Hepatocellular Carcinoma
Conditions
Keywords
liver transplant, liver resection, radiofrequency ablation, hepatocellular carcinoma
Brief summary
Curative-intent therapies for hepatocellular carcinoma (HCC) include radiofrequency ablation (RFA), liver resection (LR), and liver transplantation (LT). Controversy exists in treatment selection for early-stage tumors. We sought to evaluate the oncologic outcomes of patients who received either RFA, LR, or LT as first-line treatment for solitary HCC ≤ 3cm in an intention-to-treat analysis.
Interventions
PROCEDURERadiofrequency ablation
Treatment-naive patients with solitary HCC \<= 3 cm who received ablation as the first-line treatment
PROCEDURELiver resection
Treatment-naive patients with solitary HCC \<= 3 cm who underwent liver resection as the first-line treatment
PROCEDURELiver transplantation
Treatment-naive patients with solitary HCC \<= 3 cm who were listed for liver transplantation as the first-line treatment
Sponsors
University Health Network, Toronto
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult (≥18 years) patients * Solitary HCC ≤ 3cm * Receipt of either radiofrequency ablation, liver resection, or listing for a liver transplant * Treatment received between Feb-2000 and Nov-2018
Exclusion criteria
* Pathology other than hepatocellular carcinoma (HCC) * Receipt of prior treatment (i.e., not treatment naive) * Not eligible for all of the three treatments (ablation, liver resection, or liver transplant listing) * Platelet count \<100,000 before treatment * Alpha-1 fetoprotein (AFP) level \> 1000 before treatment * Age \> 70 years * Child-Pugh score C * Esophageal varices grade greater than 2 * Model for End-stage Liver Disease (MELD) score before treatment exceeding 15 * Presence of ascites pretreatment * Presence of encephalopathy pretreatment * Spleen size greater than 12 cm
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intention-to-treat (ITT) overall survival | Overall (median length of follow up of entire cohort 6.6 years) | ITT was evaluated from the first treatment modality that was selected for curative intent. In the case of RFA and LR this was recorded as the time of the treatment. In the case of LT, the intention-to-treat was recorded at the time of listing for transplantation. The ITT analysis thus accounted for patients who were placed on the waitlist but dropped out. |
| Disease-free survival (DFS). | Overall (median length of follow up of entire cohort 6.6 years) | DFS was defined as the time after treatment during which the patient was alive and free of disease. For DFS, patients were censored at recurrence, death, or loss to follow up. |
Outcome results
None listed