Surgical Resection as an Alternative to Local Ablation in Patients with Multifocal Hepatocellular Carcinomas within the Milan Criteria: Can It Be Justified? = Surgical Resection as an Alternative to Local Ablation in Patients with Multifocal Hepatocellular Carcinomas within the Milan Criteria: Can It Be Justified?

다국어 초록 (Multilingual Abstract)

Aims: Evidence-based guidelines recommend radiofrequency ablation (RFA) as a non-transplant option in treating patients with multiple hepatocellular carcinomas (HCCs) meeting the Milan criteria. Previous comparative studies have reported that local recurrence rate is higher in patients experiencing RFA than surgery. The purpose of this study is to compare the efficacy of RFA versus surgical resection in patients with operable HCCs within the Milan criteria.
Methods: Between 2007 and 2011, 650 asymptomatic patients with HCC fulfilling the Milan criteria were initially treated with RFA or surgery at our hospital. Among these, 129 patients with Child-Pugh A liver function who had more than one tumor were included in this study: RFA and resection were performed in 48 (37.2%) and 81 (62.8%), respectively. The patient median age was 56 years, 79.1% were males, and 83.7% were HBV-positive. Overall and recurrence- free survivals were compared between the two treatment groups. Clinical variables affecting survival or recurrence were also identified.
Results: The mean size of the largest tumor was 1.8±0.5 and 2.1±0.5 cm, respectively in the RFA and resection groups (P<0.05). Signs of portal hypertension were noted in 24 (50%) and 18 (22.2%) patients, respectively in the corresponding groups (P<0.05). During a median observation of 6.5 years, 34 (70.8%) and 50 (61.7%) recurrences; and 15 (31.3%) and 16 (19.8%) deaths occurred in the RFA and resection groups, respectively. The 5-year cumulative rates of recurrence-free- and overall survivals were 31.6% versus 32.7%; and 72.9% versus 85.2%, respectively in the corresponding groups (Ps=NS). Multivariate Cox analysis adjusted for significant confounders showed that no significant difference in the risk of recurrence or death was observed according to treatment method (Ps=NS).
Conclusions: Our data indicate that surgical resection may be not preferred over RFA in patients with multifocal HCCs at BCLC A stage, as recommended by current guidelines.