Survival in patients with recurrent hepatocellular carcinoma after primary hepatectomy: Comparative effectiveness of treatment modalities

Background Insufficient data are available on the survival of recurrent hepatocellular carcinoma after primary hepatectomy in patients receiving different treatments. We evaluated retrospectively the effects of treatment modalities on long-term survival. Methods Between 2001 and 2007, 435 posthepate...

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Veröffentlicht in:Surgery 2012-05, Vol.151 (5), p.700-709
Hauptverfasser: Ho, Cheng-Maw, MD, Lee, Po-Huang, MD, PhD, Shau, Wen-Yi, MD, PhD, Ho, Ming-Chih, MD, PhD, Wu, Yao-Ming, MD, Hu, Rey-Heng, MD, PhD
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container_end_page 709
container_issue 5
container_start_page 700
container_title Surgery
container_volume 151
creator Ho, Cheng-Maw, MD
Lee, Po-Huang, MD, PhD
Shau, Wen-Yi, MD, PhD
Ho, Ming-Chih, MD, PhD
Wu, Yao-Ming, MD
Hu, Rey-Heng, MD, PhD
description Background Insufficient data are available on the survival of recurrent hepatocellular carcinoma after primary hepatectomy in patients receiving different treatments. We evaluated retrospectively the effects of treatment modalities on long-term survival. Methods Between 2001 and 2007, 435 posthepatectomy hepatocellular carcinoma patients who developed recurrence were grouped by treatment modality into re-resection, radiofrequency ablation, transarterial chemoembolization, and supportive treatment groups. Treatment strategies for both primary hepatocellular carcinoma and its recurrence were selected using the same criteria. Postrecurrence survival was estimated using the Kaplan–Meier method and compared using the Cox proportional hazard model with adjusted independent prognostic factors. Survival rates after primary resection without recurrence were also compared. Results In re-resection, radiofrequency ablation, transarterial chemoembolization, and supportive treatment groups, the 2-year postrecurrence survival rates were 90%, 96%, 75%, and 20%, respectively, and the 5-year survival rates were 72%, 83%, 56%, and 0%, respectively. The adjusted hazard of death was less for the re-resection and radiofrequency ablation groups than for the transarterial chemoembolization group, and the adjusted hazard ratios for the re-resection and radiofrequency ablation groups were 0.45 (95% confidence interval, 0.20–0.98) and 0.25 (0.08–0.81), respectively. The adjusted hazard ratio (95% confidence interval) of death for the radiofrequency ablation group compared to the re-resection group was 0.64 (0.19–2.19). Survival in the single resection group did not differ from that in the re-resection and radiofrequency ablation groups. Conclusion Postrecurrence survival in the re-resection and radiofrequency ablation groups was significantly better than that in the transarterial chemoembolization group and similar to that of patients in the primary resection without recurrence group.
doi_str_mv 10.1016/j.surg.2011.12.015
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We evaluated retrospectively the effects of treatment modalities on long-term survival. Methods Between 2001 and 2007, 435 posthepatectomy hepatocellular carcinoma patients who developed recurrence were grouped by treatment modality into re-resection, radiofrequency ablation, transarterial chemoembolization, and supportive treatment groups. Treatment strategies for both primary hepatocellular carcinoma and its recurrence were selected using the same criteria. Postrecurrence survival was estimated using the Kaplan–Meier method and compared using the Cox proportional hazard model with adjusted independent prognostic factors. Survival rates after primary resection without recurrence were also compared. Results In re-resection, radiofrequency ablation, transarterial chemoembolization, and supportive treatment groups, the 2-year postrecurrence survival rates were 90%, 96%, 75%, and 20%, respectively, and the 5-year survival rates were 72%, 83%, 56%, and 0%, respectively. The adjusted hazard of death was less for the re-resection and radiofrequency ablation groups than for the transarterial chemoembolization group, and the adjusted hazard ratios for the re-resection and radiofrequency ablation groups were 0.45 (95% confidence interval, 0.20–0.98) and 0.25 (0.08–0.81), respectively. The adjusted hazard ratio (95% confidence interval) of death for the radiofrequency ablation group compared to the re-resection group was 0.64 (0.19–2.19). Survival in the single resection group did not differ from that in the re-resection and radiofrequency ablation groups. Conclusion Postrecurrence survival in the re-resection and radiofrequency ablation groups was significantly better than that in the transarterial chemoembolization group and similar to that of patients in the primary resection without recurrence group.