Liver Resection vs Nonsurgical Treatments for Patients With Early Multinodular Hepatocellular Carcinoma.
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Vitale Alessandro, Romano Pierluigi, Cillo Umberto, Writing Group for the HE.RC.O.LE.S Collaborative Group, Writing Group for the ITA.LI.CA Collaborative Group, HE.RC.O.LE.S and ITA.LI.CA Collaborative Groups, 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
Аннотация
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.