• Humans
• Liver Neoplasms/therapy
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic/methods
• Neoplasms, Second Primary/etiology
• Neoplasms, Second Primary/therapy

• Hepatocellular carcinoma
• Yttrium-90
• network meta-analysis
• radiation therapy
• radiofrequency ablation
• systematic review
• transarterial chemoembolization
• transarterial radioembolization

• Aged
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Catheter Ablation/statistics & numerical data
• Chemoembolization, Therapeutic/statistics & numerical data
• Combined Modality Therapy/methods
• Female
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Progression-Free Survival
• Retrospective Studies

A growing number of studies have indicated that epithelial-mesenchymal transition (EMT) phenotypes and the number of circulating tumor cells (CTCs) are significant indicators of tumor characteristics and treatment efficacy, and thus have a broad range of potential applications in the diagnosis and treatment of malignant tumors. The value of data on CTC phenotypes and CTC counts in the diagnosis of hepatocellular carcinoma (HCC) and assessment of efficacy after comprehensive interventional therapy remains unclear.

Data of 107 patients who exhibited space-occupying lesions in the liver on enhanced CT/MRI scans at the Guangdong Provincial People’s Hospital (a tertiary medical center) between August 2017 and October 2018, were retrospectively analyzed. All enrolled patients were treated with transcatheter arterial chemoembolization (TACE) combined with microwave ablation (MWA). An imFISH CTC assay was used to isolate and count CTCs with different EMT phenotypes in the patients’ peripheral blood, which facilitated an analysis of the value of CTC phenotype and CTC count data in the diagnosis or treatment of HCC.

The CTC count and EMT phenotypes in HCC patients were not associated with patient characteristics such as age, sex, Hepatitis B Virus (HBV)-DNA status, alcohol consumption history, Aspartate Transaminase (AST) to Platelet Ratio Index (APRI) score, Eastern Cooperative Oncology Group (ECOG) score, Child-Pugh score, alpha-fetoprotein (AFP), number and size of tumors, vascular invasion, or metastasis (P ​> ​0.05). The CTC count and EMT phenotypes in HCC patients before treatment were not predictive of short-term efficacy (P ​> ​0.05). Comprehensive interventional therapy reduced the total CTC count and mesenchymal CTC count (P ​= ​0.034 and 0.022, respectively).

TACE in combination with ablation reduced the total CTC count and mesenchymal CTC count. The CTC count and EMT phenotypes may be associated with long-term efficacy.

• Circulating tumor cells
• Hepatocellular carcinoma
• Microwave ablation
• Transcatheter arterial chemoembolization
• imFISH

• Carcinoma, Hepatocellular
• Catheter Ablation
• Chemoembolization, Therapeutic
• Humans
• Liver Neoplasms
• Vanilla

• I01 CX001933 CSRD VA
• R01 CA166111 NCI NIH HHS

Objective: To evaluate the efficacy and safety of surgical resection plus radiofrequency ablation (SR-RFA) for multifocal hepatocellular carcinoma (HCC) with 2 or 3 nodules compared with surgical resection (SR).

Method: We retrospectively evaluated 824 consecutive HCC patients (SR, n = 754; SR-RFA, n = 70) from January 2009 to December 2015 and performed propensity score matching (PSM) to adjust for patient imbalances at a ratio of 1:4.

Results: At baseline, patients in the SR-RFA group had a smaller tumour size and worse liver function (including more ascites, a higher total bilirubin level, and a longer prothrombin time) than patients in the SR group. However, the two groups had similar overall survival (OS) and recurrence-free survival (RFS) rates (P = 0.209 and P = 0.332). The local recurrence rate of the SR-RFA group was significantly higher than that of the SR group (25.71% and 14.32%, P = 0.011). More patients in the SR-RFA group had postoperative complications (P = 0.003). In the propensity model, there was no intergroup difference in OS or RFS (P = 0.229 and P = 0.311, respectively).

Conclusion: SR-RFA provides a similar long-term survival to that on SR in HCC patients with 2 or 3 nodules, and its application should be carefully considered.