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2011.12.015</identifier><identifier>PMID: 22284764</identifier><identifier>CODEN: SURGAZ</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Carcinoma, Hepatocellular - mortality ; Carcinoma, Hepatocellular - therapy ; Catheter Ablation ; Chemoembolization, Therapeutic ; Female ; Follow-Up Studies ; Gastroenterology. Liver. Pancreas. Abdomen ; General aspects ; Hepatectomy ; Humans ; Liver Neoplasms - mortality ; Liver Neoplasms - therapy ; Liver, biliary tract, pancreas, portal circulation, spleen ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Middle Aged ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - therapy ; Prognosis ; Retrospective Studies ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Survival Analysis ; Treatment Outcome ; Tumors</subject><ispartof>Surgery, 2012-05, Vol.151 (5), p.700-709</ispartof><rights>Mosby, Inc.</rights><rights>2012 Mosby, Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-176e94e197857c5cc0d540346b6b012ff72b9fbdd9018eb6d93bbab28c66995f3</citedby><cites>FETCH-LOGICAL-c441t-176e94e197857c5cc0d540346b6b012ff72b9fbdd9018eb6d93bbab28c66995f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.surg.2011.12.015$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3549,27923,27924,45994</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=25855011$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22284764$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ho, Cheng-Maw, MD</creatorcontrib><creatorcontrib>Lee, Po-Huang, MD, PhD</creatorcontrib><creatorcontrib>Shau, Wen-Yi, MD, PhD</creatorcontrib><creatorcontrib>Ho, Ming-Chih, MD, PhD</creatorcontrib><creatorcontrib>Wu, Yao-Ming, MD</creatorcontrib><creatorcontrib>Hu, Rey-Heng, MD, PhD</creatorcontrib><title>Survival in patients with recurrent hepatocellular carcinoma after primary hepatectomy: Comparative effectiveness of treatment modalities</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background Insufficient data are available on the survival of recurrent hepatocellular carcinoma after primary hepatectomy in patients receiving different treatments. We evaluated retrospectively the effects of treatment modalities on long-term survival. Methods Between 2001 and 2007, 435 posthepatectomy hepatocellular carcinoma patients who developed recurrence were grouped by treatment modality into re-resection, radiofrequency ablation, transarterial chemoembolization, and supportive treatment groups. Treatment strategies for both primary hepatocellular carcinoma and its recurrence were selected using the same criteria. Postrecurrence survival was estimated using the Kaplan–Meier method and compared using the Cox proportional hazard model with adjusted independent prognostic factors. Survival rates after primary resection without recurrence were also compared. Results In re-resection, radiofrequency ablation, transarterial chemoembolization, and supportive treatment groups, the 2-year postrecurrence survival rates were 90%, 96%, 75%, and 20%, respectively, and the 5-year survival rates were 72%, 83%, 56%, and 0%, respectively. The adjusted hazard of death was less for the re-resection and radiofrequency ablation groups than for the transarterial chemoembolization group, and the adjusted hazard ratios for the re-resection and radiofrequency ablation groups were 0.45 (95% confidence interval, 0.20–0.98) and 0.25 (0.08–0.81), respectively. The adjusted hazard ratio (95% confidence interval) of death for the radiofrequency ablation group compared to the re-resection group was 0.64 (0.19–2.19). Survival in the single resection group did not differ from that in the re-resection and radiofrequency ablation groups. Conclusion Postrecurrence survival in the re-resection and radiofrequency ablation groups was significantly better than that in the transarterial chemoembolization group and similar to that of patients in the primary resection without recurrence group.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Carcinoma, Hepatocellular - mortality</subject><subject>Carcinoma, Hepatocellular - therapy</subject><subject>Catheter Ablation</subject><subject>Chemoembolization, Therapeutic</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>General aspects</subject><subject>Hepatectomy</subject><subject>Humans</subject><subject>Liver Neoplasms - mortality</subject><subject>Liver Neoplasms - therapy</subject><subject>Liver, biliary tract, pancreas, portal circulation, spleen</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - mortality</subject><subject>Neoplasm Recurrence, Local - therapy</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. 