Copyright
©The Author(s) 2021.
World J Gastroenterol. May 14, 2021; 27(18): 2205-2218
Published online May 14, 2021. doi: 10.3748/wjg.v27.i18.2205
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
- URL: https://www.wjgnet.com/1007-9327/full/v27/i18/2205.htm
- DOI: https://dx.doi.org/10.3748/wjg.v27.i18.2205