• hepatocellular carcinoma
• radiofrequency ablation
• surgical resection
• survival rate
• tumour recurrence

• Bleeding
• Chemoembolization
• Combined treatment
• HCC
• Personalized medicine
• Precision medicine
• Radiofrequency ablation

Hepatocellular carcinoma (HCC) is the sixth most common type of malignancy. Several therapies are available for HCC and are determined by stage of presentation, patient clinical status and liver function. Local–regional treatment options, including transcatheter arterial chemoembolization, radiofrequency ablation or microwave ablation, are safe and effective for HCC but are accompanied by limitations. The synergistic effects of combined transcatheter arterial chemoembolization and radiofrequency ablation/microwave ablation may overcome these limitations and improve the therapeutic outcome. The purpose of this article is to review the current literature on these combined therapies and examine their efficacy, safety and influence on the overall and recurrence-free survival in patients with HCC.

• hepatocellular carcinoma
• microwave ablation
• radiofrequency ablation
• transcatheter arterial chemoembolization

• DynaCT
• Hepatocellular carcinoma
• Interventional radiology
• Therapeutic embolization

• Anesthesiology
• bias
• editorial board
• ethics
• evidence
• gastroenterology

• advanced hepatocellular carcinoma
• albumin-to-alkaline phosphatase ratio
• biomarkers.
• hepatic function reserve
• prognosis

A small proportion of hepatocellular carcinoma (HCC) patients are suitable for surgical resections and various minimally invasive procedures have been introduced as alternatives to surgical resections. However, the relative efficacy of minimally invasive procedures remains to be studied in the current literature. Several popular minimally invasive procedures (monotherapy or combined therapies) were selected for comparison and their relative long-term efficacy were determined by using the statistics of hazard ratio (HR) which evaluates the survival status of HCC patients in one, two, three and four years, respectively. Evidence were obtained from the current literature and synthesized by using the approach of conventional pairwise meta-analysis and network meta-analysis (NMA). Moreover, selected minimally invasive procedures were ranked according to their surface under the cumulative ranking curve (SUCRA) which was produced by NMA in conjunction with the Markov Chain Monte Carlo (MCMC) sampling method. HCC patients treated by combined minimally invasive procedures, particularly transcatheter arterial chemoembolization (TACE) + high intensity focused ultrasound (HIFU), TACE + radiofrequency ablation (RFA), TACE + radiotherapy (RT) and TACE + Sorafenib (SOR) exhibited a significant decrease in the HR compared to those with standard TACE (HR < 1). The combined minimally invasive procedure of TACE + HIFU appears to be the most preferable therapy. PEI seems to be less favorable than other minimally invasive procedures. Combined minimally invasive procedures may be more preferable than standard minimally invasive procedures. Percutaneous ethanol injection (PEI) may not provide adequate efficacy compared to other minimally invasive procedures for unresectable HCC patients.

• long-term efficacy
• network meta-analysis
• transarterial chemoembolization
• unresectable hepatocellular carcinoma

To evaluate the relationship between the location of hepatocellular carcinoma (HCC) and the efficacy of transarterial chemoembolization (TACE).

We evaluated 115 patients (127 nodules), excluding recurrent nodules, treated with TACE between January 2011 and June 2014. TACE efficacy was evaluated according to mRECIST. The HCC location coefficient was calculated as the distance from the central portal portion to the HCC center (mm)/liver diameter (mm) on multiplanar reconstruction images rendered (MPR) to visualize bifurcation of the right and left branches of the portal vein and HCC center. The HCC location coefficient was compared between complete response (CR) and non-CR groups in Child-Pugh grade A and B patients.

The median location coefficient of HCC among all nodules, the right lobe, and the medial segment was significantly higher in the CR group than in the non-CR group in the Child-Pugh grade A patients (0.82 vs 0.62, P < 0.001; 0.71 vs 0.59, P < 0.01; 0.81 vs 0.49, P < 0.05, respectively). However, there was no significant difference in the median location coefficient of the HCC in the lateral segment between in the CR and in the non-CR groups (0.67 vs 0.65, P > 0.05). On the other hand, in the Child-Pugh grade B patients, the HCC median location coefficient in each lobe and segment was not significantly different between in the CR and in the non-CR groups.

Improved TACE efficacy may be obtained for HCC in the peripheral zone of the right lobe and the medial segment in Child-Pugh grade A patients.