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Liver. Pancreas. Abdomen</topic><topic>General aspects</topic><topic>Hepatectomy</topic><topic>Humans</topic><topic>Liver Neoplasms - mortality</topic><topic>Liver Neoplasms - therapy</topic><topic>Liver, biliary tract, pancreas, portal circulation, spleen</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - mortality</topic><topic>Neoplasm Recurrence, Local - therapy</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ho, Cheng-Maw, MD</creatorcontrib><creatorcontrib>Lee, Po-Huang, MD, PhD</creatorcontrib><creatorcontrib>Shau, Wen-Yi, MD, PhD</creatorcontrib><creatorcontrib>Ho, Ming-Chih, MD, PhD</creatorcontrib><creatorcontrib>Wu, Yao-Ming, MD</creatorcontrib><creatorcontrib>Hu, Rey-Heng, MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ho, Cheng-Maw, MD</au><au>Lee, Po-Huang, MD, PhD</au><au>Shau, Wen-Yi, MD, PhD</au><au>Ho, Ming-Chih, MD, PhD</au><au>Wu, Yao-Ming, MD</au><au>Hu, Rey-Heng, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Survival in patients with recurrent hepatocellular carcinoma after primary hepatectomy: Comparative effectiveness of treatment modalities</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2012-05-01</date><risdate>2012</risdate><volume>151</volume><issue>5</issue><spage>700</spage><epage>709</epage><pages>700-709</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><coden>SURGAZ</coden><abstract>Background Insufficient data are available on the survival of recurrent hepatocellular carcinoma after primary hepatectomy in patients receiving different treatments. We evaluated retrospectively the effects of treatment modalities on long-term survival. Methods Between 2001 and 2007, 435 posthepatectomy hepatocellular carcinoma patients who developed recurrence were grouped by treatment modality into re-resection, radiofrequency ablation, transarterial chemoembolization, and supportive treatment groups. Treatment strategies for both primary hepatocellular carcinoma and its recurrence were selected using the same criteria. Postrecurrence survival was estimated using the Kaplan–Meier method and compared using the Cox proportional hazard model with adjusted independent prognostic factors. Survival rates after primary resection without recurrence were also compared. Results In re-resection, radiofrequency ablation, transarterial chemoembolization, and supportive treatment groups, the 2-year postrecurrence survival rates were 90%, 96%, 75%, and 20%, respectively, and the 5-year survival rates were 72%, 83%, 56%, and 0%, respectively. The adjusted hazard of death was less for the re-resection and radiofrequency ablation groups than for the transarterial chemoembolization group, and the adjusted hazard ratios for the re-resection and radiofrequency ablation groups were 0.45 (95% confidence interval, 0.20–0.98) and 0.25 (0.08–0.81), respectively. The adjusted hazard ratio (95% confidence interval) of death for the radiofrequency ablation group compared to the re-resection group was 0.64 (0.19–2.19). Survival in the single resection group did not differ from that in the re-resection and radiofrequency ablation groups. Conclusion Postrecurrence survival in the re-resection and radiofrequency ablation groups was significantly better than that in the transarterial chemoembolization group and similar to that of patients in the primary resection without recurrence group.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22284764</pmid><doi>10.1016/j.surg.2011.12.015</doi><tpages>10</tpages></addata></record>
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subjects Adult
Aged
Biological and medical sciences
Carcinoma, Hepatocellular - mortality
Carcinoma, Hepatocellular - therapy
Catheter Ablation
Chemoembolization, Therapeutic
Female
Follow-Up Studies
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Hepatectomy
Humans
Liver Neoplasms - mortality
Liver Neoplasms - therapy
Liver, biliary tract, pancreas, portal circulation, spleen
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Neoplasm Recurrence, Local - mortality
Neoplasm Recurrence, Local - therapy
Prognosis
Retrospective Studies
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Survival Analysis
Treatment Outcome
Tumors
title Survival in patients with recurrent hepatocellular carcinoma after primary hepatectomy: Comparative effectiveness of treatment modalities
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