KEY TAKEAWAYS
- The study aimed to investigate the comparative outcomes of LR vs RFA or TACE in BCLC A patients with oligo-nodular HCC.
- Researchers noticed that in BCLC A oligo-nodular HCC patients, LR should be prioritized over RFA or TACE; further investigation is ongoing.
The 2022 Barcelona Clinic Liver Cancer (BCLC) algorithm deviates from the therapeutic hierarchy concept by excluding liver resection (LR) for BCLC A patients with oligo-nodular (two or three nodules ≤3 cm) hepatocellular carcinoma (HCC). This sharply contrasts with the therapeutic hierarchy concept, implying a precise treatment order exists within each BCLC stage.
Pierluigi Romano and his team aimed to compare LR with radiofrequency ablation (RFA) or trans-arterial chemoembolization (TACE) in BCLC A patients.
Researchers performed an inclusive analysis adhering to PRISMA guidelines and the Cochrane Handbook for a meta-analysis. All relevant randomized controlled trials (RCTs), cohort, and case-control studies comparing LR versus RFA or TACE in oligo-nodular BCLC A HCC patients were comprehensively searched across databases from January 2000 to October 2023. The primary outcomes, overall survival (OS) and disease-free survival (DFS) at 3 and 5 years were assessed using risk ratio (RR) as a measure of treatment effect (OS and DFS benefit). Common and random effects estimates were computed for meta-analyses with binary outcome data.
About 2601 patients from 14 included studies were analyzed (LR = 1227, RFA = 686, TACE = 688). LR demonstrated a significant 3- and 5-year OS benefit over TACE (RR = 0.55, 95% c.i. 0.44 to 0.69, P < 0.001 and RR 0.57, 95% c.i. 0.36 to 0.90, P = 0.030, respectively). However, there was no significant 3- and 5-year OS benefit of LR over RFA (RR = 0.78, 95% c.i. 0.37 to 1.62, P = 0.452 and RR 0.74, 95% c.i. 0.50 to 1.09, P = 0.103, respectively). Notably, a significant 3- and 5-year DFS benefit of LR over RFA was observed (RR = 0.70, 95% c.i. 0.54 to 0.93, P = 0.020 and RR 0.82, 95% c.i. 0.72 to 0.95, P = 0.015, respectively). A single study comparing LR and TACE for DFS indicated the superiority of LR. The Newcastle-Ottawa Scale quality of studies was high in 8 (57%) and moderate in 6 (43%).
The study concluded that in BCLC A oligo-nodular HCC patients, LR should be prioritized over RFA or TACE, aligning with the therapeutic hierarchy concept. Urgent need exists for additional comparative cohort studies to enhance the certainty of this evidence.
No funding was provided for the study.
Source: https://pubmed.ncbi.nlm.nih.gov/38323881/
Romano P, Busti M, Billato I, et al (2024). Liver resection versus radiofrequency ablation or trans-arterial chemoembolization for early-stage (BCLC A) oligo-nodular hepatocellular carcinoma: meta-analysis. BJS Open. 2024 Jan 3;8(1):zrad158. doi: 10.1093/bjsopen/zrad158. PMID: 38323881; PMCID: PMC10848305.
