Comparison of the long-term results between surgical resection and local ablation for Child-Pugh A patients with a single hepatocellular carcinoma of 5 cm or less in size: A single center study

• Published in: Kanzo Vol. 50; no. 4; pp. 173 - 184
• Main Authors: Yamazaki, Osamu, Oka, Hiroko, Manabe, Takao, Kioka, Kiyohide, Kurai, Osamu, Murata, Katsuko, Horii, Katsuhiko, Tsukamoto, Tadashi, Inoue, Takeshi, Kawasaki, Yasuko, Kanazawa, Akishige, Shimizu, Sadatoshi, Koda, Yoichi, Nakai, Takashi
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society of Hepatology 2009
• Subjects: Child-Pugh A; hepatic resection; hepatocellular carcinoma; local ablation; single nodule
• ISSN: 0451-4203; 1881-3593
• DOI: 10.2957/kanzo.50.173

Three hundred and ninety-nine Child-Pugh A patients diagnosed between January 1994 and March 2007 were studied to evaluate the therapeutic impact of surgical resection and local ablation for a single hepatocellular carcinoma, 5 cm or less in diameter on outcomes. The patients classified into any of an anatomical resection (n=110), a limited resection (n=88), thermal ablation (n=97) and PEIT (n=104). The 5-year overall survival rate was 72%, 51%, 68% and 62% in the anatomical resection, limited resection, thermal ablation and PEIT, while the 5-year disease-free survival rate was 41%, 27%, 23% and 11%, respectively. Using Cox's regression model, the following independent favorable factors of overall survival were determined. 1) liver damage A, 2) 2 cm or less in size, 3) well differentiated type, 4) anatomical resection. Liver damage A, well differentiated type and anatomical resection were also confirmed to be independent favorable factors of disease-free survival. In patients with either degree of liver damage A or B, having a solitary tumor, 2 cm or less in size, differences of the overall survival were not significant between surgical resection and local ablation. Also in this group, no significant difference of the locoregional recurrence between an anatomical resection and a limited resection was seen, and thermal ablation had a smaller risk of local tumor progression after initial therapy than PEIT. In patients having a single tumor larger than 2 cm in diameter, prognosis of patients who underwent an atomical resection was the best of all groups, especially in liver damage A patients, the 5-year overall survival and 5-year disease-free survival were 75% and 52%, respectively. The comparative 5-year overall survival for patients who received a limited resection, thermal ablation and PEIT were 46%, 48% and 51%, 5-year disease-free survival were 27%, 0% and 9%, respectively.