Importance The 2022 Barcelona Clinic Liver Cancer algorithm currently discourages liver resection (LR) for patients with multinodular hepatocellular carcinoma (HCC) presenting with 2 or 3 nodules that are each 3 cm or smaller. Objective To compare the efficacy of liver resection (LR), percutaneous radiofrequency ablation (PRFA), and transarterial chemoembolization (TACE) in patients with multinodular HCC. Design, Setting, and Participants This cohort study is a retrospective analysis conducted using data from the HE.RC.O.LE.S register (n = 5331) for LR patients and the ITA.LI.CA database (n = 7056) for PRFA and TACE patients. A matching-adjusted indirect comparison (MAIC) method was applied to balance data and potential confounding factors between the 3 groups. Included were patients from multiple centers from 2008 to 2020; data were analyzed from January to December 2023. Interventions LR, PRFA, or TACE. Main Outcomes and Measures Survival rates at 1, 3, and 5 years were calculated. Cox MAIC-weighted multivariable analysis and competing risk analysis were used to assess outcomes. Results A total of 720 patients with early multinodular HCC were included, 543 males (75.4%), 177 females (24.6%), and 350 individuals older than 70 years (48.6%). There were 296 patients in the LR group, 240 who underwent PRFA, and 184 who underwent TACE. After MAIC, LR exhibited 1-, 3-, and 5-year survival rates of 89.11%, 70.98%, and 56.44%, respectively. PRFA showed rates of 94.01%, 65.20%, and 39.93%, while TACE displayed rates of 90.88%, 48.95%, and 29.24%. Multivariable Cox survival analysis in the weighted population showed a survival benefit over alternative treatments (PRFA vs LR: hazard ratio [HR], 1.41; 95% CI, 1.07-1.86; P = .01; TACE vs LR: HR, 1.86; 95% CI, 1.29-2.68; P = .001). Competing risk analysis confirmed a lower risk of cancer-related death in LR compared with PRFA and TACE. Conclusions and Relevance For patients with early multinodular HCC who are ineligible for transplant, LR should be prioritized as the primary therapeutic option, followed by PRFA and TACE when LR is not feasible. These findings provide valuable insights for clinical decision-making in this patient population.
Liver Resection vs Nonsurgical Treatments for Patients With Early Multinodular Hepatocellular Carcinoma / Vitale, Alessandro; Romano, Pierluigi; Cillo, Umberto; Busti, Marco; Nezi, Giulia; De Carlis, Riccardo; Ratti, Francesca; Milana, Flavio; Donadon, Matteo; Marinelli, Laura; Razionale, Francesco; Carissimi, Francesca; Scotti, Mauro Alessandro; Ciuli, Cristina; De Peppo, Valerio; Russolillo, Nadia; Giuffrida, Mauro; De Stefano, Francesca; Peverada, Jacopo; Larghi Laureiro, Zoe; Franceschi, Angelo; Pelizzo, Patrizia; Marchitelli, Ivan; Casella, Annachiara; Manzoni, Alberto; Malagnino, Alessia; Calcagno, Pietro; Cammarata, Francesco; Pennacchi, Luca; Cosola, Davide; Corleone, Pio; Cucchetti, Alessandro; Mantovani, Guido; Notte, Francesca; Montuori, Mauro; Allegrini, Gloria; Cammà, Calogero; Celsa, Ciro; Giuffrida, Paolo; Giacchetto, Carmelo Marco; Rancatore, Gabriele; Grassin, Maria Vittoria; Ciccia, Roberta; Grova, Alessandro; Salvato, Mauro; Biasini, Elisabetta; Olivani, Andrea; Chen, Rusi; Granito, Alessandro; Piscaglia, Fabio; Stefanini, Bernardo; Tovoli, Francesco; Biselli, Maurizio; Bucci, Laura; Lani, Lorenzo; Stefanini, Benedetta; Bevilacqua, Vittoria; Berardinelli, Dante; Borghi, Alberto; Casadei Gardini, Andrea; Conti, Fabio; Dall'Aglio, Anna Chiara; Ercolan, Giorgio; Campani, Claudia; Di Bonaventura, Chiara; Gitto, Stefano; Franzè, Maria Stella; Sauchella, Assunta; Coccoli, Pietro; Malerba, Antonio; Capasso, Mario; Guarino, Maria; Lauria, Valentina; Ghittoni, Giorgia; Pelecca, Giorgio; Sartori, Anna; Imondi, Angela; Penzo, Barbara; Inno, Alessandro; Marchetti, Fabiana; Di Bucchianico, Alessandro; Dajti, Elton; Ravaioli, Federico; Plaz Torres, Maria Corina; Pieri, Giulia; Olivieri, Filippo; Romagnoli, Veronica; de Matthaeis, Nicoletta; Cela, Ester