Survival in patients with recurrent hepatocellular carcinoma after primary hepatectomy: Comparative effectiveness of treatment modalities

• Published in: Surgery 2012-05, Vol.151 (5), p.700-709
• Main Authors: Ho, Cheng-Maw, MD, Lee, Po-Huang, MD, PhD, Shau, Wen-Yi, MD, PhD, Ho, Ming-Chih, MD, PhD, Wu, Yao-Ming, MD, Hu, Rey-Heng, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - therapy; Catheter Ablation; Chemoembolization, Therapeutic; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Hepatectomy; Humans; Liver Neoplasms - mortality; Liver Neoplasms - therapy; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - therapy; Prognosis; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Treatment Outcome; Tumors
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2011.12.015

Background Insufficient data are available on the survival of recurrent hepatocellular carcinoma after primary hepatectomy in patients receiving different treatments. We evaluated retrospectively the effects of treatment modalities on long-term survival. Methods Between 2001 and 2007, 435 posthepatectomy hepatocellular carcinoma patients who developed recurrence were grouped by treatment modality into re-resection, radiofrequency ablation, transarterial chemoembolization, and supportive treatment groups. Treatment strategies for both primary hepatocellular carcinoma and its recurrence were selected using the same criteria. Postrecurrence survival was estimated using the Kaplan–Meier method and compared using the Cox proportional hazard model with adjusted independent prognostic factors. Survival rates after primary resection without recurrence were also compared. Results In re-resection, radiofrequency ablation, transarterial chemoembolization, and supportive treatment groups, the 2-year postrecurrence survival rates were 90%, 96%, 75%, and 20%, respectively, and the 5-year survival rates were 72%, 83%, 56%, and 0%, respectively. The adjusted hazard of death was less for the re-resection and radiofrequency ablation groups than for the transarterial chemoembolization group, and the adjusted hazard ratios for the re-resection and radiofrequency ablation groups were 0.45 (95% confidence interval, 0.20–0.98) and 0.25 (0.08–0.81), respectively. The adjusted hazard ratio (95% confidence interval) of death for the radiofrequency ablation group compared to the re-resection group was 0.64 (0.19–2.19). Survival in the single resection group did not differ from that in the re-resection and radiofrequency ablation groups. Conclusion Postrecurrence survival in the re-resection and radiofrequency ablation groups was significantly better than that in the transarterial chemoembolization group and similar to that of patients in the primary resection without recurrence group.