Surgical resection plus radiofrequency ablation for the treatment of multifocal hepatocellular carcinoma

Background:To compare the efficacy and safety of surgical resection plus radiofrequency ablation(SR-RFA)with transarterial chemoembolization(TACE)in patients with multifocal hepatocellular carcinoma(HCC)beyond the Milan criteria.Methods:From 2009 to 2015,a total of 469 consecutive patients with multifocal HCC beyond the Milan criteria(≤5 nodules)treated with SR-RFA(n=59)or TACE(n=410)were analyzed.Their overall survival(OS)rate was compared through propensity score matching(PSM)analysis at a ratio of 1:2,and 141 patients were identified(SR-RFA,n=47;TACE,n=94).Subgroup analysis was conducted according to factors associated with treatment options.Results:Before PSM,the 1-,2-and 3-year OS rates were 81.5%,68.3%and 64.3%in the SR-RFA group and 58.7%,35.5%and 24.4%in the TACE group,respectively(all P<0.001).After PSM,the 1-,2-and 3-year OS rates in the SR-RFA group were 81.8%,68.7%and 63.4%,whereas those in the TACE group were 59.3%,36.1%and 19.4%,respectively(all P<0.001).Subgroup analysis also revealed a survival advantage of SR-RFA over TACE in each subgroup.The 30-day mortality rate was 1.22%in the TACE group and nil in the SR-RFA group(P=0.861).Conclusions:SR-RFA provides better a long-term survival rate than TACE for patients with multifocal HCC beyond the Milan criteria.SR-RFA may serve as an alternative treatment for patients with multifocal HCC in a selected patient population.

Translational medicine in hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is a highly complex disease that is generally resistant to commonly used chemotherapy and radiotherapy.Consequently,there is an urgent need for the development of new treatment strategies for this devastating disease.In the past decade,tremendous progress has been achieved in the molecular stratification of HCCs for diagnosis,prognosis,and therapeutic decision-making.To date,the molecular classification of HCCs has been carried out through transcriptomic,genetic and epigenetic profiling of tumors.Such research has led to identification of several potential molecular targets in HCC,and subsequently,development of novel systemic agents for the treatment of HCC has begun in earnest.In this article,we review the current knowledge of the molecular pathogenesis of HCC and outline potential areas for application of this knowledge in a clinical setting.As a typical virus and inflammation-associated cancer,both host immune response and tumor microenvironment have crucial roles in HCC pathogenesis.In addition,we examine the potential of immunotherapy and strategies targeting various components of the tumor microenvironment,as well as novel molecular and cellular targets in HCC such as cancer stem cells.