The role of neoadjuvant conventional transarterial chemoembolization with radiofrequency ablation in the treatment of recurrent hepatocellular carcinoma after initial hepatectomy with microvascular invasion

International Journal of Hyperthermia

卷:39

Bin Li¹  Jiaping Li²  Yaojun Zhang³  Minshan Chen³  Xiaoxue Wu⁴  Zhenwei Peng⁴  Shiting Feng⁵  Zaiguo Wang⁶  Hui Pang⁷  Manxia Lin⁸  Shuling Chen⁸  Han Xiao⁸  Ming Kuang⁹ 

[1] Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;

[2] Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;

[3] Department of Liver Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou, China;

[4] Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;

[5] Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;

[6] Department of Surgical Oncology, Dongguan People's Hospital, Dongguan, China;

[7] Deptment of Medical Records Management, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China;

[8] Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;

[9] Institute of Precision Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;

关键词: Neoadjuvant treatment;    hepatocellular carcinoma;    transarterial chemoembolization;    radiofrequency ablation;    microvascular invasion;   

DOI  :  10.1080/02656736.2022.2051613

来源: DOAJ

【 摘 要 】

Objectives Recurrent hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI)-positive primary tumor is at high risk of re-recurrence while treated with radiofrequency ablation (RFA). We aimed to investigate whether neoadjuvant conventional transarterial chemoembolization (cTACE) was effective in reducing re-recurrence after RFA for recurrent HCC patients with MVI-positive primary tumors.Methods In this retrospective multicenter study, 468 patients with solitary small recurrent HCC (≤3.0cm) underwent RFA alone (n = 322) or with neoadjuvant cTACE (n = 146) between June 2007 and December 2017 were included. Overall survival (OS) and recurrence-free survival (RFS) were compared.Results The 1-, 5-year OS rates were 74.8%, 42.5% for RFA with neoadjuvant cTACE group, and 53.5%, 28.7% for RFA group (P < 0.001). The corresponding RFS rates were 51.7%, 24.4% for RFA with neoadjuvant cTACE group, and 36.1%, 9.3% for RFA group (P < 0.001). In subgroup analyses, the OS and RFS for neoadjuvant cTACE group were longer than those for RFA group no matter tumor size > 2cm (HR = 0.52, 95% CI: 0.36–0.77; HR = 0.49, 95% CI: 0.36–0.67) or not (HR = 0.53, 95% CI: 0.32–0.88; HR = 0.65, 95% CI: 0.42–0.98), or the time interval of recurrence from initial treatment ≤ 1 year (HR = 0.53, 95% CI: 0.36–0.77; HR = 0.70, 95% CI: 0.52–0.94) or not (HR = 0.56, 95% CI: 0.34–0.95; HR = 0.39, 95% CI: 0.25–0.62). Multivariable analyses showed that RFA alone (HR = 1.329, P = 0.031; HR = 1.764, P = 0.004) and interval of recurrence from initial treatment > 1 year(HR = 0.642, P = 0.001; HR = 0.298, P = 0.037) were independent prognostic factors of OS and RFS.Conclusions Neoadjuvant cTACE could effectively reduce re-recurrence after RFA, and improve the long-term survivals for patients with solitary small recurrent HCC whose primary tumor was MVI-positive. Key pointsFor recurrent hepatocellular carcinoma (HCC) patients whose primary tumor was positive for microvascular invasion, neoadjuvant conventional transarterial chemoembolization (cTACE) with radiofrequency ablation (RFA) achieved better efficacy.Multivariable analyses showed that the interval of recurrence from initial treatment > 1 year and RFA alone were independent prognostic factors of overall survival and recurrence-free survival, respectively.

【 授权许可】

Unknown