Radiofrequency ablation combined with transcatheter arterial chemoembolization for recurrent liver cancer.

BACKGROUND: The recurrence rate of liver cancer after surgery is high. Radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) is an effective treatment for liver cancer; however, its efficacy in recurrent liver cancer remains unclear. AIM: To investigate the clinical effect of TACE combined with RFA in the treatment of recurrent liver cancer. METHODS: Ninety patients with recurrent liver cancer were divided into 2 groups according to treatment plan: Control (RFA alone); and experimental [TACE combined with RFA (TACE + RFA)]. The incidence of increased alanine aminotransferase levels, complications, and other indices were compared between the two groups before and after the procedures. RESULTS: One month after the procedures, the short-term efficacy rate and Karnofsky Performance Status scores of the experimental group were significantly higher than those of the control group (P < 0.05). Alpha-fetoprotein (AFP) and total bilirubin levels were lower than those in the control group (P < 0.05); The overall response rate was 82.22% and 66.67% in the experimental and control groups, respectively; The disease control rate was 93.33% and 82.22% in the experimental and control groups, respectively, the differences are statistically significant (P < 0.05). And there were no statistical differences in complications between the two groups (P > 0.05). CONCLUSION: TACE + RFA was effective for the treatment of recurrent liver cancer and significantly reduced AFP levels and improved various indices of liver function.

Comparison of the efficacy and safety of repeated hepatectomy and radiofrequency ablation in the treatment of primary recurrent liver cancer: a meta-analysis.

BACKGROUND: Since there is still controversy about the comparison of the efficacy and safety of RH and RFA in the treatment of recurrent liver cancer, we conducted a meta-analysis to compare the efficacy and safety, in order to provide evidence-based evidence for future research and clinical treatment. METHODS: We searched PubMed, Embase, and Cochrane Library from the establishment of the database to Feb 2021. We included studies that reported liver cancer patients underwent repeated hepatectomy (RH) or radiofrequency ablation (RFA), and we excluded duplicate publications, research without full text, incomplete information, or inability to conduct data extraction, animal experiments, reviews, and systematic reviews. The STATA 15.1 was used to analyze the data. RESULTS: The pooled results show that the 3-year and 5-year overall survival (OS) rate of the repeated hepatectomy group was significantly higher than the radiofrequency ablation group (odds ratio (OR) = 1.95, 95% confidence interval (CI):1.47-2.60, P ≤ 0.001; OR = 1.65, 95% CI: 1.12-2.43, P = 0.012). Similarly, the pooled results show that the 3-year and 5-year disease-free survival (DFS) rate of the repeated hepatectomy group was significantly higher than the radiofrequency ablation group (OR = 1.73, 95% CI: 1.30-2.31, P ≤ 0.001; OR = 1.84, 95% CI: 1.38-2.49, P ≤ 0.001). However, there is no significant difference in the 1-year OS and DFS rate of repeated hepatectomy group and radiofrequency ablation group. Additionally, the pooled results show that the postoperative Clavien-Dindo (CD) grade II or higher complication rate of the repeated hepatectomy group was significantly higher than the radiofrequency ablation group (OR = 2.80, 95% CI: 1.37-5.75, P = 0.005). CONCLUSION: Based on the pooled results of 8 existing retrospective studies, RH has a higher OS rate and DFS rate in the treatment of recurrent liver cancer, while the postoperative complication rate of RFA is lower. When survival is the primary goal, RH should be the first choice for recurrent liver cancer.

Targeted therapy and immunotherapy for recurrent liver cancer / 中国实用外科杂志

The recurrence and metastasis rate of hepatocellular carcinoma(HCC) is high after operation,and more than 50% of HCC patients will eventually receive systemic treatment. There is a lack of systemic treatment for advanced liver cancer,so that Sorafenib is the only first-line therapeutic drug in the past ten years. Recently,positive results have been obtained in the III phase clinical trials of lenvatinib,regorafenib,cabozantinib and Ramucirumab,and anticancer effect of the immunotherapy of liver cancer shows gratifying,but there are still some shortcomings,such as low objective response rate and lack of effective clinical biomarkers. The antitumor effect of immunotherapy-based combined therapy is more satisfactory than that of single drug without more serious side effects in I/II phase clinical trials,which means immunotherapy-based combined therapy should be the future treatment strategy.

Repeated hepatectomy for recurrent liver cancer / 中华肝胆外科杂志

Objective To evaluate the diagnostic approaches and influencing factors of prognosis after repeated hepatectomy for recurrent liver cancer. Methods Fifty seven cases of recurrent liver cancer underwent surgical resection. The disease free survival, cumulative survival and possible influencing factors of prognosis were studied. Results The 1-, 3-, 5- and 10-year disease free survival rates after first resection were 63.9%, 38.3%, 26.6% and 12.8%, respectively. The 1-, 3-, 5- and 10-year survival rates of resection for recurrent liver cancer were 56.6%, 37.7%, 31.9% and 16.2% and the 1-, 3-, 5- and 10-year cumulative survival rates were 82.1%, 60.85, 47.6% and 19.5%, respectively. The influencing factors of prognosis after repeated hepatectomy for recurrent liver cancer size, number of nodules, tumor-free duration and weather when the patients underwent curative resection. Conclusions For early detection of recurrent liver cancer, AFP test, sonography each month and computed tomography every 3 months should be conducted for patients after the first hepatectomy. For the recurrent liver cancer, surgical resection is an effective treating measure when it is possible. The influencing factors of prognosis after repeated hepatectomy for recurrent liver cancer are tumor size, number of nodules, tumor-free duration, tumor capsule and manner of repeated hepatectomy.