• Hepatocellular carcinoma location
• Transarterial chemoembolization efficacy
• Child-Pugh
• Modified response evaluation criteria in solid tumors
• Central zone
• Peripheral zone

• Aged
• Aged, 80 and over
• Angiography/methods
• Antineoplastic Agents/administration & dosage
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic/instrumentation
• Chemoembolization, Therapeutic/methods
• Cisplatin/administration & dosage
• Epirubicin/administration & dosage
• Ethiodized Oil/administration & dosage
• Female
• Femoral Artery/surgery
• Hepatic Artery/diagnostic imaging
• Humans
• Image Processing, Computer-Assisted
• Liver/blood supply
• Liver/diagnostic imaging
• Liver/pathology
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Multidetector Computed Tomography
• Portal Vein/diagnostic imaging
• Response Evaluation Criteria in Solid Tumors
• Retrospective Studies
• Survival Rate

• Thailand
• epidemiology
• hepatocellular carcinoma (HCC)
• treatment

• Antineoplastic Agents/administration & dosage
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic/methods
• Chemoembolization, Therapeutic/mortality
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Network Meta-Analysis
• Niacinamide/administration & dosage
• Niacinamide/analogs & derivatives
• Phenylurea Compounds/administration & dosage
• Randomized Controlled Trials as Topic
• Severity of Illness Index
• Sorafenib

• 10/4001/11 Department of Health
• 13/89/03 Department of Health

Combinations of transarterial chemoembolization (TACE) and radical therapies (pretransplantation, resection and radiofrequency ablation) for hepatocellular carcinoma (HCC) have been reported as controversial issues in recent years. A consecutive sample of 1560 patients with Barcelona Clinic Liver Cancer (BCLC) stage A/B HCC who underwent solitary Radiofrequency ablation (RFA), resection or liver transplantation (LT) or adjuvant pre-operative TACE were included. The 1-, 3- and 5-year overall survival rates and tumor-free survival rates were comparable between the solitary radical therapy group and TACE combined group in the whole group and in each of the subgroups (RFA, resection and LT) (P > 0.05). In the subgroup analysis, according to BCLC stage A or B, the advantages of adjuvant TACE were also not observed (P > 0.05). A Neutrophil-lymphocyte ratio (NLR) more than 4, multiple tumor targets, BCLC stage B, and poor histological grade were significant contributors to the overall and tumor-free survival rates. In conclusions, our results indicated that preoperative adjuvant TACE did not prolong long-term overall or tumor-free survival, but LT should nevertheless be considered the first choice for BCLC stage A or B HCC patients. Radical therapies should be performed very carefully in BCLC stage B HCC patients.

Ablative treatments currently represent the first-line option for the treatment of early stage unresectable hepatocellular carcinoma (HCC). Furthermore, they are effective as bridging/downstaging therapies before orthotopic liver transplantation. Contraindications based on size, number, and location of nodules are quite variable in literature and strictly dependent on local expertise. Among ablative therapies, radiofrequency ablation (RFA) has gained a pivotal role due to its efficacy, with a reported 5-year survival rate of 40%-70%, and safety. Although survival outcomes are similar to percutaneous ethanol injection, the lower local recurrence rate stands for a wider application of RFA in hepato-oncology. Moreover, RFA seems to be even more cost-effective than liver resection for very early HCC (single nodule ≤ 2 cm) and in the presence of two or three nodules ≤ 3 cm. There is increasing evidence that combining RFA to transarterial chemoembolization may increase the therapeutic benefit in larger HCCs without increasing the major complication rate, but more robust prospective data is still needed to validate these pivotal findings. Among other thermal treatments, microwave ablation (MWA) uses high frequency electromagnetic energy to induce tissue death via coagulation necrosis. In comparison to RFA, MWA has several theoretical advantages such as a broader zone of active heating, higher temperatures within the targeted area in a shorter treatment time and the lack of heat-sink effect. The safety concerns raised on the risks of this procedure, due to the broader and less predictable necrosis areas, have been recently overcome. However, whether MWA ability to generate a larger ablation zone will translate into a survival gain remains unknown. Other treatments, such as high-intensity focused ultrasound ablation, laser ablation, and cryoablation, are less investigated but showed promising results in early HCC patients and could be a valuable therapeutic option in the next future.

