Treatment Strategies For Intrahepatic Recurrence After Hepatectomy For Hepatocellular Carcinoma

BackgroundAlthough the incidence of recurrence(referred to as recurrent liver cancer)after hepatectomy for hepatocellular carcinoma is very high,there are no guidelines to guide the treatment after recurrence.Repeated surgical resection,salvage liver transplantation,transarterial chemoembolization(TACE),local ablation,radiotherapy,targeted drug therapy,and immunotherapy have been applied to the treatment of recurrent liver cancer,and more evidence-based medical evidence is needed to guide the treatment after recurrence.ObjectiveThe aim of this study was to explore the clinical efficacy of repeated liver resection,TACE,TACE combined ablation,and targeted drugs combined with immunotherapy in the treatment of recurrent liver cancer.MethodsRetrospective collection of 126 patients who underwent liver resection at Guangdong Provincial People’s Hospital from 2014 to 2022 with pathological diagnosis of hepatocellular carcinoma and postoperative recurrence.57 patients who underwent repeated liver resection,26 patients who received TACE treatment,33 patients who received TACE combined with ablation treatment,and 10 patients who received target immunotherapy were included in the statistical analysis.Outcome indicators include perioperative efficacy,disease-free survival,progression free survival,and tumor efficacy evaluation.ResultsThe progression free survival of the repeat surgery group was better than that of the TACE group(P<0.001)and the TACE combined ablation group(P<0.001).The progression free survival of the target immunotherapy group was better than that of the TACE group(P=0.023).The progression free survival of the repeat surgery group was similar to that of the target immunotherapy group(P=0.276),the TACE group with TACE combined ablation group(P=0.096),and the target immunotherapy group with TACE combined ablation group(P=0.648).In subgroup analysis,for recurrent liver cancer with≥ 2 tumors,the progression free survival of the target group was better than that of the TACE group(P=0.007).The progression free survival of the repeated surgery group was similar to that of the TACE group(P=0.080),TACE combined ablation group(P=0.467),and target group(P=0.166).The progression free survival of the TACE combined ablation group was similar to that of the TACE group(P=0.145),and the TACE combined ablation group was similar to that of the target group(P=0.085).In the repeated surgery group,there was no statistically significant difference in intraoperative blood loss(P=0.426),surgical duration(P=0.996),and positive margin rate(P=0.126)among the open surgery group,laparoscopic surgery group,and indocyanine green guided fluorescence laparoscopic surgery group.The postoperative hospitalization days of the laparoscopic surgery group were less than those of the open surgery group and the fluorescent laparoscopy group(P=0.003),while there was no statistical difference in the postoperative hospitalization days between the open surgery group and the fluorescent laparoscopy group.There was no statistically significant difference in disease-free survival among the open surgery group,laparoscopic surgery group,and fluorescent laparoscopic surgery group.In subgroup analysis,late recurrent(>24 months)hepatocellular carcinoma had better surgical resection results than early recurrent(≤24 months)hepatocellular carcinoma(P=0.011).The objective response rate and disease control rate of the target immune combination therapy for recurrent liver cancer were 50%and 90%,respectively.ConclusionsFor recurrent liver cancer,the progression free survival of patients who can be surgically removed is better than those who receive TACE treatment or TACE combined with ablation treatment.For recurrent hepatocellular carcinoma with more then 2 tumors,the progression free survival of TACE treatment and TACE combined ablation treatment is not inferior to surgical resection,and the progression free survival of target immunotherapy is better than that of the TACE group.The perioperative efficacy and disease-free survival of open surgery,laparoscopic surgery,and fluorescent laparoscopic surgery for recurrent liver cancer are similar,but patients recover quickly after laparoscopic surgery.The new target immune combination therapy for recurrent liver cancer has a good objective response rate and disease control rate.