- Email: [email protected]
Percutaneous radiofrequency ablation versus repeat hepatectomy for recurrent hepatocellular carcinoma: retrospective randomized control study
Journal of Medical Colleges of PLA 26 (2011)316-323
JOURNAL OF MEDICAL COLLEGES OF PLA www.elsevier.com/locate/jmcpla
Percutaneous radiofrequency ablation versus repeat hepatectomy for recurrent hepatocellular carcinoma: retrospective randomized control study☆ Duan Jicheng 1△, Yue Haiyan2△, Liu Kai1, Wu Mengchao1, Yang Jiahe1﹡ 1
Department of Laparoscopy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China 2
Department of Gastroenterology, No.455 Hospital of PLA, Shanghai 200052, China Received 28 November 2011; accepted 21 December 2011
Abstract Objective: Percutaneous radiofrequency ablation (PRFA) is known to be as effective as hepatectomy for small hepatocellular carcinoma (HCC) in the long-term.
We wished to ascertain how it is for recurrent small HCC. Methods: From
January 2009 to November 2011, a series of sixty-one patients were included
in
the study according to the criteria: each
patient had one recurrent HCC, less than 5 cm in diameter. Twenty-six of the 61 patients were treated with PRFA and the other 35 were treated with repeat hepatectomy. Results: The interval from first surgery to recurrent for repeat hepatectomy
☆
Supported by the grant of Ministry of Science and Technology of the People’s Republic of China (2008ZX10002-25) and National Natural Science
Foundation of China (81070359). △
Co-first authors.
*
Corresponding author. E-mail address: [email protected] (Yang J.)
317
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011) 316-323
and PRFA groups were (1,239.60±1,017.00) d and (903.42±975.11) d respectively (P=0.066). The tumor-free time after repeat hepatectomy and PRFA were (310.23±159.50) d and (278.27±123.29) d respectively (P=0.584). Size of tumor in repeat hepatectomy and PRFA were (7.34±3.16) cm2 and (5.59±3.40) cm2 (P=0.215), the total expenditure for each patient of the two groups were (26,150.66±7,923.60) yuan and (21,135.00±1,156.76) yuan (RMB), and the time of hospitalization for each of the two groups were (15.29±4.28) d and (7.46±2.20) d (P＜0.001). Conclusion: PRFA is proved to be as effective as repeat hepatectomy in the treatment of recurrent small HCC, and superior to repeat hepatectomy as it is less invasive.
Keywords: Hepatocellular carcinoma; Recurrent; Percutaneous radiofrequency ablation; Repeat hepatectomy
1. Introduction
Hepatocellular carcinoma (HCC) is a tumor that
2. Materials and methods
2.1. Grouping
more frequently affects patients with chronic hepatitis or hepatic cirrhosis induced by hepatitis B
From January 2009 to November 2011, a series of
in China. The recurrence and metastasis of primary
sixty-one patients with recurrent HCCs after partial
liver cancer (PLC) have always been a tough
hepatectomy were treated in our hospital according to
problem for surgeons. Chen et al reported the 1st,
the selection criteria, of whom thirty-five underwent
3rd, 5th, and 10th year survival rate in 162 recurrent
repeat
HCC subjects who underwent first surgical treatment
percutaneous radiofrequency ablation (PRFA).
hepatectomy
and
twenty-six
received
in our hospital were separately 96.8%, 66.7%, 43.6%, and 21.8%, while that in subjects who received
2.2. Inclusion criteria
second surgical treatment were separately 94.7%, 44.9% and 25.0% at the 1st, 3rd, and 5th year[1].
