Conticchio M, Inchingolo R, Delvecchio A, Laera L, Ratti F, Gelli M, Anelli F, Laurent A, Vitali G, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, di Benedetto F, de'Angelis N, Briceño J, Rampoldi A, Adam R, Cherqui D, Aldrighetti LA, Memeo R. Radiofrequency ablation vs surgical resection in elderly patients with hepatocellular carcinoma in Milan criteria. World J Gastroenterol 2021; 27(18): 2205-2218 [PMID: 34025074 DOI: 10.3748/wjg.v27.i18.2205]
Corresponding Author of This Article
Riccardo Inchingolo, MD, Chief Doctor, Director, Doctor, Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Via di Santeramo, Acquaviva delle Fonti 70021, Italy. riccardoin@hotmail.it
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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World J Gastroenterol. May 14, 2021; 27(18): 2205-2218 Published online May 14, 2021. doi: 10.3748/wjg.v27.i18.2205
Table 1 Preoperative and clinical characteristics of patients with hepatocellular carcinoma in Milan criteria who underwent surgical resection and radiofrequency ablation
Before PSM
After PSM
RFA (n = 165)
Surgery (n = 429)
P value
RFA (n = 136)
Surgery (n = 136)
P value
Male, n (%)
116 (70)
319 (74)
0.35
98 (72)
104 (76)
0.48
Age (yr) median (range)
75 (70-89)
74.9 (70-90)
0.71
75 (70-88)
74.7 (70-86.1)
0.56
BMI (kg/cm²) median (range)
26.7 (19-51)
26.7 (19-52)
0.37
26.7 (19-51)
26 (21-41)
0.85
Co-morbidities > 2, n (%)
107 (64)
142 (33)
0.001
83 (61)
81 (60)
0.90
Cause of Cirrhosis n (%)
0.002
0.11
Hepatitis C virus
89 (54)
217 (50)
73 (54)
68 (50)
Hepatitis B virus
10 (6)
80 (19)
10 (7)
22 (16)
Alcohol
37 (22)
60 (14)
31(23)
23 (17)
Others
29 (18)
72 (17)
22 (16)
23 (17)
ASA score, n (%)
0.004
0.59
I-II
45 (27)
172 (40)
41 (30)
36 (26)
III-IV
120 (73)
257 (60)
95 (70)
100 (74)
Blood tests median (range)
Bilirubin (mg/dL)
1 (0.2-2.8)
0.9 (0.18-4.5)
0.41
1 (0.2-2.8)
0.8 (0.2-4.5)
0.02
Creatinine (mg/dL)
0.9 (0.5-2.5)
1 (0.2-2.5)
0.03
0.9 (0.5-2.3)
0.9 (0.4-2.5)
0.02
Platelet count × 109/L
131 (10-856)
178 (45-900)
0.00
131.5 (10-856)
155 (47-573)
0.57
INR
1.1 (0.9-2.4)
1.2 (0.6-2.5)
0.00
1.1 (0.9-2.4)
1.1 (0.8-2.5)
0.00
Child Pugh, n (%)
0.52
0.87
A
139 (84)
370 (86)
114 (84)
116 (85)
B
26 (16)
59 (14)
22 (16)
20 (15)
MELD median (range)
8 (6-18)
6 (6-17)
0.00
8 (6-18)
8 (6-17)
0.05
Tumors number, n (%)
0.07
0.71
Single nodule
142 (86)
392 (91)
117 (86)
120 (88)
Multi nodules
23 (14)
37 (9)
19 (14)
16 (12)
Tumor size (mm) n (%)
24 (10-50)
30 (7-50)
0.00
25 (10-50)
24.5 (7-50)
0.9
< 20
49 (30)
33 (8)
0.00
36 (26)
28 (21)
0.31
20-50
116 (70)
396 (92)
100 (74)
108 (79)
Bilobar tumor, n (%)
8 (5)
8 (2)
0.08
6 (4)
2 (1)
0.28
Tumor location, n (%)
0.28
0.17
1
2 (1)
8 (2)
1 (0.7)
1 (0.7)
2
14 (8)
41 (10)
13 (9)
14 (10)
3
12 (7)
42 (10)
10 (7)
20 (15)
4
20 (12)
53 (12)
15 (11)
13 (9)
5
28 (17)
63 (15)
21 (15)
27 (19)
6
27 (16)
87 (20)
23 (17)
29 (21)
7
18 (11)
60 (14)
16 (12)
11 (8)
8
44 (28)
75 (17)
37 (27)
21 (15)
Histologically proven, n (%)
42 (25)
