Radiofrequency Ablation Is Superior to Ethanol Injection in Early-Stage Hepatocellular Carcinoma Irrespective of Tumor Size

PLOS ONE, Dec 2019

Background Randomized trials suggest that radiofrequency ablation (RFA) may be more effective than percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC). However, the survival advantage of RFA needs confirmation in daily practice. Methods We conducted a population-based cohort study using the Taiwan Cancer Registry, National Health Insurance claim database and National Death Registry data from 2004 through 2009. Patients receiving PEI or RFA as first-line treatment for newly-diagnosed stage I-II HCC were enrolled. Results A total of 658 patients receiving RFA and 378 patients receiving PEI treatment were included for final analysis. The overall survival (OS) rates of patients in the RFA and PEI groups at 5-year were 55% and 42%, respectively (p < 0.01). Compared to patients that received PEI, those that received RFA had lower risks of overall mortality and first-line treatment failure (FTF), with adjusted hazard ratios (HRs) [95% confidence interval (CI)] of 0.60 (0.50-0.73) for OS and 0.54 (0.46-0.64) for FTF. The favorable outcomes for the RFA group were consistently significant for patients with tumors > 2 cm as well as for those with tumors < 2 cm. Consistent results were also observed in other subgroup analyses defined by gender, age, tumor stage, and co-morbidity status. Conclusion RFA provides better survival benefits than PEI for patients with unresectable stage I-II HCC, irrespective of tumors > 2 cm or ≤ 2 cm, in contemporary clinical practice.

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Radiofrequency Ablation Is Superior to Ethanol Injection in Early-Stage Hepatocellular Carcinoma Irrespective of Tumor Size

et al. (2013) Radiofrequency Ablation Is Superior to Ethanol Injection in Early-Stage Hepatocellular Carcinoma Irrespective of Tumor Size. PLoS ONE 8(11): e80276. doi:10.1371/journal.pone.0080276 Radiofrequency Ablation Is Superior to Ethanol Injection in Early-Stage Hepatocellular Carcinoma Irrespective of Tumor Size Zhong-Zhe Lin 0 Wen-Yi Shau 0 Chiun Hsu 0 Yu-Yun Shao 0 Yi-Chun Yeh 0 Raymond Nien-Chen 0 Kuo 0 Chih-Hung Hsu 0 James Chih-Hsin Yang 0 Ann-Lii Cheng 0 Mei-Shu Lai 0 Tetsuo Takehara, Osaka University Graduate School of Medicine, Japan 0 1 Department of Oncology, National Taiwan University Hospital , Taipei, Taiwan , 2 Department of Internal Medicine, College of Medicine, National Taiwan University , Taipei, Taiwan , 3 Division of Health Technology Assessment, Center for Drug Evaluation , Taipei, Taiwan , 4 Graduate Institute of Oncology, College of Medicine, National Taiwan University , Taipei, Taiwan , 5 Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital , Taipei, Taiwan, 6 Taiwan Cancer Registry , Department of Health , Taipei, Taiwan , 7 Graduate Institute of Health Policy and Management, College of Public Health, National Taiwan University , Taipei, Taiwan , 8 Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University , Taipei , Taiwan Background: Randomized trials suggest that radiofrequency ablation (RFA) may be more effective than percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC). However, the survival advantage of RFA needs confirmation in daily practice. Methods: We conducted a population-based cohort study using the Taiwan Cancer Registry, National Health Insurance claim database and National Death Registry data from 2004 through 2009. Patients receiving PEI or RFA as first-line treatment for newly-diagnosed stage I-II HCC were enrolled. Results: A total of 658 patients receiving RFA and 378 patients receiving PEI treatment were included for final analysis. The overall survival (OS) rates of patients in the RFA and PEI groups at 5-year were 55% and 42%, respectively (p < 0.01). Compared to patients that received PEI, those that received RFA had lower risks of overall mortality and first-line treatment failure (FTF), with adjusted hazard ratios (HRs) [95% confidence interval (CI)] of 0.60 (0.50-0.73) for OS and 0.54 (0.46-0.64) for FTF. The favorable outcomes for the RFA group were consistently significant for patients with tumors > 2 cm as well as for those with tumors < 2 cm. Consistent results were also observed in other subgroup analyses defined by gender, age, tumor stage, and co-morbidity status. Conclusion: RFA provides better survival benefits than PEI for patients with unresectable stage I-II HCC, irrespective of tumors > 2 cm or 2 cm, in contemporary clinical practice. - Funding: This study was supported by grants DOH99-TD-B-111-001, DOH100-TD-B-111-001, DOH101-TD-B-111-001, DOH102-TD-B-111-001 from the Department of Health, Taiwan; NSC 101-2314-B-002-164, NSC 102-2314-B-002-128-MY2 from the National Science Council, Taiwan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. These authors contributed equally to this work. Hepatocellular carcinoma (HCC) is the leading cause of death from cancer in many countries [1-4]. Surgical resection provides a potential cure; however, most patients with HCC are ineligible for surgical resection [5]. For unresectable early-stage HCCs, a variety of locoregional therapies have been developed [6]. Among the available locoregional therapies, percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) have been widely used for small unresectable HCCs [7,8]. RFA or PEI results in complete necrosis of 50-95% of liver tumors [9,10]. The estimated 5-year survival of patients receiving PEI or RFA for early-stage HCC exceeds 50% [11,12], and the 5year survival rate for untreated patients is less than 20% [13]. The American Association for the Study of Liver Diseases (AASLD) [14] claims that PEI and RFA are equally effective for HCCs smaller than 2 cm, but the efficacy of RFA is superior to other local therapies for larger tumors. Several randomized controlled trials (RCTs) compared RFA to PEI for the treatment of small HCCs in moderate-sized patient cohorts [15-19]. The efficacy of RFA may exceed that of PEI [10]; however, the survival advantage of RFA has not been demonstrated consistently. The three RCTs performed in Asia [16-18], show that RFA provides a significant survival advantage compared to PEI, but the two RCTs performed in Europe [15,19] did not. A comparison of RFA with PEI from the perspective of survival is still required [17]. Using data extracted from these RCTs, three indep (...truncated)


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Zhong-Zhe Lin, Wen-Yi Shau, Chiun Hsu, Yu-Yun Shao, Yi-Chun Yeh, Raymond Nien-Chen Kuo, Chih-Hung Hsu, James Chih-Hsin Yang, Ann-Lii Cheng, Mei-Shu Lai. Radiofrequency Ablation Is Superior to Ethanol Injection in Early-Stage Hepatocellular Carcinoma Irrespective of Tumor Size, PLOS ONE, 2013, Volume 8, Issue 11, DOI: 10.1371/journal.pone.0080276