Optimal treatment strategy for recurrent hepatocellular carcinoma based on recurrence time and tumor size: A propensity score matching study - 11/08/23
Highlights |
• | Currently, there are no global guidelines to regulate the treatment of RHCC. This study analyzed the prognosis of RH and TACE-MWA in the treatment of RHCC by retrospective case-control. |
• | Recurrence time and tumor size may affect patient prognosis, therefore, subgroup analysis based on recurrence time and tumor size was conducted in this study. |
• | It is inevitable that there are differences among patients receiving different treatments. Therefore, PSM was adopted in this study to balance the differences between groups. |
• | Through retrospective analysis, the results of this study suggest that patients with RHCC should adopt personalized treatment, and the treatment methods are different with different recurrence time and tumor size. |
Abstract |
Background |
Recurrent hepatocellular carcinoma (RHCC) is commonly treated with transcatheter arterial chemoembolization (TACE) combined with microwave ablation (MWA) or repeated hepatectomy(RH), but the optimal treatment strategy is still controversial. This study aimed to compare the efficacy and safety of TACE-MWA and RH in RHCC patients after initial radical hepatectomy.
Methods |
A total of 210 RHCC patients were included between June 2014 and January 2021, with 126 patients in the TACE-MWA group and 84 patients in the RH group. The primary endpoints were median repeat recurrence-free survival (rRFS) and overall survival (OS), and the secondary endpoint was complications. Propensity-score matching (PSM) was conducted to minimize bias. Subgroup analysis based on recurrence patterns (recurrence time and tumor size) was performed, and prognostic factors were studied.
Results |
Before PSM, the RH group had better median OS (37.0 vs 26.0 months, P<0.001) and rRFS (15.0 vs 14.0 months, P = 0.003). After PSM, the RH group also had a better median OS (33.5 vs 29.0 months, P = 0.038), but there was no significant difference in median rRFS between the two groups (14.0 vs 13.0 months, P = 0.099). Subgroup analysis showed that when RHCC diameter>5 cm, RH had a better median OS (33.5 vs 25.0 months, P = 0.013) and rRFS (14.0 vs 10.9 months, P = 0.030). When the RHCC diameter was≤5 cm, there was no significant difference in the median OS (37.0 vs 31.0 months, P = 0.338) and rRFS (15.0 vs 17.0 months, P = 0.758) between the two groups. When RHCC relapses in the early stage (≤2 years), there is no significant difference in the median OS (26.0 vs 26.0 months, P = 0.310) and rRFS (12.0 vs 10.5 months, P = 0.089) between the two groups. When RHCC relapses in the late stage (>2 years), the RH group has better median OS (41.0 vs 33.0 months, P<0.001) and rRFS (30.0 vs 20.0 months, P = 0.010).
Conclusion |
Individualized therapy is necessary for RHCC. TACE -MWA may be a good choice for RHCC with early recurrence or tumor diameter ≤5 cm. However, RH should be the first choice for RHCC with late recurrence or tumor diameter>5 cm.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Recurrent hepatocellular carcinoma, Transcatheter arterial chemoembolization, Microwave ablation, Repeat hepatectomy, Overall survival, Recurrence-free survival
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Vol 47 - N° 7
Articolo 102157- Agosto 2023 Ritorno al numero
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