• Liver cancer
• Hepatocellular carcinoma
• Radiofrequency ablation
• Microwave ablation
• Radiofrequency ablation

• bipolar radiofrequency ablation
• hepatocellular carcinoma
• survival
• transarterial chemoembolization

• Bayes Theorem
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/surgery
• Carcinoma, Hepatocellular/therapy
• Catheter Ablation/methods
• Catheter Ablation/statistics & numerical data
• Chemoembolization, Therapeutic/methods
• Chemoembolization, Therapeutic/statistics & numerical data
• Combined Modality Therapy
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/surgery
• Liver Neoplasms/therapy
• Neoplasm Staging
• Prognosis
• Randomized Controlled Trials as Topic
• Survival Rate

• chemoembolization
• hepatocellular carcinoma
• thermal ablation

• Hepatocellular carcinomas
• Meta-analysis
• Radiofrequency ablation
• Transcatheter arterial chemoembolization

• Catheter Ablation
• Chemoembolization, Therapeutic
• Cryosurgery
• Humans
• Liver Neoplasms/secondary
• Liver Neoplasms/therapy

AIM: To determine whether combined transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) improve overall and recurrence-free survival (RFS) compared with RFA alone.

METHODS: We reviewed randomized clinical trials (RCTs) comparing overall survival rate as well as recurrence-free rate for hepatocellular carcinoma (HCC) between TACE-RFA therapy and RFA alone published before April 2015 by conducting a systematic review and meta-analysis. Eligible studies were identified by searching PubMed and EMBASE up to April 2015. Additional studies were retrieved via China Medical Collections, Google Scholar or a hand review of the reference lists of the retrieved articles. The summarized relative risks (RRs) with their 95%CIs were estimated using random-effects model. I² statistic was calculated to measure the heterogeneity of RRs across studies and Cochran’s Q test was used to test the statistical significance accordingly. Publication bias was assessed primarily based on visual assessment using a funnel plot, and secondly by using Egger’s regression asymmetry test or Begg’s rank correlation test as appropriate. Meta-regression was implemented to examine potential effect modifiers.

RESULTS: Nine single-center RCTs conducted in China and Japan were included, with a total of 618 patients with HCC; 321 of whom (51.9%) received TACE/RFA therapy and 297 received RFA alone. The pooled RRs with corresponding CIs comparing combined TACE/RFA to RFA alone were 1.12 (1.004-1.26) and 1.20 (1.02-1.41) for 1-year and 3-year survival rates, respectively. Similar positive associations were found for 1-year (1.19; 1.05-1.35) and 3-year (1.44; 1.00-2.07) RFS. The beneficial effect was more evident in patients with medium-sized (3-5 cm) tumors and among the Chinese population.

CONCLUSION: Combined TACE/RFA has a beneficial effect on survival and recurrence rates compared with RFA alone, especially for medium-sized HCC and among Chinese patients.

• Radiofrequency ablation
• Hepatocellular carcinoma
• Transarterial chemoembolization
• Meta-analysis
• Randomized clinical trial

• Hepatocellular carcinoma
• Radiofrequency ablation
• Surgery
• Tumor marker

The incidence of liver cancer is high in China and effective treatments are required. Recently, imaging guided radiofrequency ablation (RFA) has become increasingly accepted in treating solid tumors because of minimal invasiveness, easy operation and effectiveness. The outcome of RFA in small liver tumors is even comparable to that of surgery. However, the RFA efficacy in larger ( > 3.0 cm) liver tumors is not satisfactory and recurrence after treatment is common. The development of basic research and RFA device has provided more opportunities for us to treat>3.0 cm liver tumors. The successful ablation of solid tumors relies on three key components, the technology (i.e., the RFA generator and electrodes selected), the biology of the tumor and background tissue, and operator factors. The current development and prospective of the three main elements will be the focus in this review.

