Surgical resection vs. percutaneous ablation for hepatocellular carcinoma: a preliminary report of the Japanese nationwide survey.
OBJECTIVE
The treatment of choice for HCC remains controversial. We evaluated the therapeutic impact of surgical resection, PEI, and RFA for HCC on outcomes.


METHODS
A database derived from a Japanese nationwide survey of 17,149 patients with HCC treated by resection, PEI, or RFA between 2000 and 2003 was used to identify 7185 patients with no more than 3 tumors (< or = 3 cm) and a liver function of Child-Pugh class A or B. The patients classified into either a resection (n=2857), RFA (n=3022), or PEI group (n=1306) and their long-term outcomes were compared.


RESULTS
The median follow-up period was 10.4 months. The 2-year time-to-recurrence rate was 35.5%, 55.4%, and 73.3% in the resection, RFA, and PEI groups, respectively, while the number of recurrences was 2410, 2368, and 862. Although the number of deaths was 55 (1.9%), 49 (1.6%), and 39 (3.0%), the overall survival rates were not different. In a multivariate analysis, surgical resection was a significant negative factor for recurrence as compared with RFA (relative risk, 0.62 [95% confidence interval, 0.54-0.71], P<0.0001) and PEI (0.45 [0.38-0.52], P<0.0001).


CONCLUSIONS
This preliminary report suggested that surgical resection may provide less time-to-recurrence rate than either RFA or PEI in patients with HCC.
Hasegawa
Kiyoshi
K
Department of Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
Makuuchi
Masatoshi
M
Takayama
Tadatoshi
T
Kokudo
Norihiro
N
Arii
Shigeki
S
Okazaki
Masatoshi
M
Okita
Kiwamu
K
Omata
Masao
M
Kudo
Masatoshi
M
Kojiro
Masamichi
M
Nakanuma
Yasuni
Y
Takayasu
Kenichi
K
Monden
Morito
M
Matsuyama
Yutaka
Y
Ikai
Iwao
I
D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000208:ethnology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002492:Central Nervous System Depressants / Q000008:administration & dosage / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000379:methods*; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006306:Health Surveys; D006801:Humans; D007267:Injections; D007564:Japan; D008113:Liver Neoplasms / Q000188:drug therapy / Q000208:ethnology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D016896:Treatment Outcome
D002492:Central Nervous System Depressants; D000431:Ethanol