Surgery, RFA Had Similar Outcomes for Early HCCBY M. ALEXANDER OTTO
Elsevier Global Medical News
SAN FRANCISCO – Radiofrequency ablation appears to have similar effectiveness to surgical resection for treating early-stage hepatocellular carcinomas, based on a randomized trial of 168 patients.
Researchers at Southwest Hospital in Chongqing, China, compared radiofrequency ablation (RFA) with surgical resection. Each treatment group consisted of 84 patients, and each patient had either one or two tumors that were less than 4 cm in diameter, said Dr. Ma Kuansheng at the annual meeting of the American Association for the Study of Liver Diseases.
In the surgical resection group, 81 patients (96%) were alive at 1 year, 74 (88%) at 2 years, and 63 (75%) at 3 years.
In the RFA group, 78 (93%) were alive at 1 year, 70 (83%) at 2 years, and 57 (68%) at 3 years. The differences between groups were not statistically significant (P = .3). Results for tumor recurrence were similar: 27 (32%) of the surgery patients had tumor recurrence within 3 years, compared with 35 (42%) of the RFA patients. Again, this difference was not statistically significant.
For treatment of one or two liver tumors less than 4 cm, “RFA provided the same overall and recurrence-free survival rates as surgical resection [and] has the advantages of minimal invasiveness and a low occurrence of complications,” said Dr. Kuansheng of the hospital’s hepatobiliary surgery department. Also, costs are lower with radiofrequency ablation, he added.
The study findings could help settle the debate about which technique is better for treating early liver cancer. “There are always arguments [about whether] you should just cut it out, [or]
try [RFA]. I think this study basically shows that there is no difference, so you should decide what’s the most economic way of dealing with this,” said Dr. Jake Liang, president of the American Association for the Study of Liver Diseases and chief of the Liver Diseases Branch of the National Institute of Diabetes and Digestive and Kidney Diseases. In the United States, both treatment approaches are available. However, surgery can be especially difficult in patients with cirrhosis. “Because their livers are all scarred, it’s very difficult to resect them,” commented Dr. Liang at the meeting.
Almost 10% of the RFA patients developed complications during the procedure, including two patients with hemorrhage. In contrast, complications occurred in over 20% of surgery patients,
including two with hemorrhage that required emergency laparotomy, and one patient who developed a liver abscess.
Radiofrequency ablation took an average of 41 minutes, and had a mean blood loss of 21 mL. Surgery took 141minutes on average, and blood loss was a mean of 375 mL; many of the patients needed transfusions. The average length of hospital stay was about 1 week for RFA patients vs. just over 2 weeks for surgery patients.
Eight RFA patients had residual tumor that was missed during the procedure: six with tumor under the liver capsule, one with tumor next to the gallbladder, and one with tumor adjacent to the portal vein trunk.
The investigators determined that analysis both with and without those patients did not significantly affect 3-year survival outcomes.
Most of the patients in both arms were men, with a mean age of about 50 years. A total of 85% had blood markers of hepatitis, most often hepatitis B surface antigen. There were no statistically significant baseline differences in alanine aminotransferase; alpha-fetoprotein; tumor size, number, or grade; or other characteristics that were analyzed.
The findings come at a time when liver cancer is on the rise, “mostly because of viral hepatitis,” Dr. Liang noted. “The best treatment for liver cancer is liver transplantation. You get a very high cure rate if you transplant early enough, but, obviously, not everybody can be transplanted.
There are resource issues,” he said.
Dr. Kuansheng and Dr. Liang said they
have no financial disclosures. ■
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GI & Hepatology News is the official newspaper of the AGA Institute and provides the gastroenterologist with timely and relevant news and commentary about clinical developments and about the impact of health-care policy. The newspaper is led by an internationally renowned board of editors.
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3 cm had significantly higher survival than patients with larger tumors at 5 years (65.1% vs. 46.5%) and 10 years (30.7% vs. 18.6%). Among 237 patients who were deemed good candidates for surgical resection but refused surgery, 5-year survival after RFA was 75.9% — similar to that of patients with HCC who undergo surgical resection.
