Combined radiofrequency ablation and ethanol injection versus repeat hepatectomy for elderly patients with recurrent hepatocellular carcinoma after initial hepatic surgery

摘要

Purpose: To retrospectively compare the efficacy and safety of combined radiofrequency ablation and percutaneous ethanol injection (RFA-PEI) with repeat hepatectomy for elderly patients with initial recurrent hepatocellular carcinoma (HCC) after hepatic surgery.Methods: From January 2009 to June 2015, 105 elderly patients (70years) who underwent RFA-PEI (n=57) or repeated hepatectomy (n=48) for recurrent HCC5.0cm were included in the study. The overall survival (OS) and recurrence-free survival (RFS) were analysed with the Kaplan-Meier method and compared by the log-rank test. Non-tumour-related death, complications and hospital stays were assessed. Univariate and multivariate analyses were performed to identify the prognostic significance of the variables in predicting the OS and RFS.Results: OS rates were 78.2%, 40.8% and 36.7% at 1, 3 and 5years after RFA-PEI and 76.3%, 52.5% and 42.6% after repeat hepatectomy, respectively (p=0.413). Correspondingly, the 1-, 3- and 5-year RFS rates after RFA-PEI and repeat hepatectomy were 69.5%, 37.8%, 33.1% and 73.1%, 49.7%, 40.7%, respectively (p=0.465). Non-tumour-related deaths in the RFA-PEI group (2/57) were significantly fewer than those in the repeat hepatectomy group (10/48) (p=0.016). RFA-PEI was superior to repeat hepatectomy regarding the major complication rates and length of in-hospital stay (both p0.001). Multivariate analysis showed that the tumour number was the significant prognostic factor for the OS (hazard ratio (HR)=1.961, 95% CI=1.043-3.686, p=0.037) and RFS (HR=1.866, 95% CI=1.064-3.274, p=0.030).Conclusion: RFA-PEI provides comparable OS and RFS to repeat hepatectomy for elderly patients with small recurrent HCC after hepatectomy but with fewer non-tumour-related deaths, major complications and shorter hospital stays.