Comparison of resection and ablation for hepatocellular carcinoma: A cohort study based on a Japanese nationwide survey

Kiyoshi Hasegawa, Norihiro Kokudo, Masatoshi Makuuchi, Namiki Izumi, Takafumi Ichida, Masatoshi Kudo, Yonson Ku, Michiie Sakamoto, Osamu Nakashima, Osamu Matsui, Yutaka Matsuyama

Research output: Contribution to journalArticle

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Abstract

Background & Aims: The treatment of choice for early or moderately advanced hepatocellular carcinoma (HCC) with good liver function remains controversial. We evaluated the therapeutic impacts of surgical resection (SR), percutaneous ethanol injection (PEI), and radiofrequency ablation (RFA) on long-term outcomes in patients with HCC. Methods: A database constructed on the basis of a Japanese nationwide survey of 28,510 patients with HCC treated by SR, PEI, or RFA between 2000 and 2005 was used to identify 12,968 patients who had no more than 3 tumors (≤3 cm) and liver damage of class A or B. The patients were divided into SR (n = 5361), RFA (n = 5548), and PEI groups (n = 2059). Overall survival and time to recurrence were compared among them. Results: Median follow-up was 2.16 years. Overall survival at 3 and 5 years was respectively 85.3%/71.1% in the SR group, 81.0%/61.1% in the RFA, and 78.9%/56.3% in the PEI. Time to recurrence at 3 and 5 years was 43.3%/63.8%, 57.2%/71.7%, and 64.3%/76.9%, respectively. On multivariate analysis, the hazard ratio for death was significantly lower in the SR group than in the RFA (SR vs. RFA:0.84, 95% confidence interval, 0.74-0.95; p = 0.006) and PEI groups (SR vs. PEI:0.75, 0.64-0.86; p = 0.0001). The hazard ratios for recurrence were also lower in the SR group than in the RFA (SR vs. RFA:0.74, 0.68-0.79; p = 0.0001) and PEI groups (SR vs. PEI:0.59, 0.54-0.65; p = 0.0001). Conclusions: Our findings suggest that surgical resection results in longer overall survival and shorter time to recurrence than either RFA or PEI in patients with HCC.

Original languageEnglish
Pages (from-to)724-729
Number of pages6
JournalJournal of Hepatology
Volume58
Issue number4
DOIs
Publication statusPublished - 2013 Apr

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Hepatocellular Carcinoma
Cohort Studies
Ethanol
Injections
Recurrence
Survival
Surveys and Questionnaires
Liver
Multivariate Analysis
Databases
Confidence Intervals
Therapeutics
Neoplasms

Keywords

  • Hepatectomy
  • Percutaneous ethanol injection
  • Radiofrequency ablation
  • Surgical resection

ASJC Scopus subject areas

  • Hepatology

Cite this

Comparison of resection and ablation for hepatocellular carcinoma : A cohort study based on a Japanese nationwide survey. / Hasegawa, Kiyoshi; Kokudo, Norihiro; Makuuchi, Masatoshi; Izumi, Namiki; Ichida, Takafumi; Kudo, Masatoshi; Ku, Yonson; Sakamoto, Michiie; Nakashima, Osamu; Matsui, Osamu; Matsuyama, Yutaka.

In: Journal of Hepatology, Vol. 58, No. 4, 04.2013, p. 724-729.

Research output: Contribution to journalArticle

Hasegawa, K, Kokudo, N, Makuuchi, M, Izumi, N, Ichida, T, Kudo, M, Ku, Y, Sakamoto, M, Nakashima, O, Matsui, O & Matsuyama, Y 2013, 'Comparison of resection and ablation for hepatocellular carcinoma: A cohort study based on a Japanese nationwide survey', Journal of Hepatology, vol. 58, no. 4, pp. 724-729. https://doi.org/10.1016/j.jhep.2012.11.009
Hasegawa, Kiyoshi ; Kokudo, Norihiro ; Makuuchi, Masatoshi ; Izumi, Namiki ; Ichida, Takafumi ; Kudo, Masatoshi ; Ku, Yonson ; Sakamoto, Michiie ; Nakashima, Osamu ; Matsui, Osamu ; Matsuyama, Yutaka. / Comparison of resection and ablation for hepatocellular carcinoma : A cohort study based on a Japanese nationwide survey. In: Journal of Hepatology. 2013 ; Vol. 58, No. 4. pp. 724-729.
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abstract = "Background & Aims: The treatment of choice for early or moderately advanced hepatocellular carcinoma (HCC) with good liver function remains controversial. We evaluated the therapeutic impacts of surgical resection (SR), percutaneous ethanol injection (PEI), and radiofrequency ablation (RFA) on long-term outcomes in patients with HCC. Methods: A database constructed on the basis of a Japanese nationwide survey of 28,510 patients with HCC treated by SR, PEI, or RFA between 2000 and 2005 was used to identify 12,968 patients who had no more than 3 tumors (≤3 cm) and liver damage of class A or B. The patients were divided into SR (n = 5361), RFA (n = 5548), and PEI groups (n = 2059). Overall survival and time to recurrence were compared among them. Results: Median follow-up was 2.16 years. Overall survival at 3 and 5 years was respectively 85.3{\%}/71.1{\%} in the SR group, 81.0{\%}/61.1{\%} in the RFA, and 78.9{\%}/56.3{\%} in the PEI. Time to recurrence at 3 and 5 years was 43.3{\%}/63.8{\%}, 57.2{\%}/71.7{\%}, and 64.3{\%}/76.9{\%}, respectively. On multivariate analysis, the hazard ratio for death was significantly lower in the SR group than in the RFA (SR vs. RFA:0.84, 95{\%} confidence interval, 0.74-0.95; p = 0.006) and PEI groups (SR vs. PEI:0.75, 0.64-0.86; p = 0.0001). The hazard ratios for recurrence were also lower in the SR group than in the RFA (SR vs. RFA:0.74, 0.68-0.79; p = 0.0001) and PEI groups (SR vs. PEI:0.59, 0.54-0.65; p = 0.0001). Conclusions: Our findings suggest that surgical resection results in longer overall survival and shorter time to recurrence than either RFA or PEI in patients with HCC.",
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T2 - A cohort study based on a Japanese nationwide survey

