Liver Resection vs Nonsurgical Treatments for Patients With Early Multinodular Hepatocellular Carcinoma-Reference-Cited by-同舟云学术

Liver Resection vs Nonsurgical Treatments for Patients With Early Multinodular Hepatocellular Carcinoma

Published:2024-08-01 Issue:8 Volume:159 Page:881
ISSN:2168-6254
Container-title:JAMA Surgery
language:en
Short-container-title:JAMA Surg

Author:

Vitale Alessandro¹,Romano Pierluigi¹,Cillo Umberto¹, , , ,Busti Marco²,Nezi Giulia²,De Carlis Riccardo²,Ratti Francesca²,Milana Flavio²,Donadon Matteo²,Marinelli Laura²,Razionale Francesco²,Carissimi Francesca²,Scotti Mauro Alessandro²,Ciuli Cristina²,De Peppo Valerio²,Russolillo Nadia²,Giuffrida Mauro²,De Stefano Francesca²,Peverada Jacopo²,Larghi Laureiro Zoe²,Franceschi Angelo²,Pelizzo Patrizia²,Marchitelli Ivan²,Casella Annachiara²,Manzoni Alberto²,Malagnino Alessia²,Calcagno Pietro²,Cammarata Francesco²,Pennacchi Luca²,Cosola Davide²,Corleone Pio²,Cucchetti Alessandro²,Mantovani Guido²,Notte Francesca²,Montuori Mauro²,Allegrini Gloria²,Cammà Calogero²,Celsa Ciro²,Giuffrida Paolo²,Giacchetto Carmelo Marco²,Rancatore Gabriele²,Grassin Maria Vittoria²,Ciccia Roberta²,Grova Alessandro²,Salvato Mauro²,Biasini Elisabetta²,Olivani Andrea²,Chen Rusi²,Granito Alessandro²,Piscaglia Fabio²,Stefanini Bernardo²,Tovoli Francesco²,Biselli Maurizio²,Bucci Laura²,Lani Lorenzo²,Stefanini Benedetta²,Bevilacqua Vittoria²,Berardinelli Dante²,Borghi Alberto²,Casadei Gardini Andrea²,Conti Fabio²,Dall'Aglio Anna Chiara²,Ercolan Giorgio²,Campani Claudia²,Di Bonaventura Chiara²,Gitto Stefano²,Franzè Maria Stella²,Sauchella Assunta²,Coccoli Pietro²,Malerba Antonio²,Capasso Mario²,Guarino Maria²,Lauria Valentina²,Ghittoni Giorgia²,Pelecca Giorgio²,Sartori Anna²,Imondi Angela²,Penzo Barbara²,Inno Alessandro²,Marchetti Fabiana²,Di Bucchianico Alessandro²,Dajti Elton²,Ravaioli Federico²,Plaz Torres Maria Corina²,Pieri Giulia²,Olivieri Filippo²,Romagnoli Veronica²,de Matthaeis Nicoletta²,Cela Ester Marina²,Facciorusso Antonio²,Ponziani Francesca Romana²,Lauterio Andrea³,Sangiovanni Angelo⁴,Cabibbo Giuseppe⁵,Missale Gabriele⁶,Marseglia Mariarosaria⁷,Trevisani Franco⁸,Foschi Francesco Giuseppe⁹,Cipriani Federica¹⁰,Famularo Simone¹¹,Marra Fabio¹²,Saitta Carlo¹³,Serenari Matteo¹⁴,Vidili Gianpaolo¹⁵,Morisco Filomena¹⁶,Caturelli Eugenio¹⁷,Mega Andrea¹⁸,Pelizzaro Filippo¹⁹,Nicolini Daniele²⁰,Ardito Francesco²¹,Garancini Mattia²²,Masotto Alberto²³,Baroni Gianluca Svegliati²⁴,Azzaroli Francesco²⁵,Giannini Edoardo²⁶²⁷,Perri Pasquale²⁸,Scarinci Andrea²⁸,Fontana Andrea Pierluigi²⁹,Brunetto Maurizia Rossana³⁰,Iaria Maurizio³¹,Di Marco Maria³²,Nardone Gerardo³³,Dominioni Tommaso³⁴,Lai Quirino³⁵,Ferrari Cecilia³⁶,Rapaccini Gian Ludovico³⁷,Rodolfo Sacco³⁸,Romano Maurizio³⁹,Conci Simone⁴⁰,Zoli Marco⁴¹,Conticchio Maria⁴²,Zanello Matteo⁴³,Zimmitti Giuseppe⁴⁴,Fumagalli Luca⁴⁵,Troci Albert⁴⁶,Germani Paola⁴⁷,Gasbarrini Antonio⁴⁸,La Barba Giuliano⁴⁹,De Angelis Michela⁵⁰,Patauner Stefan⁵¹,Molfino Sarah⁵²,Zago Mauro⁵³,Pinotti Enrico⁵³,Frigo Anna Chiara⁵⁴,Baiocchi Gian Luca⁵²,Frena Antonio⁵¹,Boccia Luigi⁵⁰,Ercolani Giorgio⁴⁹,Tarchi Paola⁴⁷,Crespi Michele⁴⁶,Chiarelli Marco⁴⁵,Abu Hilal Moh’d⁴⁴,Cescon Matteo⁴³,Memeo Riccardo⁴²,Ruzzenente Andrea⁴⁰,Zanus Giacomo³⁹,Griseri Guido³⁶,Rossi Massimo³⁵,Maestri Marcello³⁴,Della Valle Raffaele³¹,Ferrero Alessandro²⁹,Grazi Gian Luca²⁸⁵⁵,Romano Fabrizio²²,Giuliante Felice²¹,Vivarelli Marco²⁰,Jovine Elio¹⁴,Torzilli Guido¹¹,Aldrighetti Luca¹⁰,De Carlis Luciano³

