Comparing Long-Term survival benefits of hepatocellular carcinoma between thermal ablation monotherapy and combined therapy with transarterial Chemoembolization: A propensity score matched study

Predictive Value of Radiographic Tumor Burden Score in Hepatocellular Carcinoma Within Milan Criteria After Microwave Ablation: Implications for Long-Term Outcomes and Treatment Planning

OBJECTIVE

This study aimed to investigate the predictive value of the radiographic tumor burden score (TBS) for long-term outcomes in hepatocellular carcinoma (HCC) patients meeting Milan criteria after microwave ablation (MWA) and to delineate its significance in guiding treatment planning.

METHODS

Retrospective analysis was conducted on clinical data from 198 HCC patients meeting Milan criteria, who underwent MWA at our hospital from January 2011 to December 2018. Using X-tile software, the optimal critical value of TBS was determined, leading to the categorization of patients into high- and low-TBS groups. Propensity score matching (PSM) was applied to balance covariates between these groups.

RESULTS

Before PSM, the 5-year overall survival (OS) rate and recurrence-free survival (RFS) rate in the high-TBS (47 cases) and low-TBS groups (151 cases) were 32.8% versus 59.7% (p = 0.033) and 23.4% versus 50.9% (p = 0.016), respectively. Following PSM, the 5-year OS rate and RFS rate in the high-TBS (44 cases) and low-TBS groups (95 cases) were 30.2% versus 64.1% (p = 0.011) and 21.9% versus 45.9% (p = 0.0059), respectively. Cox analysis identified high TBS and percutaneous microwave ablation (PMWA) as independent risk factors for OS and RFS. The stratified analysis revealed that the median RFS time for patients undergoing laparoscopic microwave ablation (LMWA) (20 cases) and PMWA (24 cases) in the high-TBS group (44 cases) was 45 and 10.5 months, respectively (p = 0.006).

CONCLUSION

TBS emerged as a robust predictor for the long-term outcomes of HCC within Milan criteria after MWA. A higher TBS was associated with a diminished long-term survival rate. Notably, among HCC patients meeting Milan criteria, those with TBS > 3 exhibited a prolonged median RFS time following LMWA compared to PWMA.

Therapeutic outcomes of thermal ablation versus repeated hepatic resection for recurrent hepatocellular carcinoma by using propensity score analysis: a multicenter real-world study

BACKGROUND

The therapeutic value of thermal ablation (TA) versus repeat hepatic resection (RHR) for recurrent hepatocellular carcinoma (rHCC) after initial hepatic resection is uncertain. This study aimed to investigate the prognosis of TA and RHR.

MATERIALS AND METHODS

In this multicenter real-world retrospective study, 473 patients were enrolled between January 2015 and August 2023, with 340 in the TA group and 133 in the RHR group. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were employed to reduce selection bias. Local tumor progression (LTP), recurrence-free survival (RFS), and post-recurrence survival (PRS) were compared before and after PSM and IPTW.

RESULTS

A total of 473 patients (231 aged ≥ 60 years; 393 men) were evaluated. LTP, RFS, and PRS rates did not differ significantly between groups before (P = 0.940, P = 0.180, and P = 0.700) and after matching (P = 0.420, P = 0.680, and P = 0.810) and weighting (P = 0.940, P = 0.180, and P = 0.700). Multivariable Cox analysis identified tumor number (HR: 2.28; P < 0.001) and PLT (HR: 0.73; P = 0.038) as independent prognostic factors for RFS in the entire rHCC cohort. And tumor location, size, number, ascites, AST, and AFP (HR: 0.55-2.18; P = 0.004-0.046) were independent prognostic factors for PRS. Subgroup analysis showed both TA and RHR were effective treatments for rHCC, regardless of tumor size, number, subcapsular, or perivascular lesions.

CONCLUSIONS

The cumulative LTP, RFS, and PRS were not significantly different between TA and RHR for rHCC within the Milan criteria. TA may be a viable curative option for early-stage rHCC patients.

Bridge Therapy before Liver Transplant for Advanced Hepatocellular Carcinoma

Hepatocellular carcinoma is the most common primary liver tumor. Orthotopic liver transplant is one of the best treatment options, but its waiting list has to be considered. Bridge therapies have been introduced in order to limit this issue. The aim of this study is to evaluate if bridge therapies in advanced hepatocellular carcinoma can improve overall survival and reduce de-listing. We selected 185 articles. The search was limited to English articles involving only adult patients. These were deduplicated and articles with incomplete text or irrelevant conclusions were excluded. Sorafenib is the standard of care for advanced hepatocellular carcinoma and increases overall survival without any significant drug toxicity. However, its survival benefit is limited. The combination of transarterial chemoembolization + sorafenib, instead, delays tumor progression, although its survival benefit is still uncertain. A few studies have shown that patients undergoing transarterial chemoembolization + radiation therapy have similar or even better outcomes than those undergoing transarterial chemoembolization or sorafenib alone for rates of histopathologic complete response (89% had no residual in the explant). Also, the combined therapy of transarterial chemoembolization + radiotherapy + sorafenib was compared to the association of transarterial chemoembolization + radiotherapy and was associated with a better survival rate (24 vs. 17 months). Moreover, immunotherapy revealed new encouraging perspectives. Combination therapies showed the most encouraging results and could become the gold standard as a bridge to transplant for patients with advanced hepatocellular carcinoma.

TACE-assisted multi-image guided radiofrequency ablation for the treatment of single hepatocellular carcinoma ≤ 5 cm: a retrospective study

Background/Objective

Treatment of hepatocellular carcinoma (HCC) with ablation alone often results in high rates of recurrence and metastasis, reaching up to 25.9% within two years. Therefore, this study aimed to examine the efficacy and safety of transarterial chemoembolization (TACE)-assisted multi-image guided radiofrequency ablation (RFA) for the treatment of stage Ia HCC according to the China liver cancer staging (CNLC).

Methods

This study enrolled and analyzed a total of 118 patients diagnosed with HCC, each with a single nodular lesion no larger than 5 cm, who received TACE-RFA as first-line therapy between February 1, 2014, and December 31, 2021. The median/mean follow-up period was 29.0 months [95% confidence interval (CI): 21.8-36.2 months] and 31.8 months (95% CI: 27.5-36.0 months), respectively. We assessed the treatment's effectiveness, potential complications, and survival rate.

Results

The technical success rate was 100% (118/118) after the initial treatment. Out of the total, 3 out of 118 patients (2.5%) developed local tumor progression (LTP) during the follow-up period. The median time for LTP was 29.0 months (95%CI: 21.9-36.1 months; mean: 31.5 months; range 1-92 months). At 1, 3, 5, and 7 years after treatment, the cumulative LTP rates were 0%, 4.6%, 4.6%, and 4.6%, respectively. The overall survival rates at 1, 3, 5, and 7 years were 100%, 95.2%, 95.2%, and 95.2%, respectively. In total, 28 patients experienced minor Grade B complications, and no major complications or treatment-related mortality occurred.

Conclusion

The treatment of CNLC stage Ia HCC using TACE-assisted multi-image-guided RFA was found to be both safe and feasible.