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- W4323536480 abstract "Introduction The 2022 version of the BCLC staging system recommends a treatment stage migration from liver transplantation (LT) directly to trans-arterial chemo-embolization (TACE) in patients with multinodular early stage HCC, when LT is not feasible. We sought to compare the effectiveness of liver resection (LR), percutaneous radiofrequency ablation (PRA), and TACE in patients with not transplantable but potentially resectable multinodular early HCC. Methods Only multinodular not transplantable early stage (2 or 3 nodules ≤3 cm) HCC patients were considered. LR patients were obtained from the HE.RC.O.LE.S. register, whereas PRA and TACE patients were obtained from the ITA.LI.CA register. Since the aim of this study was to compare the effectiveness of three potential treatments in resectable patients, the statistical method matching-adjusted indirect comparison” (MAIC) was used to match the PRA and TACE groups to the LR group. Results Between 2008 and 2020, 655 HCC cirrhotic patients were enrolled: 303 in LR, 204 in PRA, and 148 in TACE groups. Age, sex, Charlson Comorbidity index, Child-Pugh grade, MELD, platelets count, aetiology of cirrhosis, number and diameter of nodules, and alpha-fetoprotein were weighted by MAIC to create two PRA and TACE pseudo-populations balanced with the LR group. After MAIC, 1-3-5 years OS was 88%, 71%, 56% for LR (median survival 67 months), 97%, 63%, 22% for PRA (median survival 53 months), and 88%, 58%, 32% for TACE (median survival 41 months)(P < 0.001). At Cox multivariable weighted regression, the survival benefit of LR over alternative treatments was confirmed: LR group as reference; PRA (hazard ratio 1.44; 95% confidence interval 1.19-1.84; P = 0.0045); TACE (hazard ratio 1.70; 95% confidence interval 1.25-2.31; P = 0.0007). Conclusions In multinodular early not transplantable HCC, LR should be the first option, followed by PRA and TACE only when LR is not feasible." @default.
- W4323536480 created "2023-03-09" @default.
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- W4323536480 date "2023-03-01" @default.
- W4323536480 modified "2023-09-27" @default.
- W4323536480 title "Which is the best therapy for not transplantable patients with multinodular early HCC?" @default.
- W4323536480 doi "https://doi.org/10.1016/j.dld.2023.01.078" @default.
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