Objective : Treatment strategies for recurrent hepatocellular carcinoma (rHCC) is controversial. We used the status of microvascular invasion (MVI) at primary resection as a marker to choose the appropriate treatment options for rHCC patients in Barcelona Clinic Liver Cancer (BCLC) stage B-C.
Methods : From Jun, 2009 to Jun, 2017, a consecutive 242 patients with postsurgical rHCC in BCLC stage B-C who received curative treatments (re-resection (RR) or radiofrequency ablation (RFA)) or transarterial chemoembolization (TACE), were enrolled. Multivariate COX regression analysis was performed to identify the prognostic factors for the overall survival (OS) of rHCC patients. We compared the OS and costs of patients treated by RR/RFA and TACE according to MVI status. A one-to-one propensity score matching analysis was performed to reduce bias.
Results : For MVI-positive patients, the median OS in RR/RFA group (n=35) and TACE group (n=137) were 21.4 months and 11.1 months, respectively (P=0.037). The corresponding OS were 88.1 months (RR/RFA, n=20) and 23.0 months (TACE, n=50) for MVI-negative patients(P=0.013). After matching, the dominance of curative treatments over TACE disappeared in MVI-positive patients (18.7 months vs 21.4 months, P=0.267) but remained in MVI-negative patients (62.3 months vs 18.5 months, P=0.03). The cost of TACE group was significant lower than the RR/RFA group (P<0.01).
Conclusions : MVI status at primary resection could be used as a marker for optimal treatment selection in rHCC patients. For MVI-positive patients, RR/RFA provided better survival than TACE. While for MVI-negative patients, TACE was recommended