Inclusion criteria: (1) Male or female between
318
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011)316-323
20 and 60 years of age; (2) HCC was diagnosed
(6) Subjects with jaundice (not including jaundice
pathologically, and recurrent HCC was confirmed
in the bile ducts); (7) Subjects with ascites or
through ultrasonic B, CT, and magnetic resonance
extensive metastasis outside the liver; and (8)
imaging (MRI); (3) Written informed consent form
Subjects with invasion to portal vein.
was signed; (4) Good condition in vital organs such as heart, lung, and kidney; (5) Good liver function: Child
A
level,
or
nearly
hepatoprotection treatment; (6)
A
level
2.4. Approval
after
Solitary small
This study has been reviewed and approved by
cancer focus (less than 5 cm in diameter); (7)
Shanghai Eastern Hepatobiliary Surgery Hospital
Without jaundice (not including jaundice in the bile
Ethics Committee(ZD2008016-P1). This study had
ducts), without ascites or extensive metastasis
been
outside the liver; and (8) Without invasion to portal
NCT00822562) and Chinese Clinical Trial Registry
vein.
(ChiCTR-TRC-00000214).
2.3. Exclusion criteria
2.5. Treatment of PRFA group
registered
in
ClinicalTrials.gov
(ID:
Exclusion criteria: (1) Subjects who refused to
For PRFA, the patients were placed in the
participate in this study; (2) Subjects who could not
supine position. Local anesthetic with 1% lidocaine
be followed up regularly; (3) Subjects with severe
was injected from the insertion site on the skin down
heart, lung, kidney diseases; (4) Subjects with liver
to the peritoneum along the planned puncture track.
CP level B or C, and serum creatinine ≥2×ULN;
The skin was incised with a small lancet, and a
(5) Subjects with severe bone marrow depression,
needle was inserted to the chosen area. Conscious
such as neutrophil counting is lower than 1.5×109/L;
analgesic sedation by intravenous fentany citrate and
319
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011) 316-323
droperidol was applied before the procedure. PRFA
MRI was carried out if CT was uncertain about the
was performed under real-time US guidance
residual, recurrent, or metastatic lesions. Data from
(EUB-2000, HITACHI Medical Systems). After the
the two groups was compared using Student’s t-test
procedure, the patients were closely monitored. We
for continuous data and the χ2 test for categorical
used the same system and method as Liang et al[2]
data. The statistical analyses were performed using
reported.
SPSS 10.0 statistical software (SPSS Company, Chicago, Illinois,USA). Results were given as
2.6. Treatment of repeat hepatectomy group
mean±standard deviation(SD). All statistical tests were two-sided, and a significant difference was
Surgery
was
carried
out
under
general
considered when a P value was less than 0.05.
anesthesia using the incision for the initial hepatectomy. We performed anatomic resection
3. Results
aiming at a resection margin of at least 2 cm. Pringle’s maneuver was used if necessary.
There is no statistic difference of age and sex between two groups. The interval from first surgery
2.7. Statistical analysis
to recurrent in repeat hepatectomy and PRFA group were (1,239.60±1,017.00) d and (903.42±975.11) d
Tests done in every month included blood
respectively (P=0.066). The tumor-free time after
routine, liver function, AFP, color ultrasonic B; Tests
repeat hepatectomy and PRFA were (310.23±159.50)
done in every two months included abdomen CT,
d and (278.27±123.29) d respectively (P=0.584).
bone scan (if necessary), MRI and CT (on other
Size of tumor in
parts). All patients received a contrast-enhanced
were
spiral computed tomography 4 weeks after treatment.
(P=0.215), and the total expenditure for each patient
(7.34±3.16)
repeat hepatectomy and PRFA cm2
and
(5.59±3.40)
cm2
320
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011)316-323
of the two groups were (26,150.66±7,923.60) yuan
(15.29±4.28) d and (7.46±2.20) d (P＜0.001).
and (21,135.00±1,156.76) yuan (RMB), and the
(Showed in Table 1 and 2).
time of hospitalization in the
two groups were
Table 1 Survival and sex between two group Item
Repeat hepatectomy
Sex
Male
Survival
PRFA
P value
34(97.14%)
22(84.62%)
Female
1(2.86%)
4(15.38%)
Death
4(11.43%)
2(7.69%)
Survive
31(88.57%)
0.154
1.000
24(92.31%)
Table 2 Difference between two groups Item
Repeat hepatectomy
Statistical
PRFA
method
Test value
P value
Age N (missing)
35(0)
26(0)
t test
1.95
Mean±SD
48.46±8.49
51.96±5.64
.
