Clinical

Hepatic resection helpful in non-B non-C hepatoma

Last Updated: 2013-05-29 16:16:19 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - For hepatocellular carcinoma in patients without hepatitis B or C, surgery may be better than radiofrequency ablation (RFA) or transcatheter arterial chemoembolization (TACE), Japanese researchers say.

Dr. Tohru Utsunomiya from The University of Tokushima and colleagues in the Liver Cancer Study Group of Japan say the number of non-B non-C HCC patients has more than doubled in the previous decade.

For a paper online May 12 in Annals of Surgery, they compared outcomes after hepatic resection in 2,872 patients, RFA in 432 patients, and TACE in 1,437 patients. All were "non B, non C," meaning they were negative for hepatitis B surface antigen and hepatitis C antibody.

Patients were followed for a mean of 1.9 years after resection, 2.3 years after RFA, and 1.5 years after TACE.

Five-year survival rates not significantly different, at 66% after resection, 49% after RFA, and 32% after TACE (p=0.101).

But when patients were stratified by TNM stage, resection seemed to afford a significantly better prognosis than TACE in all four stages, and RFA showed a significantly better prognosis than TACE for patients in stage II or III.

Surgery yielded better outcomes than RFA only for stage II disease, but not for stage I, III, or IVa disease.

Stratifying patients by Japan Integrated Staging (JIS) score yielded similar results, except RFA seemed better than surgery for patients with JIS scores of 3.

"The findings of this large prospective cohort study indicated that hepatic resection may be recommended, especially in patients with TNM stage II and JIS scores '1' and '2' of non-B non-C HCC," the researchers conclude.

Dr. Alessandro Cucchetti from the liver and multiorgan transplant unit at Italy's University of Bologna told Reuters Health by email that surgery, when feasible, is preferable regardless of tumor stage. "However," he said, "TACE can be considered a reasonable strategy if a subsequent liver transplantation can be an option (bridge therapy)."

"Even in the face of refinements of non-surgical therapies, surgery remains the mainstay of HCC treatment even for non-B non-C patients," Dr. Cucchetti said. "Probably, RFA and hepatic resection can be considered both useful in HCCs less than 2cm in diameter."

Dr. Utsunomiya did not respond to a request for comments on this report.

SOURCE: http://bit.ly/13jiKdO

Ann Surg 2013.