Comparison of clinical efficacy between reoperation and radiofrequency ablation for recurrent hepatocellular carcinoma

doi:10.3877/cma.j.issn.2095-3232.2026.02.011

Abstract

Abstract:

Objective

To compare the safety and efficacy between repeated hepatectomy (RH) and radiofrequency ablation (RFA) in the treatment of recurrent hepatocellular carcinoma (HCC), and to explore the influencing factors of postoperative survival.

Methods

Clinical data of 96 patients with recurrent HCC admitted to the First People's Hospital of Foshan from January 2017 to December 2023 were retrospectively analyzed. Among them, 86 patients were male and 10 female, aged from 27 to 78 years, with a median age of 55 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different treatment methods, all patients were divided into the RH (n=43) and RFA groups (n=53). Patients between two groups were matched by 1∶1 propensity score matching (PSM). Clinical efficacy and safety between RH and RFA in patients with recurrent HCC were also compared. Overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier method and Log-rank test. Prognostic factors were determined by using multivariate Cox's regression analysis.

Results

After PSM, the 1-, 3- and 5-year OS rates in the RH group were 93.1%, 81.8% and 71.9%, and 83.7%, 58.9% and 45.4% in the RFA group, respectively, with no statistical significance between two groups (χ²=3.133, P=0.077). The 1-, 3- and 5-year PFS rates in the RH group were 70.8%, 45.4% and 34.4%, and 45.1%, 7.6% and 4.0% in the RFA group, respectively, with statistical significance between two groups (χ²=12.308, P<0.001). PFS subgroup analysis revealed that RH was superior to RFA in small tumors, single and multiple lesion subgroups (Z=9.811, 6.699, 5.998; all P<0.05). Cox's regression analysis revealed that treatment regimen, liver cirrhosis and satellite lesion were the independent influencing factors of PFS in patients with recurrent HCC (RR=0.005, 0.015, 0.013; all P<0.05). After PSM, the length of postoperative hospital stay was 2 (1,2) d in the RFA group, also significantly shorter than 7 (6,9) d in the RH group (Z=-6.612, P<0.001). The incidence of complications was 10%(3/31) in the RFA group, significantly lower than 42% (13/31) in the RH group (χ²=6.823, P=0.009).

Conclusions

For patients with recurrent HCC, RH achieves better PFS benefits compared with RFA, especially in patients with small tumors, single and multiple lesions. Patients between two groups obtain similar OS.

Key words: Carcinoma,hepatocellular, Recurrence, Rehepatectomy, Radiofrequency ablation(RFA), Prognosis

Jierong Wu, Qing Yan, Jianyuan Hu, Huanwei Chen. Comparison of clinical efficacy between reoperation and radiofrequency ablation for recurrent hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(02): 211-218.

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Figures/Tables 5

变量	PSM前				PSM后
变量	RH组	RFA组	统计值	P值	RH组	RFA组	统计值	P值
年龄(岁, $x ¯$ ±s)	54±13	55±12	t=0.575	0.567	53±12	57±13	t=1.391	0.169
男性(例)	38	48	χ²=0.000	0.989	26	31	χ²=3.481	0.062
AFP≥400 μg/L(例)	3	8	χ²=0.846	0.358	2	5	χ²=0.644	0.422
肝硬化(例)	19	26	χ²=0.073	0.787	14	18	χ²=0.581	0.446
HBV感染(例)	42	52	χ²=0.000	>0.999	30	31	χ²=0.000	>0.999
Child-Pugh分级A级(例)	43	53	-	-	35	35	-	-
复发间隔[月, M(Q₁, Q₃)]	18(11, 32)	8(5, 16)	Z=4.233	>0.999	15(10, 25)	13(6,21)	Z=1.042	0.297
肿瘤最大直径[cm, M(Q₁, Q₃)]	2.3(1.5, 2.8)	1.6(1.2, 1.9)	Z=3.284	0.001	2.0(1.5, 2.5)	1.70(1.3, 2.5)	Z=0.494	0.621
肿瘤单发(例)	35	33	χ²=4.218	0.121	24	22	χ²=0.378	0.828
TB[μmol/L, M(Q₁, Q₃)]	12.7(9.5, 17.4)	15.2(11.7, 18.3)	Z=1.592	0.111	12.7(10.3, 17.7)	17.3(12.2, 20.7)	Z=1.795	0.073
ALB(g/L)^a	39±4	40±4	t=1.295	0.198	39(38, 42)	41(38, 42)	Z=0.810	0.418
ALT[U/L, M(Q₁, Q₃)]	22(15, 34)	24(19, 29)	Z=0.446	0.656	23(17, 3)	27(23, 29)	Z=0.634	0.526
AST[U/L, M(Q₁, Q₃)]	27(23, 32)	30(23, 33)	Z=0.937	0.349	27(23, 35)	28(22, 33)	Z=0.212	0.832
MVI(例)^b	8	25	χ²=7.367	0.007	6	10	χ²=0.758	0.384
卫星灶(例)^b	11	20	χ²=1.096	0.295	11	11	-	-
低分化(例)^b	29	37	χ²=2.527	0.283	20	23	χ²=1.432	0.489