.
Median(Q1-Q3)
49.00(42.00-56.00)
52.00(49.00-57.00)
.
.
Min-Max
31.00-60.00
41.00-60.00
.
.
N (missing)
35(0)
26(0)
Kruskal-Wallis
39.65
Mean±SD
15.29±4.28
7.46±2.20
.
.
Median (Q1-Q3)
15.00(12.00-17.00)
7.50(6.00-8.00)
.
.
Min-Max
8.00-28.00
3.00-12.00
.
.
0.163
Time of hospitalization
(To be continued)
0.000
321
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011) 316-323
Item
Repeat hepatectomy
Statistical
Test
P
method
value
value
0.001
PRFA
Sum N(missing)
35(0)
26(0)
Kruskal-Wallis
10.58
Mean±SD
26,150.66±7,923.60
21,135.00±1,156.76
.
.
Median(Q1-Q3)
24,855.00(21,155.00-29,104.00)
21,315.00(20,344.00-21,971.00)
.
.
Min-Max
13,967.00-50,986.00
18,930.00-23,483.00
.
.
N (missing)
35(0)
26(0)
Kruskal-Wallis
2.79
Mean±SD
7.34±3.16
5.59±3.40
.
.
Median(Q1-Q3)
7.50(6.20-8.99)
3.96(3.04-7.48)
.
.
Min-Max
1.20-13.20
1.60-14.35
.
.
N(missing)
35(0)
26(0)
Kruskal-Wallis
0.76
Mean±SD
310.23±159.50
278.27±123.29
.
.
Median(Q1-Q3)
272.00(233.00-346.00)
246.50(207.00-375.00)
.
.
Min-Max
45.00-739.00
45.00-575.00
.
.
N(missing)
35(0)
26(0)
Kruskal-Wallis
4.01
Mean±SD
1,239.60±1,017.00
903.42±975.11
.
.
Median(Q1-Q3)
1,026.00(600.00-1,585.00)
526.00(177.00-1,317.00)
.
.
Min-Max
171.00-4,614.00
71.00-3,189.00
.
.
Size of tumor(cm2) 0.215
TFS 0.584
DFI 0.066
322
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011)316-323
the following advantages: firstly, PRFA can be 4. Discussion
applied repeatedly for treatment of recurrent HCC; secondly, it can be used for recurrent HCC in a
To date, the best choice for HCC is still partial
patient with poor liver function who might not be
hepatectomy, however, the overall prognosis after
able to tolerate a repeat hepatectomy; thirdly, time of
surgery is unsatisfactory [3-4]. The main cause of
hospitalization is much shorter.
treatment failure after partial hepatectomy for HCC
In this study, we used the same selection criteria
is the high incidence of intrahepatic recurrence.
to make the baseline demographic data comparable
Reports from different centers demonstrated a
for patients who received repeat hepatectomy or
cumulative 5-year recurrence rate after resection for
PRFA. We used solitary tumor and the tumor of less
HCC to range from 77% to 100% [1,5–8]. Repeat
than 5 cm to conform to the commonly adopted
hepatectomy is the most accepted treatment for
indications of PRFA for HCC. Our study indicated
recurrent HCC. A 5-year survival rate ranging from
that there was no significant difference in the overall
19.4% to 56% has been reported after repeat
survival of patients with recurrent HCC treated by
hepatectomy for recurrent HCC [9-11]. These results
repeat hepatectomy or PRFA. But PRFA had the
are the same as those of initial hepatectomy for HCC.
advantage over surgical resection as it was less
But only a small proportion of patients with recurrent
invasive and caused fewer complications. There
HCC are suitable for repeat hepatectomy.
were some limitations in
PRFA is an accepted primary treatment for
this study. First, the
number of patients in this study was
relatively
HCC. A retrospective randomized study by Chen
smaller. Second, the mean follow-up period was
and associates [12] demonstrated that PRFA was as
significantly shorter.