• Radiofrequency ablation
• Hepatocellular carcinoma
• Medium to large tumor
• Outcome

• Chemotherapy
• Hepatocellular carcinoma
• Radiofrequency ablation
• Survival rates
• Transcatheter arterial chemoembolization
• Tumor ablation

• Adult
• Aged
• Carcinoma, Hepatocellular/blood
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/therapy
• Catheter Ablation/adverse effects
• Chemoembolization, Therapeutic/adverse effects
• Combined Modality Therapy
• Female
• Humans
• Liver Neoplasms/blood
• Liver Neoplasms/mortality
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Prospective Studies
• Survival Rate
• Treatment Outcome
• alpha-Fetoproteins/analysis

Hepatocellular carcinoma (HCC) is one of the commonest malignant tumours in the East. Although the management of HCC in the West is mainly based on the Barcelona Clinic for Liver Cancer staging, it is considered too conservative by Asian countries where the number of HCC patients is huge. Scientific and clinical advances were made in aspects of diagnosis, staging, and treatment of HCC. HCC is well known to be associated with cirrhosis and the treatment of HCC must take into account the presence and stage of chronic liver disease. The major treatment modalities of HCC include: (1) surgical resection; (2) liver transplantation; (3) local ablation therapy; (4) transarterial locoregional treatment; and (5) systemic treatment. Among these, resection, liver transplantation and ablation therapy for small HCC are considered as curative treatment. Portal vein embolisation and the associating liver partition with portal vein ligation for staged hepatectomy may reduce dropout in patients with marginally resectable disease but the midterm and long-term results are still to be confirmed. Patient selection for the best treatment modality is the key to success of treatment of HCC. The purpose of current review is to provide a description of the current advances in diagnosis, staging, pre-operative liver function assessment and treatment options for patients with HCC in the east.

• Hepatocellular carcinoma
• Liver cirrhosis
• Treatment
• Management
• Evidence
• Survival
• Update

Intermediate stage, or stage B according to Barcelona Clinic Liver Cancer classification, of hepatocellular carcinoma (HCC) comprises a heterogeneous population with different tumor burden and liver function. This heterogeneity is confirmed by the large variability of treatment choice and disease-relate survival. The aim of this review was to highlight the existing evidences regarding this specific topic. In a multidisciplinary evaluation, patients with large (> 5 cm) solitary HCC should be firstly considered for liver resection (LR). When LR is unfeasible, locoregional treatments are evaluable therapeutic options, being transarterial chemoembolization (TACE), the most used procedure. Percutaneous ablation can be an evaluable treatment for large HCC. However, the efficacy of all ablative procedures decrease as tumor size increases over 3 cm. In clinical practice, a combination treatment strategy [TACE or transarterial radioembolization (TARE)-plus percutaneous ablation] is “a priori” preferred in a relevant percentage of these patients. On the other hands, sorafenib is the treatment of choice in patients who are unsuitable to surgery and/or with a contraindication to locoregional treatments. In multifocal HCC, TACE is the first-line treatment. The role of TARE is still undefined. Surgery may have also a role in the treatment of multifocal HCC in selected cases (patients with up to three nodules, multifocal HCC involving 2-3 adjacent liver segments). In some patients with bilobar disease the combination of LR and ablative treatment may be a valuable option. The choice of the best treatment in the patient with intermediate stage HCC should be “patient-tailored” and made by a multidisciplinary team.

• Hepatocellular carcinoma
• Percutaneous ablation
• Hepatectomy
• Chemoembolization
• Liver transplantation
• Combination therapy

AIM: To evaluate the outcomes of patients with medium-sized hepatocellular carcinoma (HCC) who underwent percutaneous microwave ablation (MWA).

METHODS: We retrospectively reviewed all patients with a single medium-sized HCC who underwent percutaneous MWA from January 2010 to January 2013. Technical success, technical effectiveness and complications were subsequently observed. Survival curves were constructed using the Kaplan-Meier method. The Cox proportional hazards model was fitted to each variable. The relative prognostic significance of the variables for predicting overall survival rate, recurrence-free survival rate and local tumor recurrence(s) was assessed using univariate analysis. All variables with a P value < 0.20 were subjected to multivariate analysis.

