Survival outcome of salvage hepatectomy in patients with local, recurrent hepatocellular carcinoma who underwent radiofrequency ablation as their first treatment

详细信息    查看全文

• 作者：Masaki Ueno ; MD ; PhD^a ; ^{ma@wakayama-med.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Takuya Nakai ; MD ; PhD^b ; Michihiro Hayashi ; MD ; PhD^c ; Fumitoshi Hirokawa ; MD ; PhD^c ; Hiroaki Nagano ; MD ; PhD^d ; Hiroshi Wada ; MD ; PhD^d ; Masaki Kaibori ; MD ; PhD^f ; Kosuke Matsui ; MD ; PhD^f ; Shogo Tanaka ; MD ; PhD^e ; Hiroki Yamaue ; MD ; PhD^a ; Shoji Kubo ; MD ; PhD^e
• 刊名：Surgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：160
• 期：3
• 页码：661-670
• 全文大小：897 K

文摘

Local recurrence is a specific problem after radiofrequency ablation of small hepatocellular carcinoma, and additional treatment is an important issue. We aimed to investigate the outcome of salvage hepatectomy in patients who develop local, recurrent hepatocellular carcinoma after treatment with radiofrequency ablation.

Methods

From 2001–2013, we reviewed 58 patients from 6 university hospitals with local, recurrent hepatocellular carcinoma who underwent salvage hepatectomy after their initial radiofrequency ablation treatment. Pathologic characteristics and prognostic factors influencing overall survival were analyzed.

Results

Noncurative resection, des-gamma carboxy prothrombin levels >40 mAU/mL, and multiple preceding treatments before salvage hepatectomy were negative prognostic factors for overall survival. The 5-year survivals for the prognostic factors were 0%, 24%, and 30%, respectively, after salvage hepatectomy, and 0%, 54%, and 54% after initial radiofrequency ablation treatment, respectively. As for the pathologic finding of local, recurrent hepatocellular carcinoma after radiofrequency ablation, vascular invasion was observed frequently in patients with increases in des-gamma carboxy prothrombin levels and with multiple preceding treatments before salvage hepatectomy with a frequency of 59% and 53%, respectively (P < .01 and .05).

Conclusion

Noncurative resection, increases in serum des-gamma carboxy prothrombin, and multiple preceding treatments were prognostic factors for subsequent salvage hepatectomy; nevertheless, survival outcomes were still acceptable when a curative salvage hepatectomy was performed. Increases in serum des-gamma carboxy prothrombin and multiple preceding treatments were positive predictors for pathologic vascular invasion. These factors should be taken into consideration when selecting treatment modalities for locally recurrent hepatocellular carcinoma following radiofrequency ablation. Repetition of unsuccessful, loco-regional treatment would appear to decrease the potential survival.