变量	PSM前				PSM后
变量	RH组	RFA组	统计值	P值	RH组	RFA组	统计值	P值
年龄(岁, $x ¯$ ±s)	54±13	55±12	t=0.575	0.567	53±12	57±13	t=1.391	0.169
男性(例)	38	48	χ²=0.000	0.989	26	31	χ²=3.481	0.062
AFP≥400 μg/L(例)	3	8	χ²=0.846	0.358	2	5	χ²=0.644	0.422
肝硬化(例)	19	26	χ²=0.073	0.787	14	18	χ²=0.581	0.446
HBV感染(例)	42	52	χ²=0.000	>0.999	30	31	χ²=0.000	>0.999
Child-Pugh分级A级(例)	43	53	-	-	35	35	-	-
复发间隔[月, M(Q₁, Q₃)]	18(11, 32)	8(5, 16)	Z=4.233	>0.999	15(10, 25)	13(6,21)	Z=1.042	0.297
肿瘤最大直径[cm, M(Q₁, Q₃)]	2.3(1.5, 2.8)	1.6(1.2, 1.9)	Z=3.284	0.001	2.0(1.5, 2.5)	1.70(1.3, 2.5)	Z=0.494	0.621
肿瘤单发(例)	35	33	χ²=4.218	0.121	24	22	χ²=0.378	0.828
TB[μmol/L, M(Q₁, Q₃)]	12.7(9.5, 17.4)	15.2(11.7, 18.3)	Z=1.592	0.111	12.7(10.3, 17.7)	17.3(12.2, 20.7)	Z=1.795	0.073
ALB(g/L)^a	39±4	40±4	t=1.295	0.198	39(38, 42)	41(38, 42)	Z=0.810	0.418
ALT[U/L, M(Q₁, Q₃)]	22(15, 34)	24(19, 29)	Z=0.446	0.656	23(17, 3)	27(23, 29)	Z=0.634	0.526
AST[U/L, M(Q₁, Q₃)]	27(23, 32)	30(23, 33)	Z=0.937	0.349	27(23, 35)	28(22, 33)	Z=0.212	0.832
MVI(例)^b	8	25	χ²=7.367	0.007	6	10	χ²=0.758	0.384
卫星灶(例)^b	11	20	χ²=1.096	0.295	11	11	-	-
低分化(例)^b	29	37	χ²=2.527	0.283	20	23	χ²=1.432	0.489

亚组	OS(95%CI)		Z值	P值	PFS(95%CI)		Z值	P值
亚组	RH组	RFA组	Z值	P值	RH组	RFA组	Z值	P值
肿瘤最大直径≤3 cm	77(64, 89)	54(40, 68)	3.410	0.065	39(28, 49)	18(10, 25)	9.811	0.002
肿瘤最大直径>3 cm	44(20, 67)	42(23, 61)	<0.001	0.984	36(3, 70)	10(5, 15)	0.961	0.327
肿瘤单发	76(63, 90)	61(46, 76)	1.179	0.277	35(26, 44)	20(11, 29)	6.699	0.010
肿瘤多发	58(36, 80)	39(35, 62)	1.452	0.228	39(17, 61)	9(5, 14)	5.998	0.014

变量	OS						PFS
	单因素分析			多因素分析			单因素分析			多因素分析
	RR	95%CI	P值	RR	95%CI	P值	RR	95%CI	P值	RR	95%CI	P值
年龄≥50岁	0.62	0.32~1.21	0.162	0.48	0.22~1.02	0.056	1.65	1.00~2.70	0.049	1.33	0.78~2.25	0.298
RFA(对比RH)	1.97	0.94~4.12	0.073	1.49	0.65~3.42	0.348	2.78	1.69~4.58	<0.001	2.26	1.29~3.97	0.005
肝硬化	1.08	0.55~2.11	0.829	1.26	0.57~2.76	0.568	1.42	0.89~2.26	0.141^a	1.97	1.14~3.41	0.015
复发时间间隔≥24个月	0.50	0.18~1.43	0.198	0.72	0.22~2.40	0.591	0.37	0.19~0.72	0.003	0.63	0.30~1.36	0.239
肿瘤多发	1.99	1.00~3.91	0.047	1.23	0.52~2.93	0.640	1.61	0.99~2.63	0.057	1.55	0.85~2.82	0.151
AST	1.01	0.99~1.03	0.002	1.04	1.01~1.06	0.003	1.02	1.00~1.05	0.061	1.02	0.99~1.04	0.179
MVI	1.83	0.93~3.59	0.079	1.31	0.51~3.33	0.575	1.69	1.05~2.71	0.030	1.14	0.61~2.13	0.678
卫星灶	1.64	0.83~3.25	0.155	1.57	0.75~3.29	0.235	2.01	1.25~3.24	0.004	2.06	1.16~3.65	0.013

变量	RH组	RFA组	χ²值	P值
术后并发症	13	3	6.823	0.009
疼痛	6	3
高热	1	0
胸腔积液	4	0
腹腔积液	3	0
消化道出血	1	0
伤口脂肪液化	1	0
Clavien-Dindo分级
Ⅰ	7	3
Ⅱ	2	0
Ⅲ	4	0

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