J Cancer 2019; 10(13):2857-2867. doi:10.7150/jca.31246

Research Paper

Resection vs Ablation for Multifocal Hepatocellular Carcinomas meeting the Barcelona-Clinic Liver Cancer A Classification: A Propensity Score Matching Study

Wenwu Liu1,2#, Zhiwen Yang1,2#, Ruhai Zou1,3#, Jiliang Qiu1,2, Jingxian Shen1,4, Yadi Liao1,2, Chenwei Wang1,2, Yuanping Zhang1,2, Yongjin Wang1,2, Yichuan Yuan1,2, Kai Li1,2, Dinglan Zuo1, Wei He1,2, Yun Zheng1,2*, Binkui Li1,2*, Yunfei Yuan1,2*✉

1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
2. Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Centre, Guangzhou, China
3. Department of Ultrasound, Sun Yat-Sen University Cancer Centre, Guangzhou, China
4. Department of Medical Imaging, Sun Yat-Sen University Cancer Centre, Guangzhou, China
# These authors contributed equally to this work.
* Senior authors contributed equally to this work.

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Citation:
Liu W, Yang Z, Zou R, Qiu J, Shen J, Liao Y, Wang C, Zhang Y, Wang Y, Yuan Y, Li K, Zuo D, He W, Zheng Y, Li B, Yuan Y. Resection vs Ablation for Multifocal Hepatocellular Carcinomas meeting the Barcelona-Clinic Liver Cancer A Classification: A Propensity Score Matching Study. J Cancer 2019; 10(13):2857-2867. doi:10.7150/jca.31246. Available from http://www.jcancer.org/v10p2857.htm

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Abstract

With development of surgical technology, we aimed to investigate whether resection could challenge the standard treatment, ablation, in treating multifocal hepatocellular carcinomas meeting the Barcelona-Clinic Liver Cancer A stage. From January 2005 to January 2017, the oncological outcomes of patients undergoing resection (n = 72) or ablation (n = 63) were retrospectively analysed using propensity score matching. At baseline, patients in the ablation group had more tri-focal lesions (30.2% vs. 6.9%, P = 0.001) and smaller tumours (2.00 cm vs. 2.50 cm, P = 0.002) than resection group. After matching, the baseline was well-balanced between treatments (n = 46 pairs); resection provided comparable 5-year overall survival (77.0% vs. 83.6, P = 0.790) and superior 5-year recurrence-free survival (40.4% vs. 16.9%, P = 0.022) to ablation. The multivariate Cox model confirmed that ablation was not associated with worse overall survival (HR = 0.89; 95% CI, 0.33 - 2.42, P = 0.819), but identified ablation as an unfavourable predictor of recurrence-free survival (HR = 2.13; 95% CI, 1.27 - 3.57, P <0.001). For subgroup patients with multifocal tumours located in different segments, both treatments offered similar 5-year overall survival (74.3% vs. 95.5%, P = 0.190) and 5-year recurrence-free survival (42.9 vs. 25.9%, P = 0.170). Additionally, ablation resulted in less major complications than resection (3.2% vs 13.9%, P = 0.035). Compared with ablation, resection achieved comparable overall survival and even superior recurrence-free survival for patients with multifocal hepatocellular carcinomas meeting the BCLC A stage.

Keywords: Hepatectomy, Local ablation, Liver cancer, Outcomes