115 (27)
0.75
36 (26)
42 (31)
0.50
Previous treatment, n (%)
53 (32)
53 (12)
0.00
42 (31)
21 (15)
0.004
Table 2 Clinical and perioperative characteristics of patients with hepatocellular carcinoma in Milan criteria who underwent surgical resection and radiofrequency ablation
Before PSM
After PSM
RFA (n = 165)
Surgery (n = 429)
P value
RFA (n = 136)
Surgery (n = 136)
P value
Operative time (min) median (range)
25 (5-250)
205 (55-600)
0.002
25 (5-250)
190 (55-600)
0.001
Blood transfusion, n (%)
13 (8)
66 (15)
0.01
11(8)
23 (17)
0.04
Dindo-Clavien Classification, n (%)
0.001
0.002
I-II
163 (99)
378 (91)
134 (98)
121 (89)
III-IV
2 (1)
38 (9)
2 (1)
15 (11)
Postoperative complication, n (%)
0.001
0.002
Yes
31 (19)
188 (44)
28 (21)
75 (55)
No
134 (81)
241 (56)
108 (79)
61 (45)
Type of complication, n (%)
Liver failure
1 (1)
35 (8)
0.002
1 (0.7)
14 (10)
0.001
Ascites
3 (2)
60 (14)
0.003
3 (2)
17 (12)
0.002
Biliary leakage
0 (0)
9 (2)
0.064
0 (0)
3 (2)
0.25
Hemorrhage
4 (2)
19 (4)
0.340
3 (2)
11 (8)
0.51
Systemic Infection
4 (2)
30 (7)
0.03
4 (3)
14 (10)
0.03
Intra-abdominal abscess
0 (0)
23 (5)
0.00
0 (0)
8 (6)
0.007
Wound infection
2 (1)
12 (3)
0.37
2 (1)
7 (5)
0.17
Portal thrombosis
1 (1)
3 (1)
1.007
1 (0.7)
2 (1)
1
Pulmonary
7 (4)
33 (8)
0.15
6 (4)
15 (11)
0.07
Cardiac
1 (1)
18 (4)
0.03
1 (0.7)
8 (6)
0.03
Renal
1 (1)
18 (4)
0.03
1 (0.7)
6 (4)
0.12
Reoperation, n (%)
0 (0)
7 (2)
0.19
0 (0)
2 (1)
0.5
Postoperative treatment, n (%)
3 (2)
19 (4)
0.15
3 (2)
10 (7)
0.08
Length of hospital stay median (range)
2 (1-23)
6 (1-203)
0.00
2 (1-23)
7 (1-203)
0.00
Mortality 90 d, n (%)
3 (2)
13 (3)
0.001
3 (2)
4 (3)
1
Table 3 Univariate and multivariate models for survival
Univariate analysis
Multivariate analysis
P value
RR (95%CI)
P value
RFA
0.001
1.46 (1.1-1.79)
0.001
Age ≤ 75 yr
0.63
Male
0.001
Co-morbidity ≥ 2
0.001
BMI < 24
0.001
ASA score III-IV
0.07
TBil (mg/dL > 2)
0.001
Crea (mg/dL > 1)
0.57
PLT (U/μL > 150 × 10³)
0.001
INR (> 1.3)
0.001
1.60 (1.03-2.49)
0.03
Tumor size < 3 cm
0.001
Multiple nodule
0.001
1.19 (1.08-4.17)
0.03
Child Pugh A
0.001
MELD > 10
0.007
1.89 (1.21-2.92)
0.005
Table 4 Univariate and multivariate models for recurrence
Univariate analysis
Multivariate analysis
P value
RR (95%CI)
P value
RFA
0.001
1.37 (1.17-1.60)
0.0001
Age ≤ 75 yr
0.28
Male
0.91
Co-morbidity ≥ 2
0.01
BMI < 24
0.61
ASA score III-IV
0.61
Bilirubin (mg/dL > 2)
0.37
Creatinine (mg/dL > 1)
0.62
PLT (U/μL > 150 × 10³)
0.001
INR (> 1.3)
0.02
Tumor size < 3 cm
0.001
Multiple nodule
0.07
Child Pugh A
0.26
MELD > 10
0.01
1.51 (1.04-2.17)
0.03
Citation: Conticchio M, Inchingolo R, Delvecchio A, Laera L, Ratti F, Gelli M, Anelli F, Laurent A, Vitali G, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, di Benedetto F, de'Angelis N, Briceño J, Rampoldi A, Adam R, Cherqui D, Aldrighetti LA, Memeo R. Radiofrequency ablation vs surgical resection in elderly patients with hepatocellular carcinoma in Milan criteria. World J Gastroenterol 2021; 27(18): 2205-2218