Marina; Facciorusso, Antonio; Ponziani, Francesca Romana; Lauterio, Andrea; Sangiovanni, Angelo; Cabibbo, Giuseppe; Missale, Gabriele; Marseglia, Mariarosaria; Trevisani, Franco; Foschi, Francesco Giuseppe; Cipriani, Federica; Famularo, Simone; Marra, Fabio; Saitta, Carlo; Serenari, Matteo; Vidili, Gianpaolo; Morisco, Filomena; Caturelli, Eugenio; Mega, Andrea; Pelizzaro, Filippo; Nicolini, Daniele; Ardito, Francesco; Garancini, Mattia; Masotto, Alberto; Baroni, Gianluca Svegliati; Azzaroli, Francesco; Giannini, Edoardo; Perri, Pasquale; Scarinci, Andrea; Fontana, Andrea Pierluigi; Brunetto, Maurizia Rossana; Iaria, Maurizio; Di Marco, Maria; Nardone, Gerardo; Dominioni, Tommaso; Lai, Quirino; Ferrari, Cecilia; Rapaccini, Gian Ludovico; Rodolfo, Sacco; Romano, Maurizio; Conci, Simone; Zoli, Marco; Conticchio, Maria; Zanello, Matteo; Zimmitti, Giuseppe; Fumagalli, Luca; Troci, Albert; Germani, Paola; Gasbarrini, Antonio; La Barba, Giuliano; De Angelis, Michela; Patauner, Stefan; Molfino, Sarah; Zago, Mauro; Pinotti, Enrico; Frigo, Anna Chiara; Baiocchi, Gian Luca; Frena, Antonio; Boccia, Luigi; Ercolani, Giorgio; Tarchi, Paola; Crespi, Michele; Chiarelli, Marco; Abu Hilal, Moh'D; Cescon, Matteo; Memeo, Riccardo; Ruzzenente, Andrea; Zanus, Giacomo; Griseri, Guido; Rossi, Massimo; Maestri, Marcello; Della Valle, Raffaele; Ferrero, Alessandro; Grazi, Gian Luca; Romano, Fabrizio; Giuliante, Felice; Vivarelli, Marco; Jovine, Elio; Torzilli, Guido; Aldrighetti, Luca; De Carlis, Luciano; Null, Null; Null, Null; Null, Null. - In: JAMA SURGERY. - ISSN 2168-6254. - (2024). [10.1001/jamasurg.2024.1184]
Liver Resection vs Nonsurgical Treatments for Patients With Early Multinodular Hepatocellular Carcinoma
Sauchella, Assunta;Vidili, Gianpaolo;
2024-01-01
Abstract
Importance The 2022 Barcelona Clinic Liver Cancer algorithm currently discourages liver resection (LR) for patients with multinodular hepatocellular carcinoma (HCC) presenting with 2 or 3 nodules that are each 3 cm or smaller. Objective To compare the efficacy of liver resection (LR), percutaneous radiofrequency ablation (PRFA), and transarterial chemoembolization (TACE) in patients with multinodular HCC. Design, Setting, and Participants This cohort study is a retrospective analysis conducted using data from the HE.RC.O.LE.S register (n = 5331) for LR patients and the ITA.LI.CA database (n = 7056) for PRFA and TACE patients. A matching-adjusted indirect comparison (MAIC) method was applied to balance data and potential confounding factors between the 3 groups. Included were patients from multiple centers from 2008 to 2020; data were analyzed from January to December 2023. Interventions LR, PRFA, or TACE. Main Outcomes and Measures Survival rates at 1, 3, and 5 years were calculated. Cox MAIC-weighted multivariable analysis and competing risk analysis were used to assess outcomes. Results A total of 720 patients with early multinodular HCC were included, 543 males (75.4%), 177 females (24.6%), and 350 individuals older than 70 years (48.6%). There were 296 patients in the LR group, 240 who underwent PRFA, and 184 who underwent TACE. After MAIC, LR exhibited 1-, 3-, and 5-year survival rates of 89.11%, 70.98%, and 56.44%, respectively. PRFA showed rates of 94.01%, 65.20%, and 39.93%, while TACE displayed rates of 90.88%, 48.95%, and 29.24%. Multivariable Cox survival analysis in the weighted population showed a survival benefit over alternative treatments (PRFA vs LR: hazard ratio [HR], 1.41; 95% CI, 1.07-1.86; P = .01; TACE vs LR: HR, 1.86; 95% CI, 1.29-2.68; P = .001). Competing risk analysis confirmed a lower risk of cancer-related death in LR compared with PRFA and TACE. Conclusions and Relevance For patients with early multinodular HCC who are ineligible for transplant, LR should be prioritized as the primary therapeutic option, followed by PRFA and TACE when LR is not feasible. These findings provide valuable insights for clinical decision-making in this patient population.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