effective as partial hepatectomy for small HCC less
In conclusion, the retrospective study indicated
than 5 cm in diameter and had the advantage over
that treatment with PRFA for small recurrent HCC
surgical resection of being less invasive. PRFA has
gave similar survival as repeat hepatectomy. PRFA
323
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011) 316-323
had the advantage of being less invasive. But the
63–70.
number of patients in this study was relatively small
6. Fong Y, Sun RL, Jarnagin W, et al. An analysis of 412 cases
and the mean follow-up period was significantly
of hepatocellular carcinoma at a Western center. Ann Surg,
shorter. Further clinical studies are required to document the effectiveness of PRFA in the treatment
1999; 229: 790–800. 7. Makuuchi M, Takayama T, Kubota K, et al. Hepatic resection for hepatocellular carcinoma: Japanese experience.
of recurrent HCC after partial hepatectomy. Hepatogastroenterology, 1998; 45: 1267–1274. 8. Belghiti J, Panis Y, Farges O, et al. Intrahepatic recurrence
References
after resection of hepatocellular carcinoma complicating cirrhosis.Ann Surg, 1991; 214:114–117.
1. Chen H, Wu MC, Luo XJ, et al. An analysis of prospective
9. Sugimachi K, Maehara S, Tanaka S, et al. Repeat
outcome of re-resection for recurrent liver cancer and
hepatectomy is the most useful treatment for recurrent
extrahepatic metastases, a follow-up of 267 cases. Chin
hepatocellular carcinoma. J Hepatobiliary Pancreat Surg,
German J Clin Oncol, 2003; 2(1): 2–9.
2001; 8: 410–416.
2. Liang HH, Chen MS, Peng ZW, et al. Percutaneous
10. Itamoto T, Nakahara H, Amano H, et al. Repeat hepatectomy
radiofrequency ablation versus repeat hepatectomy for
for recurrent hepatocellular carcinoma. Surgery, 2007; 141:
recurrent hepatocellular carcinoma: a retrospective study.
589–597.
Ann Surgi Oncol, 2008; 15: 3484–3493. 3. Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet, 2003; 362:1907–1917.
11. Nagasue N, Kohno H, Hayashi T, et al. A repeat hepatectomy for recurrent hepatocellular carcinoma. Br J Surg, 1996; 83: 127–131.
4. Takenaka K, Kawahara N, Yamamoto K, et al. Results of
12. Chen MS, Li JQ, Zheng Y, et al. A prospective randomized
280 liver resections for hepatocellular carcinoma. Arch Surg,
trial comparing percutaneous local ablative therapy and
1996; 131: 71–76.
partial hepatectomy for small hepatocellular carcinoma. Ann
5. Poon RT, Fan ST, Lo CM, et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg, 2001; 234:
Surg, 2006; 243(3): 321–328.
(Editor Lu Renmin)
JOURNAL OF MEDICAL COLLEGES OF PLA www.elsevier.com/locate/jmcpla
Percutaneous radiofrequency ablation versus repeat hepatectomy for recurrent hepatocellular carcinoma: retrospective randomized control study☆ Duan Jicheng 1△, Yue Haiyan2△, Liu Kai1, Wu Mengchao1, Yang Jiahe1﹡ 1
Department of Laparoscopy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China 2
Department of Gastroenterology, No.455 Hospital of PLA, Shanghai 200052, China Received 28 November 2011; accepted 21 December 2011
Abstract Objective: Percutaneous radiofrequency ablation (PRFA) is known to be as effective as hepatectomy for small hepatocellular carcinoma (HCC) in the long-term.
We wished to ascertain how it is for recurrent small HCC. Methods: From
January 2009 to November 2011, a series of sixty-one patients were included
in
the study according to the criteria: each
patient had one recurrent HCC, less than 5 cm in diameter. Twenty-six of the 61 patients were treated with PRFA and the other 35 were treated with repeat hepatectomy. Results: The interval from first surgery to recurrent for repeat hepatectomy
☆
Supported by the grant of Ministry of Science and Technology of the People’s Republic of China (2008ZX10002-25) and National Natural Science
Foundation of China (81070359). △
Co-first authors.
