4 cm 이하의 단일결절 간세포암종에서 고주파열치료와 경동맥화학색전술의 효과 비교 = Comparison of radiofrequency ablation and transarterial chemoembolization for the treatment of a single hepatocellular carcinoma smaller than 4 cm

다국어 초록 (Multilingual Abstract)

Carcinoma, Hepatocellular, Radiofrequency ablation, Chemoembolization, Therapeutic, 간세포암종, 고주파열치료, 경동맥화학 색전술

다국어 초록 (Multilingual Abstract)

Background/Aims: Radiofrequency ablation (RFA) is an established curative therapeutic modality for unresectable hepatocellular carcinoma (HCC), and transarterial chemoembolization (TACE) has been used as a palliative treatment for inoperable HCC. It is still unknown whether RFA and TACE are equally effective for improving the survival of patients with unresectable HCC that is amenable to either treatment. The aim of this retrospective study was to compare the clinical impacts of two treatments, and analyze the prognostic factors for recurrence and survival. Methods: Ninety-three patients with a single HCC smaller than 4 cm who showed complete responses (complete ablation or complete lipiodol tagging) after treatment with RFA (n=43) or TACE (n=50) between January 2002 and February 2009 were investigated. Univariate and multivariate analyses were performed for 13 potential prognostic factors using the Cox proportional-hazards model. Results: The time-to-recurrence rates at 1, 2, and 3 years after treatment were 32.9%, 44.3%, and 55.4%, respectively, for the RFA group, and 42%, 68.3%, 71.7% for the TACE group. The probability of survival at 1, 2, and 3 years was 97.7%, 77.4%, and 63.1%, respectively, for the RFA group, and 95.9%, 76.1%, and 60.2% for the TACE group. The time-to-recurrence and overall survival rates did not differ significantly between the two treatment groups. A multivariate Cox proportional-hazards model revealed that a tumor size larger than 3 cm and lower serum albumin levels were independent risk factors for recurrence, and that being male, being seropositive for hepatitis B surface antigen, and having a higher serum albumin level were independent favorable prognostic factors for survival. Conclusions: TACE and RFA exhibited similar therapeutic effects in terms of recurrence and survival for patients with a single HCC smaller than 4 cm, if they could exhibited complete responses. (Korean J Hepatol 2009;15:474-485)

참고문헌 (Reference)

1 Brown DB, "Transcatheter therapy for hepatic malignancy: standardization of terminology and reporting criteria" 20 (20): S425-S434, 2009

2 Camma C, "Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials" 224 : 47-54, 2002

3 Lee HS, "Therapeutic efficacy of transcatheter arterial chemoembolization as compared with hepatic resection in hepatocellular carcinoma patients with compensated liver function in a hepatitis B virus-endemic area: a prospective cohort study" 20 : 4459-4465, 2002

4 Lau WY, "The current role of radiofrequency ablation in the management of hepatocellular carcinoma: a systematic review" 249 : 20-25, 2009

5 Llovet JM, "Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival" 37 : 429-442, 2003

6 Cho YK, "Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies" 49 : 453-459, 2009

7 Livraghi T, "Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?" 47 : 82-89, 2008

8 Hasegawa K, "Surgical resection vs. percutaneous ablation for hepatocellular carcinoma: a preliminary report of the Japanese nationwide survey" 49 : 589-594, 2008

9 Matsui O, "Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization" 188 : 79-83, 1993

10 Raut CP, "Significant long-term survival after radiofrequency ablation of unresectable hepatocellular carcinoma in patients with cirrhosis" 12 : 616-628, 2005

11 Arii S, "Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan" 32 : 1224-1229, 2000

12 Lee JK, "Recurrences of hepatocellular carcinoma following initial remission by transcatheter arterial chemoembolization" 17 : 52-58, 2002

13 Lo CM, "Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma" 35 : 1164-1171, 2002

14 Lin SM, "Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less" 54 : 1151-1156, 2005

15 Orlando A, "Radiofrequency thermal ablation vs. percutaneous ethanol injection for small hepatocellular carcinoma in cirrhosis: meta-analysis of randomized controlled trials" 104 : 514-524, 2009

