SNFGE SNFGE
 
Thématique :
- Foie
- Carcinome hépatocellulaire (CHC)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
 
 
Journal of Hepatology
  2018/06  
 
  2018 Jun;68(6):1172-1180.  
  doi: 10.1016/j.jhep.2018.01.014.  
 
  No-touch multibipolar radiofrequency ablation vs. surgical resection for solitary hepatocellular carcinoma ranging from 2 to 5 cm  
 
  Mohkam K, Dumont PN, Manichon AF, Jouvet JC, Boussel L, Merle P, Ducerf C, Lesurtel M, Rode A, Mabrut JY  
  https://www.ncbi.nlm.nih.gov/pubmed/29410287  
 
 

Abstract

BACKGROUND & AIMS:

No-touch multibipolar radiofrequency ablation (NTM-RFA) represents a novel therapy that surpasses standard RFA for hepatocellular carcinoma (HCC), but it has not been compared to surgical resection (SR). We aimed to compare the outcomes of NTM-RFA and SR for intermediate-sized HCC.

METHODS:

Between 2012 and 2016, 141 patients with solitary HCC ranging from 2 to 5 cm were treated by NTM-RFA or SR at a single-center. The outcomes of 128 patients were compared after using inverse probability of treatment weighting (IPTW).

RESULTS:

Seventy-nine patients had NTM-RFA and 62 had SR. After IPTW, the two groups were well-balanced for most baseline characteristics including tumor size, location, etiology, severity of underlying liver disease and alpha-fetoprotein level. Morbidity was higher (67.9% vs. 50.0%, p = 0.042) and hospital stay was longer (12 [IQR 8-13] vs. 7 [IQR 5-9] days, p <0.001) after SR. Local recurrence rates at one and three years were 5.5% and 10.0% after NTM-RFA and 1.9% and 1.9% after SR, respectively (p = 0.065). The rates of systematized recurrence (within the treated segment or in an adjacent segment within a 2 cm distance from treatment site) were higher after NTM-RFA (7.4% vs. 1.9% at one year, 27.8% vs. 3.3% at three years, p = 0.008). Most patients with recurrence were eligible for rescue treatment, resulting in similar overall survival (86.7% after NTM-RFA, 91.4% after SR at three years, p = 0.954) and disease-free survival (40.8% after NTM-RFA, 56.4% after SR at three years, p = 0.119).

CONCLUSION:

Compared to SR, NTM-RFA for solitary intermediate-sized HCC was associated with less morbidity and more systematized recurrence, while the rate of local recurrence was not significantly different. Most patients with intrahepatic recurrence remained eligible for rescue therapies, resulting in equivalent long-term oncological results after both treatments.

LAY SUMMARY:

Outcomes of patients treated for intermediate-sized hepatocellular carcinoma by surgical resection or no-touch multibipolar radiofrequency ablation were compared. No-touch multibipolar radiofrequency ablation was associated with a lower overall morbidity and a higher rate of systematized recurrence within the treated segment or in an adjacent segment within a 2 cm distance from the initial tumor site. Most patients with intrahepatic recurrence remained eligible for rescue curative therapy, enabling them to achieve similar long-term oncological results after both treatments.

 

 
Question posée
 
Ablation par radiofréquence multi-bipolaire sans contact (RF) vs résection chirurgicale (RS) pour un carcinome hépatocellulaire (CHC) solitaire de 2 à 5 cm.
 
Question posée
 
Comparativement à la RS, la RF pour les CHC solitaires de taille intermédiaire était associée à une morbidité moindre mais à une récurrence plus élevée, toutefois le taux de récidive locale n'était pas significativement différent. La plupart des patients ayant une récidive intra-hépatique sont restés éligibles à un traitement complémentaire, ce qui a conduit à des résultats oncologiques à long terme équivalents après les deux traitements
 
Commentaires

Une option thérapeutique à confirmer.

 
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