), the researchers report in the Journal of the American College of Surgeons, online August 19.

In contrast, relapse-free survival was significantly higher in the resection group than in the RFA group at one year (87.5% vs. 83.1%, respectively), three years (53.1% vs. 34.0%), and five years (20.1% vs. 9.7%).

In a propensity-matched analysis of 140 pairs of patients, overall survival was similar but relapse-free survival was significantly higher in the resection group, compared with the RFA group.

On multivariate analysis, the presence of three tumors, portal hypertension, and tumors located in different hepatic segments independently predicted poor postoperative survival.

"For patients with multifocal tumors meeting the BCLC stage A, hepatic resection may offer significantly better relapse-free survival (RFS) than RFA although no differences exist in the overall survival between group hepatic resection and RFA, and hepatic resection may be considered as the first-line treatment option for those patients," the researchers conclude.

However, they add, "RFA may provide shorter length of postoperative hospital stay, less cost, and less influence for quality of life."

The team concludes, "hepatic resection may be more suitable for early HCC patients with 2 tumors than RFA, but both hepatic resection and RFA may be suitable for early HCC patients with 3 tumors. Similarly, hepatic resection may be more suitable for early HCC patients with tumors locating in the same lobe (Couinaud's segmentation) or segment (Takasaki's Segmentation) than RFA, but both hepatic resection and RFA may be suitable for early HCC patients with tumors locating in the different lobes or segments."

Dr. Giovanni G. Di Costanzo from Cardarelli Hospital in Naples, Italy, recently reviewed the best treatments for intermediate-stage HCC. He told Reuters Health by email, "This retrospective study shows in a large sample (this is a main strength of the study) that resection is associated with longer RFS in patients with two nodules located in the same liver lobe. The same results were previously reported for single tumors within BCLC A."

"In the other cases (3 nodules, location in different lobes), main outcomes after resection and RFA were comparable," he said. "Therefore, in these last cases, due to the (lower) cost, (shorter) hospital stay, and better quality of life, RFA should be the treatment of choice."

"However, due to the retrospective design and potential selection biases, this study is not enough to indicate definite choices," Dr. Di Costanzo concluded. "A randomized controlled trial should be needed (using the 3-year recurrence rate in patients with 2 nodules, the sample size for each group will be 88 patients)."

Dr. Yan did not respond to a request for comments.

SOURCE: http://bit.ly/1hJtUWI

J Am Coll Surg 2015.