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Title: Radiofrequency ablation vs surgical resection in elderly patients with hepatocellular carcinoma in Milan criteria.
Authors: Conticchio, Maria
Inchingolo, Riccardo
Delvecchio, Antonella
Laera, Letizia
Ratti, Francesca
Gelli, Maximiliano
Anelli, Ferdinando
Laurent, Alexis
Vitali, Giulio
Magistri, Paolo
Assirati, Giacomo
Felli, Emanuele
Wakabayashi, Taiga
Pessaux, Patrick
Piardi, Tullio
di Benedetto, Fabrizio
de'Angelis, Nicola
Briceño, Javier
Rampoldi, Antonio
Adam, Renè
Cherqui, Daniel
Aldrighetti, Luca Antonio
Memeo, Riccardo
Keywords: Elderly patients;Hepatocellular carcinoma;Milan criteria;Propensity score matching;Radiofrequency ablation;Surgical resection
metadata.dc.subject.mesh: Aged
Carcinoma, Hepatocellular
Catheter Ablation
End Stage Liver Disease
Liver Neoplasms
Neoplasm Recurrence, Local
Radiofrequency Ablation
Retrospective Studies
Severity of Illness Index
Treatment Outcome
Issue Date: 2021
Abstract: Surgical resection and radiofrequency ablation (RFA) represent two possible strategy in treatment of hepatocellular carcinoma (HCC) in Milan criteria. To evaluate short- and long-term outcome in elderly patients (> 70 years) with HCC in Milan criteria, which underwent liver resection (LR) or RFA. The study included 594 patients with HCC in Milan criteria (429 in LR group and 165 in RFA group) managed in 10 European centers. Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching (PSM) and Cox regression. After PSM, we compared 136 patients in the LR group with 136 patients in the RFA group. Overall survival at 1, 3, and 5 years was 91%, 80%, and 76% in the LR group and 97%, 67%, and 41% in the RFA group respectively (P = 0.001). Disease-free survival at 1, 3, and 5 years was 84%, 60% and 44% for the LR group, and 63%, 36%, and 25% for the RFA group (P = 0.001).Postoperative Clavien-Dindo III-IV complications were lower in the RFA group (1% vs 11%, P = 0.001) in association with a shorter length of stay (2 d vs 7 d, P = 0.001).In multivariate analysis, Model for End-stage Liver Disease (MELD) score (> 10) [odds ratio (OR) = 1.89], increased value of international normalized ratio (> 1.3) (OR = 1.60), treatment with radiofrequency (OR = 1.46) ,and multiple nodules (OR = 1.19) were independent predictors of a poor overall survival while a high MELD score (> 10) (OR = 1.51) and radiofrequency (OR = 1.37) were independent factors associated with a higher recurrence rate. Despite a longer length of stay and a higher rate of severe postoperative complications, surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients (> 70 years) with HCC in Milan criteria.
metadata.dc.identifier.doi: 10.3748/wjg.v27.i18.2205
Appears in Collections:Producción 2020

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