*
Corresponding author. E-mail address: [email protected] (Yang J.)
317
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011) 316-323
and PRFA groups were (1,239.60±1,017.00) d and (903.42±975.11) d respectively (P=0.066). The tumor-free time after repeat hepatectomy and PRFA were (310.23±159.50) d and (278.27±123.29) d respectively (P=0.584). Size of tumor in repeat hepatectomy and PRFA were (7.34±3.16) cm2 and (5.59±3.40) cm2 (P=0.215), the total expenditure for each patient of the two groups were (26,150.66±7,923.60) yuan and (21,135.00±1,156.76) yuan (RMB), and the time of hospitalization for each of the two groups were (15.29±4.28) d and (7.46±2.20) d (P＜0.001). Conclusion: PRFA is proved to be as effective as repeat hepatectomy in the treatment of recurrent small HCC, and superior to repeat hepatectomy as it is less invasive.
Keywords: Hepatocellular carcinoma; Recurrent; Percutaneous radiofrequency ablation; Repeat hepatectomy
1. Introduction
Hepatocellular carcinoma (HCC) is a tumor that
2. Materials and methods
2.1. Grouping
more frequently affects patients with chronic hepatitis or hepatic cirrhosis induced by hepatitis B
From January 2009 to November 2011, a series of
in China. The recurrence and metastasis of primary
sixty-one patients with recurrent HCCs after partial
liver cancer (PLC) have always been a tough
hepatectomy were treated in our hospital according to
problem for surgeons. Chen et al reported the 1st,
the selection criteria, of whom thirty-five underwent
3rd, 5th, and 10th year survival rate in 162 recurrent
repeat
HCC subjects who underwent first surgical treatment
percutaneous radiofrequency ablation (PRFA).
hepatectomy
and
twenty-six
received
in our hospital were separately 96.8%, 66.7%, 43.6%, and 21.8%, while that in subjects who received
2.2. Inclusion criteria
second surgical treatment were separately 94.7%, 44.9% and 25.0% at the 1st, 3rd, and 5th year[1].
Inclusion criteria: (1) Male or female between
318
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011)316-323
20 and 60 years of age; (2) HCC was diagnosed
(6) Subjects with jaundice (not including jaundice
pathologically, and recurrent HCC was confirmed
in the bile ducts); (7) Subjects with ascites or
through ultrasonic B, CT, and magnetic resonance
extensive metastasis outside the liver; and (8)
imaging (MRI); (3) Written informed consent form
Subjects with invasion to portal vein.
was signed; (4) Good condition in vital organs such as heart, lung, and kidney; (5) Good liver function: Child
A
level,
or
nearly
hepatoprotection treatment; (6)
A
level
2.4. Approval
after
Solitary small
This study has been reviewed and approved by
cancer focus (less than 5 cm in diameter); (7)
Shanghai Eastern Hepatobiliary Surgery Hospital
Without jaundice (not including jaundice in the bile
Ethics Committee(ZD2008016-P1). This study had
ducts), without ascites or extensive metastasis
been
outside the liver; and (8) Without invasion to portal
NCT00822562) and Chinese Clinical Trial Registry
vein.
(ChiCTR-TRC-00000214).
2.3. Exclusion criteria
2.5. Treatment of PRFA group
registered
in
ClinicalTrials.gov
(ID:
Exclusion criteria: (1) Subjects who refused to
For PRFA, the patients were placed in the
participate in this study; (2) Subjects who could not
supine position. Local anesthetic with 1% lidocaine
be followed up regularly; (3) Subjects with severe
was injected from the insertion site on the skin down
heart, lung, kidney diseases; (4) Subjects with liver
to the peritoneum along the planned puncture track.
