A RECENT retrospective cohort study has linked liver resection (LR) to improved survival outcomes in patients with early liver cancer, finding that the 5-year overall survival (OS) rate almost doubled in patients who had undergone LR compared to those who had undergone non-surgical treatment.
The study aimed to compare the efficacy of LR, percutaneous radiofrequency ablation (PRFA), and trans-arterial chemoembolisation (TACE) in patients with early multinodular hepatocellular carcinoma (HCC), defined as having two or three nodules, each measuring 3 cm or smaller. This retrospective cohort study analysed data from two large registries: the HE.RC.O.LE.S register, which included 5,331 patients who underwent LR (n=296), and the ITA.LI.CA database, which included 7,056 patients treated with PRFA (n=240) and TACE (n=184). Data were collected from multiple centres between 2008 and 2020, with analysis conducted throughout 2023. A matching-adjusted indirect comparison (MAIC) method was used to balance the data and adjust for potential confounders.
The study included 720 patients with early multinodular HCC (75.4% male; 48.6% >70 years). Among them, 296 underwent LR, 240 received PRFA, and 184 were treated with TACE. The results showed that liver resection had superior survival rates at 1, 3, and 5 years compared to PRFA and TACE. Specifically, the LR group had survival rates of 89.11%, 70.98%, and 56.44%, respectively. In contrast, PRFA showed survival rates of 94.01%, 65.20%, and 39.93%, while TACE had rates of 90.88%, 48.95%, and 29.24%.
Multivariable Cox survival analysis in the weighted population demonstrated a survival advantage for LR over PRFA (hazard ratio: 1.41; 95% confidence interval: 1.07–1.86; P=0.01) and TACE (hazard ratio: 1.86; 95% confidence interval: 1.29–2.68; P=0.001). Additionally, competing risk analysis confirmed that LR was associated with a lower risk of cancer-related death compared to PRFA and TACE. The study was led by Alessandro Vitale, Pierluigi Romano, and Umberto Cillo, along with their colleagues from the HE.RC.O.LE.S and ITA.LI.CA Collaborative Groups.
These findings challenge the current 2022 Barcelona Clinic Liver Cancer algorithm, which discourages liver resection for patients with multinodular HCC. Commenting on the current literature, the authors said: “Although a large amount of solid indirect evidence suggests the superiority of LR over PRFA or TACE regardless of Barcelona Clinic Liver Cancer stage, direct evidence comparing these three treatments in the subgroup of early multinodular HCC is relatively poor”. The research proposes that, for patients with early multinodular HCC who are not eligible for liver transplantation, liver resection ought to be considered the first-line therapeutic option. PRFA and TACE can, accordingly, be considered where liver resection is unsuitable. This study provides valuable insights that could influence clinical decision-making and improve survival outcomes for patients with this form of liver cancer.
Reference:
Vitale A et al. Liver resection vs nonsurgical treatments for patients with early multinodular hepatocellular carcinoma. JAMA Surg. 2024.
