Preoperative Estimated Risk of Microvascular Invasion is Associated with Prognostic Differences Following Liver Resection Versus Radiofrequency Ablation for Early Hepatitis B Virus-Related Hepatocellular Carcinoma

Objectives The aim of this study was to examine prognostic differences between liver resection (LR) and percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma (HCC) based on preoperative predicted microvascular invasion (MVI) risk. Methods Data on consecutive patients who underwent...

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Bibliographic Details
Published in:Annals of surgical oncology 2021-12, Vol.28 (13), p.8174-8185
Main Authors: Bai, Shilei, Yang, Pinghua, Xie, Zhihao, Li, Jun, Lei, Zhengqing, Xia, Yong, Qian, Guojun, Zhang, Baohua, Pawlik, Timothy M., Lau, Wan Yee, Shen, Feng
Format: Article
Language:English
Subjects:
Ablation
Carcinoma, Hepatocellular - surgery
Disease control
Hepatectomy
Hepatitis
Hepatitis B
Hepatitis B virus
Hepatobiliary Tumors
Hepatocellular carcinoma
Humans
Liver
Liver cancer
Liver Neoplasms - surgery
Medicine
Medicine & Public Health
Microvasculature
Multivariate analysis
Neoplasm Invasiveness
Neoplasm Recurrence, Local - surgery
Nomograms
Oncology
Prognosis
Radiofrequency Ablation
Retrospective Studies
Risk groups
Surgery
Surgical Oncology
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Summary:Objectives The aim of this study was to examine prognostic differences between liver resection (LR) and percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma (HCC) based on preoperative predicted microvascular invasion (MVI) risk. Methods Data on consecutive patients who underwent LR ( n  = 1344) or PRFA ( n  = 853) for hepatitis B virus-related HCC within the Milan criteria (MC) were analyzed. A preoperative nomogram was used to estimate MVI risk. Overall survival (OS), time to recurrence, and patterns of recurrence were compared using propensity score matching. Results The concordance indices of the nomogram to predict MVI were 0.813 and 0.781 among LR patients with HCC within the MC or ≤ 3 cm, respectively. LR and PRFA resulted in similar 5-year recurrence and OS for patients with nomogram-predicted low-risk of MVI. LR provided better 5-year recurrence and OS versus PRFA for patients with high-risk of MVI (71.6% vs. 80.7%, p  = 0.013; 47.9% vs. 34.0%, p  = 0.002, for HCC within the MC; 62.3% vs. 78.8%, p  = 0.020; 63.6% vs. 38.3%, p  = 0.015, for HCC ≤ 3 cm). Among high-risk patients, LR was associated with lower recurrence and improved OS compared with PRFA, on multivariate analysis [hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.63–0.97, and HR 0.68, 95% CI 0.52–0.88, for HCC within the MC; HR 0.51, 95% CI 0.32–0.81, and HR 0.47, 95% CI 0.26–0.84, for HCC ≤ 3 cm], and resulted in less early and local recurrence than PRFA (42.4% vs. 54.8%, p  = 0.007, and 31.2% vs. 46.1%, p  = 0.007, for HCC within the MC; 27.9% vs. 50.8%, p  = 0.016, and 15.6% vs. 39.5%, p  = 0.046, for HCC ≤ 3 cm). Conclusions LR was oncologically superior over PRFA for early HCC patients with predicted high-risk of MVI. LR was associated with better local disease control than PRFA in these patients.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-021-09901-3