CP level B or C, and serum creatinine ≥2×ULN;
The skin was incised with a small lancet, and a
(5) Subjects with severe bone marrow depression,
needle was inserted to the chosen area. Conscious
such as neutrophil counting is lower than 1.5×109/L;
analgesic sedation by intravenous fentany citrate and
319
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011) 316-323
droperidol was applied before the procedure. PRFA
MRI was carried out if CT was uncertain about the
was performed under real-time US guidance
residual, recurrent, or metastatic lesions. Data from
(EUB-2000, HITACHI Medical Systems). After the
the two groups was compared using Student’s t-test
procedure, the patients were closely monitored. We
for continuous data and the χ2 test for categorical
used the same system and method as Liang et al[2]
data. The statistical analyses were performed using
reported.
SPSS 10.0 statistical software (SPSS Company, Chicago, Illinois,USA). Results were given as
2.6. Treatment of repeat hepatectomy group
mean±standard deviation(SD). All statistical tests were two-sided, and a significant difference was
Surgery
was
carried
out
under
general
considered when a P value was less than 0.05.
anesthesia using the incision for the initial hepatectomy. We performed anatomic resection
3. Results
aiming at a resection margin of at least 2 cm. Pringle’s maneuver was used if necessary.
There is no statistic difference of age and sex between two groups. The interval from first surgery
2.7. Statistical analysis
to recurrent in repeat hepatectomy and PRFA group were (1,239.60±1,017.00) d and (903.42±975.11) d
Tests done in every month included blood
respectively (P=0.066). The tumor-free time after
routine, liver function, AFP, color ultrasonic B; Tests
repeat hepatectomy and PRFA were (310.23±159.50)
done in every two months included abdomen CT,
d and (278.27±123.29) d respectively (P=0.584).
bone scan (if necessary), MRI and CT (on other
Size of tumor in
parts). All patients received a contrast-enhanced
were
spiral computed tomography 4 weeks after treatment.
(P=0.215), and the total expenditure for each patient
(7.34±3.16)
repeat hepatectomy and PRFA cm2
and
(5.59±3.40)
cm2
320
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011)316-323
of the two groups were (26,150.66±7,923.60) yuan
(15.29±4.28) d and (7.46±2.20) d (P＜0.001).
and (21,135.00±1,156.76) yuan (RMB), and the
(Showed in Table 1 and 2).
time of hospitalization in the
two groups were
Table 1 Survival and sex between two group Item
Repeat hepatectomy
Sex
Male
Survival
PRFA
P value
34(97.14%)
22(84.62%)
Female
1(2.86%)
4(15.38%)
Death
4(11.43%)
2(7.69%)
Survive
31(88.57%)
0.154
1.000
24(92.31%)
Table 2 Difference between two groups Item
Repeat hepatectomy
Statistical
PRFA
method
Test value
P value
Age N (missing)
35(0)
26(0)
t test
1.95
Mean±SD
48.46±8.49
51.96±5.64
.
.
Median(Q1-Q3)
49.00(42.00-56.00)
52.00(49.00-57.00)
.
.
Min-Max
31.00-60.00
41.00-60.00
.
.
N (missing)
35(0)
26(0)
Kruskal-Wallis
39.65
Mean±SD
15.29±4.28
7.46±2.20
.
.
Median (Q1-Q3)
15.00(12.00-17.00)
7.50(6.00-8.00)
.
.
Min-Max
8.00-28.00
3.00-12.00
.
.
0.163
Time of hospitalization
(To be continued)
0.000
321
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011) 316-323
Item
Repeat hepatectomy
Statistical
Test
P
method
value
value
0.001
PRFA
Sum N(missing)
35(0)
26(0)
Kruskal-Wallis
10.58
Mean±SD
26,150.66±7,923.60
21,135.00±1,156.76
.
.
Median(Q1-Q3)
24,855.00(21,155.00-29,104.00)
21,315.00(20,344.00-21,971.00)
.
.
Min-Max
13,967.00-50,986.00
18,930.00-23,483.00
.
