Cryoablation Provides Superior Local Control of Primary Hepatocellular Carcinomas of >2 cm Compared with Radiofrequency Ablation and Microwave Coagulation Therapy: An Underestimated Tool in the Toolbox

Shigenori Ei, Taizo Hibi, Minoru Tanabe, Osamu Itano, Masahiro Shinoda, Minoru Kitago, Yuta Abe, Hiroshi Yagi, Koji Okabayashi, Daisuke Sugiyama, Go Wakabayashi, Yuukou Kitagawa

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Abstract

Background: Although cryoablation (Cryo) has been advocated as an effective locoregional therapy for hepatocellular carcinoma (HCC), few studies have compared the outcomes with those of radiofrequency ablation (RFA) and microwave coagulation therapy (MCT). Methods: Consecutive patients with primary HCCs of <5 cm received Cryo or RFA/MCT between 1998 and 2011 and were monitored for local recurrence (defined as a recurrent tumor at or in direct contact with the ablated area) and overall complication rates. Results: The median tumor size was 2.5 cm in the Cryo group (n = 55) and 1.9 cm in the RFA/MCT group (n = 64; P < 0.001), but other patient characteristics were similar. Multivariate Cox regression analysis revealed Cryo as the only independent factor for improved 2-year local recurrence-free survival, with a hazard ratio (HR) of 0.3 (95 % confidence interval, 0.1–0.9; P = 0.02). Tumor diameter was a negative indicator of local recurrence-free survival (HR, 2.0; 95 % confidence interval, 1.1–3.5; P = 0.02). Subgroup analysis of patients with tumors of >2 cm demonstrated significantly better local recurrence rates in the Cryo group compared with the RFA/MCT group (21 vs. 56 % at 2 years; P = 0.006). Overall complication rates and incidences of Clavien–Dindo classification grade ≥III were identical (both P = 1.00). No in-hospital mortality occurred. Conclusions: Appropriate use of Cryo, as shown in this series, is safe and provides significantly improved local control for the treatment of primary HCCs of >2 cm compared with RFA/MCT.

Original languageEnglish
Pages (from-to)1294-1300
Number of pages7
JournalAnnals of Surgical Oncology
Volume22
Issue number4
DOIs
Publication statusPublished - 2015

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Cryosurgery
Microwaves
Hepatocellular Carcinoma
Therapeutics
Group Psychotherapy
Hospital Mortality
Recurrence
Incidence

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{2e09d6165d4e4909bc55d90629a84c6f,
title = "Cryoablation Provides Superior Local Control of Primary Hepatocellular Carcinomas of >2 cm Compared with Radiofrequency Ablation and Microwave Coagulation Therapy: An Underestimated Tool in the Toolbox",
abstract = "Background: Although cryoablation (Cryo) has been advocated as an effective locoregional therapy for hepatocellular carcinoma (HCC), few studies have compared the outcomes with those of radiofrequency ablation (RFA) and microwave coagulation therapy (MCT). Methods: Consecutive patients with primary HCCs of <5 cm received Cryo or RFA/MCT between 1998 and 2011 and were monitored for local recurrence (defined as a recurrent tumor at or in direct contact with the ablated area) and overall complication rates. Results: The median tumor size was 2.5 cm in the Cryo group (n = 55) and 1.9 cm in the RFA/MCT group (n = 64; P < 0.001), but other patient characteristics were similar. Multivariate Cox regression analysis revealed Cryo as the only independent factor for improved 2-year local recurrence-free survival, with a hazard ratio (HR) of 0.3 (95 {\%} confidence interval, 0.1–0.9; P = 0.02). Tumor diameter was a negative indicator of local recurrence-free survival (HR, 2.0; 95 {\%} confidence interval, 1.1–3.5; P = 0.02). Subgroup analysis of patients with tumors of >2 cm demonstrated significantly better local recurrence rates in the Cryo group compared with the RFA/MCT group (21 vs. 56 {\%} at 2 years; P = 0.006). Overall complication rates and incidences of Clavien–Dindo classification grade ≥III were identical (both P = 1.00). No in-hospital mortality occurred. Conclusions: Appropriate use of Cryo, as shown in this series, is safe and provides significantly improved local control for the treatment of primary HCCs of >2 cm compared with RFA/MCT.",
author = "Shigenori Ei and Taizo Hibi and Minoru Tanabe and Osamu Itano and Masahiro Shinoda and Minoru Kitago and Yuta Abe and Hiroshi Yagi and Koji Okabayashi and Daisuke Sugiyama and Go Wakabayashi and Yuukou Kitagawa",
year = "2015",
doi = "10.1245/s10434-014-4114-7",
language = "English",
volume = "22",
pages = "1294--1300",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",
number = "4",