16 Cabassa P, "Radiofrequency ablation of hepatocellular carcinoma: long- term experience with expandable needle electrodes" 1866 (1866): S316-S321, 2006

17 Rhim H, "Radiofrequency ablation of hepatic tumors: lessons learned from 3000 procedures" 23 : 1492-1500, 2008

18 Takayasu K, "Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients" 131 : 461-469, 2006

19 Bruix J, "Prognostic prediction and treatment strategy in hepatocellular carcinoma" 35 : 519-524, 2002

20 Okada S, "Predictive factors for postoperative recurrence of hepatocellular carcinoma" 106 : 1618-1624, 1994

21 Tateishi R, "Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases" 103 : 1201-1209, 2005

22 Choi D, "Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long- term results and prognostic factors in a large single- institution series" 17 : 684-692, 2007

23 Liem MS, "Outcome of transarterial chemoembolization in patients with inoperable hepatocellular carcinoma eligible for radiofrequency ablation" 11 : 4465-4471, 2005

24 Llovet JM, "Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials" 29 : 62-67, 1999

25 Villa E, "Natural history of inoperable hepatocellular carcinoma: estrogen receptors' status in the tumor is the strongest prognostic factor for survival" 32 : 233-238, 2000

26 Okuda K, "Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients" 56 : 918-928, 1985

27 지숙경, "Multivariate Analysis of the Predictors of Survival for Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Focusing on Superselective Chemoembolization" 대한영상의학회 9 (9): 534-540, 2008

28 "Ministry of Health and Welfare Republic of Korea" 2003

29 Machi J, "Long-term follow-up outcome of patients undergoing radiofrequency ablation for unresectable hepatocellular carcinoma" 29 : 1364-1373, 2005

30 Seung Hyun Park, "Local Recurrence of Hepatocellular Carcinoma after Segmental Transarterial Chemoembolization: Risk Estimates Based on Multiple Prognostic Factors" 대한영상의학회 8 (8): 111-119, 2007

31 Park JW, "Korean Liver Cancer Study Group and National Cancer Center. Practical guideline for diagnosis and treatment of hepatocellular carcinoma" 10 : 88-98, 2004

32 Poon RT, "Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors" 229 : 216-222, 1999

33 Lau WY, "Hepatocellular carcinoma: current management and recent advances" 7 : 237-257, 2008

34 Park JW, "Hepatocellular carcinoma in Korea: introduction and overview" 45 : 217-226, 2005

35 O’Suilleabhain CB, "Factors predictive of 5-year survival after transarterial chemoembolization for inoperable hepatocellular carcinoma" 90 : 325-331, 2003

36 Kew MC, "Epidemiology of hepatocellular carcinoma" 181-182 : 35-38, 2002

37 Miraglia R, "Efficacy of transcatheter embolization/ chemoembolization (TAE/TACE) for the treatment of single hepatocellular carcinoma" 13 : 2952-2955, 2007

38 Lencioni R, "Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image- guided radiofrequency ablation" 234 : 961-967, 2005

39 Poon RT, "Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma" 89 : 500-507, 2000

40 Chok KS, "Comparable survival in patients with unresectable hepatocellular carcinoma treated by radiofrequency ablation or transarterial chemoembolization" 141 : 1231-1236, 2006

41 Sacco R, "Clinical impact of selective transarterial chemoembolization on hepatocellular carcinoma: a cohort study" 15 : 1843-1848, 2009

42 Llovet JM, "Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial" 359 : 1734-1739, 2002

43 Ng KK, "Analysis of recurrence pattern and its influence on survival outcome after radiofrequency ablation of hepatocellular carcinoma" 12 : 183-191, 2008

44 Shiina S, "A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma" 129 : 122-130, 2005

45 Chen MS, "A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma" 243 : 321-328, 2006

46 Chevret S, "A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire" 31 : 133-141, 1999

47 Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire, "A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma" 332 : 1256-1261, 1995

48 Tanabe G, "A comparison of hepatocellular carcinoma associated with HBV or HCV infection" 46 : 2442-2446, 1999