.
N (missing)
35(0)
26(0)
Kruskal-Wallis
2.79
Mean±SD
7.34±3.16
5.59±3.40
.
.
Median(Q1-Q3)
7.50(6.20-8.99)
3.96(3.04-7.48)
.
.
Min-Max
1.20-13.20
1.60-14.35
.
.
N(missing)
35(0)
26(0)
Kruskal-Wallis
0.76
Mean±SD
310.23±159.50
278.27±123.29
.
.
Median(Q1-Q3)
272.00(233.00-346.00)
246.50(207.00-375.00)
.
.
Min-Max
45.00-739.00
45.00-575.00
.
.
N(missing)
35(0)
26(0)
Kruskal-Wallis
4.01
Mean±SD
1,239.60±1,017.00
903.42±975.11
.
.
Median(Q1-Q3)
1,026.00(600.00-1,585.00)
526.00(177.00-1,317.00)
.
.
Min-Max
171.00-4,614.00
71.00-3,189.00
.
.
Size of tumor(cm2) 0.215
TFS 0.584
DFI 0.066
322
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011)316-323
the following advantages: firstly, PRFA can be 4. Discussion
applied repeatedly for treatment of recurrent HCC; secondly, it can be used for recurrent HCC in a
To date, the best choice for HCC is still partial
patient with poor liver function who might not be
hepatectomy, however, the overall prognosis after
able to tolerate a repeat hepatectomy; thirdly, time of
surgery is unsatisfactory [3-4]. The main cause of
hospitalization is much shorter.
treatment failure after partial hepatectomy for HCC
In this study, we used the same selection criteria
is the high incidence of intrahepatic recurrence.
to make the baseline demographic data comparable
Reports from different centers demonstrated a
for patients who received repeat hepatectomy or
cumulative 5-year recurrence rate after resection for
PRFA. We used solitary tumor and the tumor of less
HCC to range from 77% to 100% [1,5–8]. Repeat
than 5 cm to conform to the commonly adopted
hepatectomy is the most accepted treatment for
indications of PRFA for HCC. Our study indicated
recurrent HCC. A 5-year survival rate ranging from
that there was no significant difference in the overall
19.4% to 56% has been reported after repeat
survival of patients with recurrent HCC treated by
hepatectomy for recurrent HCC [9-11]. These results
repeat hepatectomy or PRFA. But PRFA had the
are the same as those of initial hepatectomy for HCC.
advantage over surgical resection as it was less
But only a small proportion of patients with recurrent
invasive and caused fewer complications. There
HCC are suitable for repeat hepatectomy.
were some limitations in
PRFA is an accepted primary treatment for
this study. First, the
number of patients in this study was
relatively
HCC. A retrospective randomized study by Chen
smaller. Second, the mean follow-up period was
and associates [12] demonstrated that PRFA was as
significantly shorter.
effective as partial hepatectomy for small HCC less
In conclusion, the retrospective study indicated
than 5 cm in diameter and had the advantage over
that treatment with PRFA for small recurrent HCC
surgical resection of being less invasive. PRFA has
gave similar survival as repeat hepatectomy. PRFA
323
Duan Jicheng et al./ Journal of Medical Colleges of PLA 26(2011) 316-323
had the advantage of being less invasive. But the
63–70.
number of patients in this study was relatively small
6. Fong Y, Sun RL, Jarnagin W, et al. An analysis of 412 cases
and the mean follow-up period was significantly
of hepatocellular carcinoma at a Western center. Ann Surg,
shorter. Further clinical studies are required to document the effectiveness of PRFA in the treatment
1999; 229: 790–800. 7. Makuuchi M, Takayama T, Kubota K, et al. Hepatic resection for hepatocellular carcinoma: Japanese experience.
of recurrent HCC after partial hepatectomy. Hepatogastroenterology, 1998; 45: 1267–1274. 8. Belghiti J, Panis Y, Farges O, et al. Intrahepatic recurrence
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(Editor Lu Renmin)