AU - Hasegawa, Kiyoshi

AU - Kokudo, Norihiro

AU - Makuuchi, Masatoshi

AU - Izumi, Namiki

AU - Ichida, Takafumi

AU - Kudo, Masatoshi

AU - Ku, Yonson

AU - Sakamoto, Michiie

AU - Nakashima, Osamu

AU - Matsui, Osamu

AU - Matsuyama, Yutaka

PY - 2013/4

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N2 - Background & Aims: The treatment of choice for early or moderately advanced hepatocellular carcinoma (HCC) with good liver function remains controversial. We evaluated the therapeutic impacts of surgical resection (SR), percutaneous ethanol injection (PEI), and radiofrequency ablation (RFA) on long-term outcomes in patients with HCC. Methods: A database constructed on the basis of a Japanese nationwide survey of 28,510 patients with HCC treated by SR, PEI, or RFA between 2000 and 2005 was used to identify 12,968 patients who had no more than 3 tumors (≤3 cm) and liver damage of class A or B. The patients were divided into SR (n = 5361), RFA (n = 5548), and PEI groups (n = 2059). Overall survival and time to recurrence were compared among them. Results: Median follow-up was 2.16 years. Overall survival at 3 and 5 years was respectively 85.3%/71.1% in the SR group, 81.0%/61.1% in the RFA, and 78.9%/56.3% in the PEI. Time to recurrence at 3 and 5 years was 43.3%/63.8%, 57.2%/71.7%, and 64.3%/76.9%, respectively. On multivariate analysis, the hazard ratio for death was significantly lower in the SR group than in the RFA (SR vs. RFA:0.84, 95% confidence interval, 0.74-0.95; p = 0.006) and PEI groups (SR vs. PEI:0.75, 0.64-0.86; p = 0.0001). The hazard ratios for recurrence were also lower in the SR group than in the RFA (SR vs. RFA:0.74, 0.68-0.79; p = 0.0001) and PEI groups (SR vs. PEI:0.59, 0.54-0.65; p = 0.0001). Conclusions: Our findings suggest that surgical resection results in longer overall survival and shorter time to recurrence than either RFA or PEI in patients with HCC.

AB - Background & Aims: The treatment of choice for early or moderately advanced hepatocellular carcinoma (HCC) with good liver function remains controversial. We evaluated the therapeutic impacts of surgical resection (SR), percutaneous ethanol injection (PEI), and radiofrequency ablation (RFA) on long-term outcomes in patients with HCC. Methods: A database constructed on the basis of a Japanese nationwide survey of 28,510 patients with HCC treated by SR, PEI, or RFA between 2000 and 2005 was used to identify 12,968 patients who had no more than 3 tumors (≤3 cm) and liver damage of class A or B. The patients were divided into SR (n = 5361), RFA (n = 5548), and PEI groups (n = 2059). Overall survival and time to recurrence were compared among them. Results: Median follow-up was 2.16 years. Overall survival at 3 and 5 years was respectively 85.3%/71.1% in the SR group, 81.0%/61.1% in the RFA, and 78.9%/56.3% in the PEI. Time to recurrence at 3 and 5 years was 43.3%/63.8%, 57.2%/71.7%, and 64.3%/76.9%, respectively. On multivariate analysis, the hazard ratio for death was significantly lower in the SR group than in the RFA (SR vs. RFA:0.84, 95% confidence interval, 0.74-0.95; p = 0.006) and PEI groups (SR vs. PEI:0.75, 0.64-0.86; p = 0.0001). The hazard ratios for recurrence were also lower in the SR group than in the RFA (SR vs. RFA:0.74, 0.68-0.79; p = 0.0001) and PEI groups (SR vs. PEI:0.59, 0.54-0.65; p = 0.0001). Conclusions: Our findings suggest that surgical resection results in longer overall survival and shorter time to recurrence than either RFA or PEI in patients with HCC.

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KW - Percutaneous ethanol injection

KW - Radiofrequency ablation

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