Clinical

Surgery may be best for early liver cancer

Last Updated: 2012-12-04 15:00:23 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - In early or moderately advanced hepatocellular carcinoma, surgery appears to produce better results than percutaneous ethanol injection (PEI) or radiofrequency ablation (RFA), Japanese researchers say.

According to Dr. Kiyoshi Hasegawa, lead author of a report online November 7th in the Journal of Hepatology, the findings are "the second best evidence" for guiding the management of small hepatocellular carcinoma.

"As you know," Dr. Hasegawa told Reuters Health in an email, "the best evidence is provided by RCTs (randomized controlled trials). So far, there have been at least five RCTs on this issue reported from China and Taiwan. However, their conclusions were inconsistent and none of them were free from underpowered sample size and some flaws in the study design."

To investigate long-term outcomes, Dr. Hasegawa of the University of Tokyo and colleagues used a nationwide survey database to identify 5,361 patients who had surgical resection, 5,548 who underwent RFA, and 2,059 who had PEI.

No one had more than three tumors, or tumors larger than 3 cm. Liver damage was class A or B.

With a median follow-up of 2.16 years, the overall survival at three years was 83.5% in the resection group, 81.0% in the RFA group, and 78.9% in the PEI group. Recurrence rates were 43.3%, 57.2% and 64.3%, respectively.

At five years, overall survival rates were 71.1%, 61.1% and 56.3%, respectively, and recurrence rates were 63.8%, 71.7% and 76.9%.

On multivariate analysis, the hazard ratio for death after resection was significantly less than after RFA (0.84) or PEI (0.75). Surgery also had a lower recurrence risk compared to RFA (0.74) and PEI (0.59).

This information will be useful for doctors and patients, Dr. Hasegawa said.

In 2009, Dr. Hasegawa's group began their own randomized trial comparing resection with RFA in such patients (http://www.surftrial.jp/). Follow-up is expected to last until 2017.

SOURCE: http://bit.ly/UdfN86

J Hepatol 2012.