Affiliation:

1. Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Second General Surgical Unit, Padova Teaching Hospital, Padua, Italy

2. for the HE.RC.O.LE.S and ITA.LI.CA Collaborative Groups

3. Department of General and Transplant Surgery, Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy

4. Department of Gastroenterologiy and Hepatology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan, Milan, Italy

5. Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Section of Gastroenterology & Hepatology, University of Palermo, Palermo, Italy

6. Department of Medicine and Surgery, Infectious Diseases and Hepatology Unit, University of Parma and Azienda Ospedaliero-Universitaria of Parma, Parma, Italy

7. Division of Internal Medicine, Hepatobiliary and Immunoallergic Disease, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

8. Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

9. Medicina Interna Faenza, Dipartimento Emergenza, Medicina Interna e Cardiologia IRCCS-Istituto Scientifico Romagnolo per lo Studio dei Tumori “Dino Amadori” Meldola, AUSL Romagna, Meldola, Italy

10. Hepatobiliary Surgery Division, “Vita e Salute” University, Ospedale San Raffaele IRCCS, Milan, Italy

11. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

12. Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Florence, Italy

13. Department of Clinical and Experimental Medicine, Division of Medicine and Hepatology, University of Messina, Messina, Italy

14. Hepatobiliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

15. Department of Medicine, Surgery and Pharmacy, AOU Sassari, Italy

16. Department of Clinical Medicine and Surgery, Departmental Program “Diseases of the Liver and Biliary System”, University of Napoli “Federico II”, Naples, Italy

17. Gastroenterology Unit, Belcolle Hospital, Viterbo, Italy

18. Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy

19. Department of Surgery, Oncology, and Gastroenterology, Gastroenterology Unit, University of Padova, Padua, Italy

20. HPB Surgery and Transplantation Unit, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Ancona, Italy

21. Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy

22. School of medicine and surgery, University of Milano Bicocca, IRCCS Fondazione San Gerardo, Monza, Italy

23. Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy

24. Liver Injury and Transplant Unit and Obesity Center, Polytechnic University of Marche, Ancona, Italy

25. Gastroenterology Unit, Department of Surgical and Medical Sciences, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy

26. Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy

27. Gastroenterology Unit, IRCCS Ospedale San Martino, Genoa, Italy

28. Division of Hepatobiliary pancreatic Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy

29. Department of General and Oncological Surgery, Mauriziano Hospital “Umberto I”, Turin, Italy

30. UO Epatologia, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy

31. Department of Medicine and Surgery, University of Parma, Parma, Italy

32. Medicine Unit, Bolognini Hospital, Seriate, Italy

33. Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli “Federico II”, Naples, Italy;

34. Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy

35. General Surgery and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy

36. HPB Surgical Unit, San Paolo Hospital, Savona, Italy

37. Gastroenterology Unit, Fondazione Policlinico Universitario A Gemelli, IRCCS, Roma, Italy

38. Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy

39. Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Hepatobiliary and Pancreatic Surgery Unit, Treviso Hospital, Treviso, Italy

40. Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy

41. Department of Medical and Surgical Sciences, Internal Medicine–Zoli Unit, Alma Mater Studiorum,Università di Bologna, Padova, Italy

42. Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy

43. Alma Mater Studiorum, University of Bologna, AOU Sant’Orsola Malpighi, IRCCS at Maggiore Hospital, Bologna, Italy

44. Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy

45. Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy

46. Department of Surgery, L Sacco Hospital, Milan, Italy

47. Division of General Surgery, Department of Medical and Surgical Sciences, ASUGI, Trieste, Italy

48. Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy

49. General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Department of Medical and Surgical Sciences, University of Bologna Forlì, Forlì, Italy

50. Department of General Surgery, Ospedale Carlo Poma, Mantua, Italy

51. Department of General and Pediatric Surgery, Bolzano Central Hospital, Bolzano, Italy

52. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

53. Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy; Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy

54. Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy

55. Now with HepatoBiliaryPancreatic Surgery, AOU Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

Abstract

ImportanceThe 2022 Barcelona Clinic Liver Cancer algorithm currently discourages liver resection (LR) for patients with multinodular hepatocellular carcinoma (HCC) presenting with 2 or 3 nodules that are each 3 cm or smaller.ObjectiveTo compare the efficacy of liver resection (LR), percutaneous radiofrequency ablation (PRFA), and transarterial chemoembolization (TACE) in patients with multinodular HCC.Design, Setting, and ParticipantsThis cohort study is a retrospective analysis conducted using data from the HE.RC.O.LE.S register (n = 5331) for LR patients and the ITA.LI.CA database (n = 7056) for PRFA and TACE patients. A matching-adjusted indirect comparison (MAIC) method was applied to balance data and potential confounding factors between the 3 groups. Included were patients from multiple centers from 2008 to 2020; data were analyzed from January to December 2023.InterventionsLR, PRFA, or TACE.Main Outcomes and MeasuresSurvival rates at 1, 3, and 5 years were calculated. Cox MAIC-weighted multivariable analysis and competing risk analysis were used to assess outcomes.ResultsA total of 720 patients with early multinodular HCC were included, 543 males (75.4%), 177 females (24.6%), and 350 individuals older than 70 years (48.6%). There were 296 patients in the LR group, 240 who underwent PRFA, and 184 who underwent TACE. After MAIC, LR exhibited 1-, 3-, and 5-year survival rates of 89.11%, 70.98%, and 56.44%, respectively. PRFA showed rates of 94.01%, 65.20%, and 39.93%, while TACE displayed rates of 90.88%, 48.95%, and 29.24%. Multivariable Cox survival analysis in the weighted population showed a survival benefit over alternative treatments (PRFA vs LR: hazard ratio [HR], 1.41; 95% CI, 1.07-1.86; P = .01; TACE vs LR: HR, 1.86; 95% CI, 1.29-2.68; P = .001). Competing risk analysis confirmed a lower risk of cancer-related death in LR compared with PRFA and TACE.Conclusions and RelevanceFor patients with early multinodular HCC who are ineligible for transplant, LR should be prioritized as the primary therapeutic option, followed by PRFA and TACE when LR is not feasible. These findings provide valuable insights for clinical decision-making in this patient population.

Publisher

American Medical Association (AMA)

Link

https://jamanetwork.com/journals/jamasurgery/articlepdf/2818741/jamasurgery_vitale_2024_oi_240025_1723061382.46226.pdf

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