Repeat hepatic resection and ablation tied to similar overall survival in recurrent hepatocellular carcinoma: Study

China: A new study comparing repeat hepatic resection (rHR) and ablation based on the radio- or microwaves found that both the procedures resulted in similar overall survival in patients with recurrent hepatocellular carcinoma after resection of the primary tumor. The article was published in the BJS Open.

Hepatocellular carcinoma (HCC), or liver cancer, remains a global health challenge as it is one of the most serious cancers in adults. It occurs often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection. It is observed that HCC incidence and mortality rates have been increasing for decades. Though it is a life-threatening illness, if diagnosed early it can be successfully treated with surgery or a liver transplant.

Hepatic resection and radiofrequency or microwave ablation are commonly used to treat patients with hepatocellular carcinoma (HCC) satisfying the Milan criteria (single nodule 5 cm or less, or up to three nodules less than 3 cm each, and no macrovascular invasion or distant metastasis). The 5-year recurrence rate is as high as 49–60 percent among patients with early-stage HCC. HCC recurrence remains the leading cause of HCC-related deaths, thus more effective treatment strategies are needed for recurrent HCC. Previous studies on the efficacy of repeat hepatic resection (rHR) in treating recurrent hepatocellular carcinoma compared with radiofrequency or microwave ablation after resection of the primary tumor provided controversial conclusions.

Bao-Hong Yuan, Kunming Medical University, China, and his research team performed a systematic review and meta-analysis study to compare the safety and efficacy of repeat hepatic resection (rHR) and radiofrequency or microwave ablation procedures to treat recurrent hepatocellular carcinoma

Researchers systematically searched PubMed, Embase, Scopus, Cochrane Library, and China National Knowledge Infrastructure databases to identify studies comparing repeat hepatic resection (rHR) and radiofrequency or microwave ablation procedures. Researchers compared overall and recurrence-free survival after different treatments, based on pooled hazard ratios with a random-effects model. Two randomized clinical trials and 28 observational studies were included, involving 1961 and 2787 patients who underwent rHR and ablation respectively.

Key points noted during the analysis,

• Median perioperative mortality in both groups was zero. Still, patients in the repeat hepatic resection group had higher median morbidity rates (17.0 percent) than those in the ablation group (3.3 percent).

• Repeat hepatic resection achieved significantly longer recurrence-free survival than ablation (HR- 0.79).

• Both groups had similar overall survival (HR- 0.93).

Researchers conclude that repeat hepatic resection and local ablation are associated with similar overall survival (OS) in patients with recurrent HCC. Repeated hepatic resection is associated with better recurrence-free survival (RFS), whereas local ablation leads to lower perioperative morbidity. The study results highlight the need for individualized, multidisciplinary strategies for treating recurrent hepatocellular carcinoma.

Reference:

Bao-Hong Yuan, Yan-Kun Zhu, Xu-Ming Zou, Hao-Dong Zhou, Ru-Hong Li, Jian-Hong Zhong, Repeat hepatic resection versus percutaneous ablation for the treatment of recurrent hepatocellular carcinoma: meta-analysis, BJS Open, Volume 6, Issue 2, April 2022, zrac036, https://doi.org/10.1093/bjsopen/zrac036