Combined radiofrequency ablation and ethanol injection versus repeat hepatectomy for elderly patients with recurrent hepatocellular carcinoma after initial hepatic surgery |
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Authors: | Shuling Chen Zhenwei Peng Han Xiao Manxia Lin Zebin Chen Chunlin Jiang |
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Affiliation: | 1. Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;2. Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;3. Department of Clinical Trial Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;4. Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;5. Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China |
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Abstract: | Purpose: To retrospectively compare the efficacy and safety of combined radiofrequency ablation and percutaneous ethanol injection (RFA–PEI) with repeat hepatectomy for elderly patients with initial recurrent hepatocellular carcinoma (HCC) after hepatic surgery.Methods: From January 2009 to June 2015, 105 elderly patients (≥70?years) who underwent RFA–PEI (n?=?57) or repeated hepatectomy (n?=?48) for recurrent HCC?≤?5.0?cm were included in the study. The overall survival (OS) and recurrence-free survival (RFS) were analysed with the Kaplan–Meier method and compared by the log-rank test. Non-tumour-related death, complications and hospital stays were assessed. Univariate and multivariate analyses were performed to identify the prognostic significance of the variables in predicting the OS and RFS.Results: OS rates were 78.2%, 40.8% and 36.7% at 1, 3 and 5?years after RFA–PEI and 76.3%, 52.5% and 42.6% after repeat hepatectomy, respectively (p?=?0.413). Correspondingly, the 1-, 3- and 5-year RFS rates after RFA–PEI and repeat hepatectomy were 69.5%, 37.8%, 33.1% and 73.1%, 49.7%, 40.7%, respectively (p?=?0.465). Non-tumour-related deaths in the RFA–PEI group (2/57) were significantly fewer than those in the repeat hepatectomy group (10/48) (p?=?0.016). RFA–PEI was superior to repeat hepatectomy regarding the major complication rates and length of in-hospital stay (both p?0.001). Multivariate analysis showed that the tumour number was the significant prognostic factor for the OS (hazard ratio (HR)?=?1.961, 95% CI?=?1.043–3.686, p?=?0.037) and RFS (HR?=?1.866, 95% CI?=?1.064–3.274, p?=?0.030).Conclusion: RFA–PEI provides comparable OS and RFS to repeat hepatectomy for elderly patients with small recurrent HCC after hepatectomy but with fewer non-tumour-related deaths, major complications and shorter hospital stays. |
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Keywords: | Recurrent hepatocellular carcinoma radiofrequency ablation ethanol injection repeat hepatectomy the elderly |
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