First Study to Compare Resection With RFA for Liver Cancer

Pam Harrison

March 11, 2015

VIENNA — For patients with hepatocellular carcinoma who meet the Milan criteria, rates of disease-free and overall survival are similar after treatment with surgical resection or radiofrequency ablation, according to a European study.

When patients are matched for propensity score, outcomes are similar with the two procedures, "but because adverse events rates are significantly lower and hospital stays are significantly shorter with RFA, I think RFA should be the procedure of choice," said lead investigator Arnaud Hocquelet, MD, from the University of Bordeaux in France.

The study results were presented here at the European Congress of Radiology 2015.

"In Europe, we have mainly cirrhotic patients," Dr Hocquelet told Medscape Medical News. However, "we don't do large resections because of the risk of liver failure."

In contrast, in Asia, where previous comparisons of the two treatments have been done, hepatocellular carcinoma occurs mainly in patients with hepatitis B but no cirrhosis, he noted.

The retrospective study involved consecutive patients with a first occurrence of hepatocellular carcinoma meeting the Milan criteria who received either surgical resection or radiofrequency ablation as a first-line treatment.

From 2004 to 2013, 64 patients underwent surgical resection and 64 underwent radiofrequency ablation.

Propensity scores were matched to ensure that baseline variables, especially tumor size and underlying disease severity, were similar in the two groups.

In the resection group, only about 20% of the patients underwent a large hepatectomy.

In the radiofrequency ablation group, about half of the patients required a multipolar device, in which two needles work together to achieve an area of necrosis larger than is possible with a monopolar device. Multipolar devices are usually required for tumors larger than 3 cm.

For tumors larger than 5 cm, radiofrequency ablation is not suitable, Dr Hocquelet reported.

At a median follow-up of 34.1 months, rates of overall survival were similar in the two groups (P =.209), as were rates of disease-free survival (P = .757).

Table. Outcomes

Survival Radiofrequency Ablation, % Surgical Resection, %
   1 year 95.2 92.9
   3 years 62.3 79.1
   5 years 54.5 59.9
   1 year 64.5 59.0
   3 years 40.1 44.1
   5 years 24.5 17.0


The rate of local recurrence was higher in the radiofrequency ablation group than in the surgical resection group (12.2% vs 2.3%).

However, "this difference was not statistically significant and we can easily retreat patients if they develop a local recurrence with repeat RFA without complications," Dr Hocquelet said.

There were two main differences between the procedures, both of which favored radiofrequency ablation.

The rate of major adverse events was significantly lower in the radiofrequency ablation group than in the surgical resection group (3.2% vs 28.0%; P < .001), and the mean hospital stay was significantly shorter in the radiofrequency ablation group (1.2 vs 9.6 days; P < .001).

First in Western Patients

"I fully endorse the main conclusion of this important work," said Olivier Seror, MD, from Hôpital Jean-Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis in Paris.

He said that, to his knowledge, this is the first trial comparing liver resection with radiofrequency ablation in the treatment of hepatocellular carcinoma in Western patients who meet the Milan criteria.

Although this is not a randomized trial, "the propensity score used to match the two arms is a strong statistical tool to balance heterogeneities of baseline characteristics of the two retrospective patient treatment groups," Dr Seror told Medscape Medical News.

Had the investigators used at least three needles for their multipolar radiofrequency ablation, "the local recurrence rate reported after RFA would have been dramatically lower," he explained.

In a recent study, Dr Seror's team compared monopolar with multipolar devices (J Vasc Interv Radiol. 2014;25:599-607). They found that the rate of complete necrosis was significantly better with the multipolar approach, in which clinicians inserted two or three straight electrodes around the nodule to avoid intratumor puncture, than with the monopolar approach.

"When there is underlying chronic liver disease reaching the stage of cirrhosis, RFA should be the first-choice treatment and liver resection should be reserved for patients for whom such an option is feasible and RFA is contraindicated," Dr Seror concluded.

Dr Hocquelet has disclosed no relevant financial relationships. Dr Seror reports that he has served as a consultant for Olympus and for AngioDynamics.

European Congress of Radiology (ECR) 2015: Abstract B-0857. Presented March 6, 2015.


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