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Comparison of outcome between liver resection, radiofrequency ablation, and transarterial therapy for multiple small hepatocellular carcinoma within the Milan criteria

Annals of Surgical Treatment and Research 2020년 99권 4호 p.238 ~ 246
오주현, 신동현, 최규성, 김종만, 조재원, 강태욱, 현동호, 강원석, 곽금연, 백용한, 이준혁, 고광철, 백승운, 최문석,
소속 상세정보
오주현 ( Oh Joo-Hyun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
신동현 ( Sinn Dong-Hyun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
최규성 ( Choi Gyu-Seong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
김종만 ( Kim Jong-Man ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
조재원 ( Joh Jae-Won ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
강태욱 ( Kang Tae-Wook ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiology
현동호 ( Hyun Dong-Ho ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiology
강원석 ( Kang Won-Seok ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
곽금연 ( Gwak Geum-Youn ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
백용한 ( Paik Yong-Han ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
이준혁 ( Lee Joon-Hyeok ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
고광철 ( Koh Kwang-Cheol ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
백승운 ( Paik Seung-Woon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
최문석 ( Choi Moon-Seok ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine

Abstract


Purpose: Although surgical resection is usually considered for a single tumor, several reports have suggested that resection can be considered for multiple tumors. The objective of this study was to determine whether resection could provide better long-term outcome for patients with multiple hepatocellular carcinomas (HCCs) within Milan criteria.

Methods: A total of 276 patients with multiple HCCs within Milan criteria with liver function preserved who underwent resection, radiofrequency ablation (RFA), or transarterial chemoembolization (TACE) between 2009 and 2013 were analyzed. Propensity-score (PS) matching was conducted.

Results: Five-year overall survival (OS) and recurrence-free survival (RFS) were better in the resection group than that in the RFA or TACE group. Patients who underwent resection had more preserved liver function and different tumor characteristics compared to those received RFA or TACE. With similar baseline characteristics generated in the PS model, there was no difference in 5-year OS among 3 groups (79.5% vs. 72.3% or 62.0%, P = 0.232), but the 5-year RFS was better for patients who received resection than those who received RFA or TACE (51.9% vs. 22.0% or 0.0%, P < 0.001). Although the major complication rate was slightly higher than RFA or TACE, there was no significant difference between the 3 groups before and after PS matching.

Conclusion: Resection was associated with better RFS than RFA or TACE and showed comparable OS in multiple HCC patients within the Milan criteria, but at a cost of slightly increased risk of complication. Resection can be considered as a first-line option if selected appropriately.

키워드

Chemoembolization; Hepatectomy; Hepatocellular carcinoma; Propensity score; Radiofrequency ablation

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