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Publications

Journal Article Multicenter Study Comparative Study Ppublish 2 citations

PubMed: 42478167 DOI: 10.1111/liv.70802

Laparoscopic or Open Liver Resection Versus Multibipolar Radiofrequency Ablation of HCC Within Milan Criteria on Cirrhosis.

Liver Int 46(8):e70802

Authors: Christian Hobeika, François Cauchy, Agnès Rode, Ephrem Salamé, Olivier Scatton, Lilian Schwarz, Panteleimon Papadopoulos, Arnaud Hocquelet, Anne-Frédérique Manichon, Christophe Aubé, Frederic Oberti, Angelo Della Corte, Alain Luciani, Suzanne Gay, Mickaël Lesurtel, Chetana Lim, Pierre Nahon, Nathalie Ganne-Carrié, Lorraine Blaise, Olivier Soubrane, Olivier Sutter, Raffaele Brustia, Louise Barbier, Alexis Laurent, Olivier Seror, Jean-Charles Nault

Affiliations

  • Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, AP-HP, Clichy, Paris-Cité University, Paris, France.
  • Department of Hepato-Pancreato-Biliary and Liver Transplantation, Hôpitaux Universitaires de Genève, Genève, Switzerland.
  • Service de radiologie, CHU Hospices Civils de Lyon, Lyon, France.
  • Service de chirurgie Digestive et Transplantation Hépatique, CHU Tours, Université de Tours, Tours, France.
  • Service de chirurgie hépatobiliaire et digestive, APHP, CHU Pitié Salpétrière, Paris, France.
  • Service de chirurgie hépatobiliaire et digestive, CHU de Rouen, Rouen, France.
  • Service de radiologie, CHU Bordeaux, Bordeaux, France.
  • Service of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
  • Service de radiologie, Hôpital Croix Rousse, Lyon, France.
  • Department of Radiology, Angers University Hospital, CHU d'Angers, Angers, France.
  • Laboratoire HIFIH, EA 3859, UNIV Angers, Université d'Angers, Angers, France.
  • Service d'imagerie Médicale, Hôpital Henri Mondor, APHP, UPEC, Créteil, INSERM U955 - Equipe 18, Créteil, France.
  • Department of Hepato Gastroenterology, Angers University Hospital, CHU d'Angers, Angers, France.
  • Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Université Paris Est Créteil. INSERM IMRB, Créteil, France.
  • AP-HP, hôpital Avicenne, service d'hépatologie, Bobigny, France.
  • Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.
  • Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, team « Functional Genomics of Solid Tumors », Paris, France.
  • Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France.
  • Unité fonctionnelle de radiologie interventionnelle, APHP, Hôpital Avicenne, Bobigny, France.
  • Université Paris-Est Créteil, UPEC, Créteil, France.
  • Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Department of Digestive and Hepato-Pancreatic-Biliary Surgery, Assistance Publique-Hôpitaux de Paris, Henri Mondor-University Hospital, Créteil, France.
  • Department of HPB Surgery and Transplantation, Auckland City Hospital, Auckland, New Zealand.

Abstract

BACKGROUND & AIMS

We compared multibipolar radiofrequency ablation (mbpRFA) with open liver resection (OLR) or laparoscopic liver resection (LLR) in patients with HCCs within Milan.

METHODS

This multicenter cohort study included patients treated by mbpRFA, OLR or LLR for HCC within the Milan Criteria, developed on advanced fibrosis in nine French centres between 2008 and 2018. Adjustments on HCC size/number, gender, age, ASA, HCV, HBV, metabolic syndrome, chronic alcohol intake, MELD score, serum AFP level, APRI score, cirrhosis, significant portal hypertension and HCC localization were performed using multivariable regressions with centre-robust variance and propensity score-based matching (3:1 nearest-neighbour with calliper < 0.1; effective ratios 2.18:1 and 2.43:1).

RESULTS

1040 patients were included (median age: 64 years; male 82.9%), with 606, 266 and 168 treated by mbpRFA, LLR and OLR. Most HCCs were solitary (84.8%) and on cirrhosis (89.2%). In months, the follow-up was 50.2 (95% CI: 45.3, 54.3), 43.3 (95% CI: 40.0, 48.6) and 47.4 (95% CI: 40.8, 58.7) for mbpRFA, LLR and OLR patients. After matching, OLR patients had similar overall survival (OS) (HR = 1.05 [CI 95% = 0.65, 1.69], p = 0.853), transplant-free survival (TFS) (HR = 0.91 [CI 95% = 0.56, 1.47]; p = 0.690) or recurrence-free survival (RFS) (HR = 0.99 [CI 95% = 0.69, 1.43]; p = 0.968) compared to mbpRFA patients but with more severe adverse events (RR = 2.58 [CI 95% = 1.16, 5.71]; p = 0.02) and mortality (RR = 4.51 [CI 95% = 1.16, 17.59]; p = 0.03). After matching, LLR patients had better OS (HR = 0.57 [CI 95% = 0.38, 0.88], p = 0.01) but similar TFS (HR = 0.77 [CI 95% = 0.55, 1.1]; p = 0.152) and more severe adverse events (RR = 2.61 [CI 95% = 1.15, 5.96]; p = 0.022) compared to mbpRFA patients. LLR patients had a better RFS (HR = 0.7 [CI 95% = 0.53, 0.91]; p = 0.009) than mbpRFA patients. When distant-only recurrences were considered in the mbpRFA patients, there was no significant difference in RFS (p = 0.087). The LLR survival benefit was consistent across pre-specified subgroups, with no interaction surviving correction for multiple testing.

CONCLUSIONS

Minimally invasive modalities (LLR or mbpRFA) should be prioritized when treating early HCC. LLR maximizes oncological outcomes, but mbpRFA maintains optimal TFS with less morbidity.

MeSH

Carcinoma, Hepatocellular, Minimally Invasive Surgical Procedures, Liver, Drug-Related Side Effects And Adverse Reactions, Radiofrequency Ablation, Transplantation