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Comparison of Hepatic Resection Combined with Intraoperative Radiofrequency Ablation, or Hepatic Resection Alone, for Hepatocellular Carcinoma Patients with Multifocal Tumors Meeting the University of California San Francisco (UCSF) Criteria: A Propensity Score-Matched Analysis

Annals of Surgical Oncology volume 27, pages 2334–2345 (2020)Cite this article

Abstract

Background

Whether hepatic resection (HR) combined with radiofrequency ablation (RFA) or HR alone is the treatment of choice for early or moderately advanced multifocal hepatocellular carcinomas (HCCs) is a matter of debate. This study compared the short- and long-term outcomes of patients with multifocal tumors meeting the University of California San Francisco (UCSF) criteria after HR plus intraoperative RFA or HR alone.

Methods

A total of 261 consecutive patients with multifocal HCCs meeting the UCSF criteria from January 2010 to January 2018, who underwent combined treatment (n = 51) or HR (n = 210), were included. Propensity score matching was performed to adjust for baseline differences. Overall survival (OS) and recurrence-free survival (RFS) were calculated, and subgroup analysis, along with univariate and multivariate analyses, were performed.

Results

The 1-, 3-, and 5-year OS rates after combined treatment or HR alone were 86.3%, 66.6%, and 34.2%, and 92.8%, 67.1%, and 37%, respectively (p = 0.423); combined treatment provided similar RFS rates as HR at 1, 3, and 5 years (78.4%, 35.8% and 20.9% vs. 82.6%, 50.4% and 24.5%, respectively; p = 0.076). The propensity matching model showed similar results. Subgroup analysis showed that HR was associated with better RFS than HR plus RFA for patients with two tumors or major tumors ≤ 3 cm. Multivariate analysis revealed that portal hypertension and three tumors are independent risk factors.

Conclusions

For multifocal HCC patients meeting the UCSF criteria, combined treatment may offer similar OS and RFS as HR; however, HR may be more suitable than combined treatment for patients with two tumors or major tumors ≤ 3 cm.

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Acknowledgment

The authors would like to thank Dr Xi Xu for his contribution to the statistical analysis.

Funding

This study was supported by grants from the National Natural Science Foundation of China (81400636) and Sichuan Province Key Research and Development Project (2019YFS0203).

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Author notes

  1. Yang Huang and Jiulin Song contributed equally to this study and are co-first authors.

Affiliations

  1. Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China

    Yang Huang MD, Jiulin Song MD, Jinli Zheng MD, Li Jiang MD, Lunan Yan MD, Jiayin Yang MD, Yong Zeng MD & Hong Wu MD

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  1. Yang Huang MD
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Correspondence to Li Jiang MD or Jiayin Yang MD.

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Jiulin Song, Yang Huang, Jinli Zheng, Li Jiang, Lunan Yan, Jiayin Yang, Yong Zeng, and Hong Wu have no disclosures to declare.

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Huang, Y., Song, J., Zheng, J. et al. Comparison of Hepatic Resection Combined with Intraoperative Radiofrequency Ablation, or Hepatic Resection Alone, for Hepatocellular Carcinoma Patients with Multifocal Tumors Meeting the University of California San Francisco (UCSF) Criteria: A Propensity Score-Matched Analysis. Ann Surg Oncol 27, 2334–2345 (2020). https://doi.org/10.1245/s10434-020-08231-0

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  • DOI: https://doi.org/10.1245/s10434-020-08231-0