Strategies for the treatment of hepatocellular carcinoma: HR and MCN

Abstract

Purpose: To evaluate the prognostic impact of microwave coagulo-necrotic therapy (MCN) versus hepatic resection (HR) on patient survival after treatment for hepatocellular carcinoma (HCC).
Materials & methods: Between July 1994 and December 2006, 1567 patients underwent hepatic surgery at our institute. Of these, 613 who received their initial therapy for HCC were analyzed. MCN was performed in 456 patients, hepatic resection (HR) in 111, and HR + MCN in 42. The remaining 4 patients were treated with laparotomic ethanol injection. We analyzed the therapeutic survival, local tumor progression and overall recurrence rates.
Results: The cumulative survival rates for patients treated with MCN (mean tumor size, 28.2 mm; mean number of lesions, 2.62) were 97.5, 77.6, 58.7, and 37.3%, at 1, 3, 5 and 10 years, respectively. The 5-year survival rate was 58.7% after MCN and 56.4% after HR (p = 0.9480).
The cumulative survival rates for 238 patients treated with MCN who had 3 or fewer lesions of ≤3 cm in diameter were 98.1, 85.2, 70.3 and 43.5% at 1, 3, 5 and 10 years,. There were no significant differences in cumulative survival (p = 0.7358), disease-free survival or local recurrence rates between patients treated with MCN versus those treated with HR. Of the 613 patients receiving their initial treatment, 319 had recurrences after an average of 639.6 days after operation; 61 of these had 4 or more recurrent lesions, while 204 patients could be treated with MCN (mean tumor size, 23.7 mm; mean number of lesions, 3.08).
Conclusion: Our findings suggest that MCN is an effective treatment for loco-regional control of HCC and is comparable to HR. MCN is particularly suitable for the treatment of patients presenting with multiple tumors or tumor recurrence. We recommend that HR and MCN should both be considered as first-choice treatments for HCC.