Abstract and Introduction
Background: Stage progression of 374 small hepatocellular carcinomas (HCC) was retrospectively analysed.
Patients and methods: During 8 years, 236 patients with the early stage of HCC received radiofrequency ablation (RFA), and 138 underwent surgery as an initial therapy. More patients of young age and with better liver function tended to undergo surgical treatment. Based on 1892 patient-year data, the Markov model analysed the stepwise progression of early stage (multiple up to three nodules, 3 cm or less each) to intermediate stage (four nodules or more, or larger than 3 cm), to advanced stage (portal invasion, extrahepatic metastasis or Child–Pugh C) and to death.
Results: The recurrence rates after RFA and surgery were 53.3 and 40.6% in the third year. The annual progression rates from the early stage to the intermediate stage, advanced stage and death were 5.40, 1.63 and 1.73% in the RFA group and 3.90, 1.87 and 0.62% in the surgery group respectively. The progression rate from the early to the intermediate stage was significantly lower (2.34% annually) in the younger patient group (<60 years) than that in the older group (≥60 years, 5.70%, P=0.0053). In contrast, the progression rate from the intermediate to the advanced stage was significantly higher in the younger patient group (<60 years, 37.50% annually) than that in the older groups (60–69 years, 30.30%, 70 years or older 22.09%, P=0.0011). Multivariate hazard analysis showed that initial treatment did not significantly affect the stage progression rate (hazard ratio of RFA 1.09, P=0.70) and the survival rate (hazard ratio of RFA 1.09, P=0.73).
Conclusion: Although the recurrence rate was slightly higher in the RFA group, additional ablation procedures could control the progression of HCC, with a rate comparable to the surgical group.
Hepatocellular carcinoma (HCC) is one of the most common neoplasms in the world today. Although routine imaging check-ups can often detect a small HCC at an early stage in high-risk patients with chronic hepatitis and cirrhosis, surgical resection is performed only in 20% or less of the cases because of the association of cirrhosis and tumour multiplicity. In the management of patients with HCC associated with cirrhosis, treatment repetition is common and inevitable for newly appearing multicentric tumours, and many practitioners hope each ablation procedure to be less invasive, less expensive and with a shorter hospitalization period.
Radiofrequency ablation (RFA) is currently considered the most effective percutaneous therapy for small HCCs, and certain centres now use it as a first-line treatment option, even in patients suitable for surgery. Indeed, RFA is sometimes considered as a less radical therapy compared with surgical resection because of the relatively high rate of local recurrence, but most of the local tumour progression can be completely treated through an additional RFA procedure. Surgical therapy, on the other hand, is an invasive mode of treatment with a higher cost, but achieves a lower recurrence rate. Only a few studies have evaluated the long-term outcome and prognostic factors of percutaneous RFA in comparison with surgical therapy.
When a recurrent tumour shows relatively advanced characteristics at an intermediate stage with a large tumour or multiples of four or more, transcatheter arterial chemoembolization (TACE) is preferred to surgical therapy or local ablation. We introduced the Markov model to simulate the steps of stage progression of patients with small HCC under an intensive medical intervention. Here, we retrospectively evaluated the progression of HCC and the long-term prognosis of patients who had undergone RFA or surgical resection as the initial therapy for small HCCs, and assessed the prognostic factors of those patients.
The purposes of this study were, therefore, (i) to compare the recurrence rates, progression of tumour stage and survival rates between those patients who received percutaneous RFA and those who underwent surgery and (ii) to elucidate the significance of the selection of initial therapy for small HCCs from the viewpoints of stage progression and prognosis.