RESULTS: The study included 182 patients (mean age, 58 years; age range: 22-86 years) with a single HCC (mean size, 3.72 ± 0.54 cm; range: 3.02-5.00 cm). The estimated technical effectiveness rate was 93% in 182 patients. The major complication rate was 2.7% (5/182), including liver abscess in 4 cases, and abdominal bleeding at the puncture site in 1 case. Thirty-day mortality rate was 0.5% (1/182). One patient died due to liver abscess-related septicemia. Cumulative recurrence-free survival and overall survival (OS) rates were 51%, 36%, 27% and 89%, 74%, 60% at 1, 2, and 3 years, respectively. Age (P = 0.017) and tumor diameter (P = 0.029) were independent factors associated with local tumor recurrence. None of the factors had a statistically significant impact on recurrence-free survival. Serum albumin level (P = 0.009) and new lesion(s) (P = 0.029) were independently associated with OS.

CONCLUSION: Percutaneous MWA is a relatively safe and effective treatment for patients with medium-sized HCC.

• Hepatocellular carcinoma
• Medium-sized tumor
• Microwave ablation
• Outcomes
• Cox analysis

• Ablation Techniques/adverse effects
• Ablation Techniques/mortality
• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/surgery
• Disease-Free Survival
• Female
• Humans
• Kaplan-Meier Estimate
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Magnetic Resonance Imaging
• Male
• Microwaves/adverse effects
• Microwaves/therapeutic use
• Middle Aged
• Multivariate Analysis
• Neoplasm Recurrence, Local
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• Tumor Burden
• Young Adult

AIM: To investigate the efficacy and safety of transarterial chemoembolization (TACE)-based multimodal treatment in patients with large hepatocellular carcinoma (HCC).

METHODS: A total of 146 consecutive patients were included in the analysis, and their medical records and radiological data were reviewed retrospectively.

RESULTS: In total, 119 patients received TACE-based multi-modal treatments, and the remaining 27 received conservative management. Overall survival (P < 0.001) and objective tumor response (P = 0.003) were significantly better in the treatment group than in the conservative group. After subgroup analysis, survival benefits were observed not only in the multi-modal treatment group compared with the TACE-only group (P = 0.002) but also in the surgical treatment group compared with the loco-regional treatment-only group (P < 0.001). Multivariate analysis identified tumor stage (P < 0.001) and tumor type (P = 0.009) as two independent pre-treatment factors for survival. After adjusting for significant pre-treatment prognostic factors, objective response (P < 0.001), surgical treatment (P = 0.009), and multi-modal treatment (P = 0.002) were identified as independent post-treatment prognostic factors.

CONCLUSION: TACE-based multi-modal treatments were safe and more beneficial than conservative management. Salvage surgery after successful downstaging resulted in long-term survival in patients with large, unresectable HCC.

• Hepatocellular carcinoma
• Multimodal treatment
• Transarterial chemoembolization
• Salvage surgery

• Adult
• Aged
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Chemoembolization, Therapeutic/adverse effects
• Chemoembolization, Therapeutic/mortality
• Chemotherapy, Adjuvant
• Chi-Square Distribution
• Female
• Hepatectomy
• Humans
• Kaplan-Meier Estimate
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Multivariate Analysis
• Neoadjuvant Therapy
• Neoplasm Staging
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome

Hepatocellular carcinoma (HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The Barcelona clinic liver cancer classification is the current standard classification system for the clinical management of patients with HCC and suggests that patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization (TACE). Interventional treatments such as TACE, balloon-occluded TACE, drug-eluting bead embolization, radioembolization, and combined therapies including TACE and radiofrequency ablation, continue to evolve, resulting in improved patient prognosis. However, patients with advanced-stage HCC typically receive only chemotherapy with sorafenib, a multi-kinase inhibitor, or palliative and conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidates for systemic therapy. However, these patients require therapy that is more effective than sorafenib or conservative treatment. Several researchers try to perform more effective therapies, such as combined therapies (TACE with radiotherapy and sorafenib with TACE), modified TACE for HCC with arterioportal or arteriohepatic vein shunts, TACE based on hepatic hemodynamics, and isolated hepatic perfusion. This review summarizes the published data and data on important ongoing studies concerning interventional treatments for unresectable HCC and discusses the technical improvements in these interventions, particularly for advanced-stage HCC.

