Ann Surg Treat Res.  2021 Aug;101(2):85-92. 10.4174/astr.2021.101.2.85.

Clinical impact of the treatment modality on small, solitary, recurrent intrahepatic hepatocellular carcinomas after primary liver resection

• Kim HS
• Yi NJ
• Kim JM
• Joh JW
• Lee KW
• Suh KS

• KMID: 2519001
• DOI: http://doi.org/10.4174/astr.2021.101.2.85

Abstract

Purpose
The aim of this study was to determine the survival benefit based on different treatment strategies in patients with small, solitary, recurring intrahepatic hepatocellular carcinomas (HCCs) that were defined as recurred Barcelona Clinic Liver Cancer stage O (reBCLC-O).
Methods
Among the 917 patients with HCC recurrence after primary hepatic resection, 394 patients with reBCLC-O were selected. Of these, 150 patients underwent curative treatment (re-resection, radiofrequency ablation, and liver transplantation) and 203 underwent transarterial chemoembolization (TACE) group for recurrent HCC. After propensity score matching (PSM), both the groups were well balanced (89 patients in each group).
Results
Before PSM, the 1-, 3-, and 5-year overall survival (OS) rates of patients in the curative treatment group (96.7%, 78.6%, and 70.5%, respectively) were significantly better than those in the TACE treatment group (95.6%, 53.7%, and 44.2%, respectively) (P < 0.001). After PSM, the 1-, 3-, and 5-year OS rates also differed significantly (92.0%, 79.6%, and 71.1% in the curative treatment group vs. 88.8%, 65.6%, and 57.9% in the TACE group) (P = 0.005). The independent predictors of worse OS were tumor number at the time of resection and treatment modality for the recurrence, time interval to recurrence, and prothrombin time international normalized ratio and alpha-fetoprotein levels at the time of recurrence.
Conclusion
The OS of patients in the curative treatment group was better than that in the non-curative treatment group after PSM. Based on our results, curative treatment should be strongly recommended in the patients with reBCLC-O recurrence for better survival.

Keyword

Hepatocellular carcinoma; Treatment outcome; Propensity score match; Recurrence; Resection

Figure

• 

  Fig. 1 Flow chart of patients' selection. HCC, hepatocellular carcinoma; reBCLC, recurred Barcelona Clinic Liver Cancer; reBCLC-O, reBCLC stage O; PEI, percutaneouse ethanol injection; TACE, transarterial chemoembolization.

• 

  Fig. 2 Overall survival rates of patients in the curative and transarterial chemoembolization (TACE) treatment groups before (A) and after (B) propensity score matching.

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