}

TY - JOUR

T1 - Cryoablation Provides Superior Local Control of Primary Hepatocellular Carcinomas of >2 cm Compared with Radiofrequency Ablation and Microwave Coagulation Therapy

T2 - An Underestimated Tool in the Toolbox

AU - Ei, Shigenori

AU - Hibi, Taizo

AU - Tanabe, Minoru

AU - Itano, Osamu

AU - Shinoda, Masahiro

AU - Kitago, Minoru

AU - Abe, Yuta

AU - Yagi, Hiroshi

AU - Okabayashi, Koji

AU - Sugiyama, Daisuke

AU - Wakabayashi, Go

AU - Kitagawa, Yuukou

PY - 2015

Y1 - 2015

N2 - Background: Although cryoablation (Cryo) has been advocated as an effective locoregional therapy for hepatocellular carcinoma (HCC), few studies have compared the outcomes with those of radiofrequency ablation (RFA) and microwave coagulation therapy (MCT). Methods: Consecutive patients with primary HCCs of <5 cm received Cryo or RFA/MCT between 1998 and 2011 and were monitored for local recurrence (defined as a recurrent tumor at or in direct contact with the ablated area) and overall complication rates. Results: The median tumor size was 2.5 cm in the Cryo group (n = 55) and 1.9 cm in the RFA/MCT group (n = 64; P < 0.001), but other patient characteristics were similar. Multivariate Cox regression analysis revealed Cryo as the only independent factor for improved 2-year local recurrence-free survival, with a hazard ratio (HR) of 0.3 (95 % confidence interval, 0.1–0.9; P = 0.02). Tumor diameter was a negative indicator of local recurrence-free survival (HR, 2.0; 95 % confidence interval, 1.1–3.5; P = 0.02). Subgroup analysis of patients with tumors of >2 cm demonstrated significantly better local recurrence rates in the Cryo group compared with the RFA/MCT group (21 vs. 56 % at 2 years; P = 0.006). Overall complication rates and incidences of Clavien–Dindo classification grade ≥III were identical (both P = 1.00). No in-hospital mortality occurred. Conclusions: Appropriate use of Cryo, as shown in this series, is safe and provides significantly improved local control for the treatment of primary HCCs of >2 cm compared with RFA/MCT.

AB - Background: Although cryoablation (Cryo) has been advocated as an effective locoregional therapy for hepatocellular carcinoma (HCC), few studies have compared the outcomes with those of radiofrequency ablation (RFA) and microwave coagulation therapy (MCT). Methods: Consecutive patients with primary HCCs of <5 cm received Cryo or RFA/MCT between 1998 and 2011 and were monitored for local recurrence (defined as a recurrent tumor at or in direct contact with the ablated area) and overall complication rates. Results: The median tumor size was 2.5 cm in the Cryo group (n = 55) and 1.9 cm in the RFA/MCT group (n = 64; P < 0.001), but other patient characteristics were similar. Multivariate Cox regression analysis revealed Cryo as the only independent factor for improved 2-year local recurrence-free survival, with a hazard ratio (HR) of 0.3 (95 % confidence interval, 0.1–0.9; P = 0.02). Tumor diameter was a negative indicator of local recurrence-free survival (HR, 2.0; 95 % confidence interval, 1.1–3.5; P = 0.02). Subgroup analysis of patients with tumors of >2 cm demonstrated significantly better local recurrence rates in the Cryo group compared with the RFA/MCT group (21 vs. 56 % at 2 years; P = 0.006). Overall complication rates and incidences of Clavien–Dindo classification grade ≥III were identical (both P = 1.00). No in-hospital mortality occurred. Conclusions: Appropriate use of Cryo, as shown in this series, is safe and provides significantly improved local control for the treatment of primary HCCs of >2 cm compared with RFA/MCT.

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