• Unresectable
• Hepatocellular carcinoma
• Intermediate-stage
• Advanced-stage
• Interventional

• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Catheter Ablation/adverse effects
• Chemoembolization, Therapeutic/adverse effects
• Combined Modality Therapy
• Embolization, Therapeutic/adverse effects
• Embolization, Therapeutic/methods
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Molecular Targeted Therapy/adverse effects
• Neoplasm Staging
• Radiopharmaceuticals/adverse effects
• Radiopharmaceuticals/therapeutic use
• Treatment Outcome

• Ethics
• irresponsible research practices
• plagiarism
• research misconduct

• biomarkers
• hepatocellular carcinoma
• immune therapy
• liver transplantation
• locoregional therapy
• partial hepatectomy
• sorafenib

AIM: To compare clinical outcomes between surgical resection (RES) and nonsurgical-RES (nRES) ablation therapies for small hepatocellular carcinoma (HCC).

METHODS: MEDLINE, Embase and Cochrane Library databases were systematically searched for studies of RES and nRES treatments for small HCC between January 2003 and October 2013. The clinical outcome measures evaluated included overall survival rate, disease-free survival rate, adverse events, and local recurrence rate. Odds ratios (ORs) with 95%CIs were calculated using either the fixed effects model or random effects model. The χ² and I² tests were calculated to assess the heterogeneity of the data. Funnel plots were used to assess the risk of publication bias.

RESULTS: Our analysis included 12 studies that consisted of a total of 1952 patients (RES vs nRES), five studies that consisted of 701 patients [radiofrequency ablation (RFA) vs percutaneous ethanol injection (PEI)], and five additional studies [RFA vs RFA + transcatheter arterial chemoembolization (TACE)] that all addressed the treatment of small HCC. For cases of RES vs nRES, there was no significant difference in the 1-year (OR = 0.99, 95%CI: 0.87-1.12, P = 0.85) or 3-year (OR = 0.97, 95%CI: 0.84-1.11, P = 0.98) overall survival rate; however, there was a significant increase in the RES group in the 5-year overall survival rate (OR = 0.81, 95%CI: 0.68-0.95, P = 0.01). The 1-year (OR = 0.94, 95%CI: 0.82-1.08, P = 0.37) and 5-year (OR = 0.99, 95%CI: 0.85-1.14, P = 0.85) disease-free survival rates showed no significant differences between the two groups. The 3-year disease-free survival rate (OR = 0.81, 95%CI: 0.69-0.96; P = 0.02) was higher in the RES group. For cases of RFA vs PEI, our data analysis indicated that RFA treatment was associated with significantly higher 2-year (OR = 0.76, 95%CI: 0.58-0.99, P = 0.043) and 3-year (OR = 0.73, 95%CI: 0.54-0.98, P = 0.039) overall survival rates; however, there were no significant differences in the 1-year (OR = 0.92, 95%CI: 0.72-1.17, P = 0.0502) overall survival rate or incidence of adverse events (OR = 1.84, 95%CI: 0.76-4.45, P = 0.173). For cases of RFA vs RFA+TACE, there were no significant differences in the 1-year (OR = 1.17, 95%CI: 0.88-1.56, P = 0.27) or 3-year (OR = 1.25, 95%CI: 0.90-1.73, P = 0.183) overall survival rate; however, the 5-year overall survival rate (OR = 3.19, 95%CI: 1.51-6.74, P = 0.002) in patients treated by RFA+TACE was higher than that treated by RFA alone.

CONCLUSION: Surgical resection is superior to nonsurgical ablation for the treatment of small HCC. Among the studies analyzed, RFA is the most efficacious single nonsurgical ablation treatment.

• Hepatocellular carcinoma
• Meta-analysis
• Surgical resection
• Nonsurgical ablation
• Radiofrequency ablation
• Percutaneous ethanol injection
• Recurrence
• Survival

• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/surgery
• Catheter Ablation/adverse effects
• Catheter Ablation/mortality
• Chi-Square Distribution
• Disease Progression
• Disease-Free Survival
• Hepatectomy/adverse effects
• Hepatectomy/mortality
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Neoplasm Recurrence, Local
• Odds Ratio
• Postoperative Complications/mortality
• Risk Factors
• Survival Analysis
• Time Factors
• Treatment Outcome
• Tumor Burden