ArticleJAMA surgery2024
Liver Resection vs Nonsurgical Treatments for Patients With Early Multinodular Hepatocellular Carcinoma.
Abstract readComparative StudyComment
In one paragraph
Article in JAMA surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 1 pooled it
–field-weighted citation impact
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Comparison of surgical resection and radiofrequency ablation for the treatment of small hepatocellular carcinoma (≤ 3 cm): an updated meta-analysis.Systematic reviews · 2026Pooled it
- Effect of Two-Stage Goal-Directed Crystalloid versus Colloid Fluid Therapy on Postoperative Quality of Recovery in Patients Undergoing Laparoscopic Hepatectomy: A Randomized Controlled Trial.Drug design, development and therapy · 2025Trial
- Management of Satellite Lesions in Hepatocellular Carcinoma: An Updated Review.Journal of surgical oncology · 2026Review
- Laparoscopic or Open Liver Resection Versus Multibipolar Radiofrequency Ablation of HCC Within Milan Criteria on Cirrhosis.Liver international : official journal of the International Association for the Study of the Liver · 2026Article
- Neutrophil extracellular traps drive local tumor progression and metastasis following thermal ablation in liver cancer via TLR9-mediated inflammatory feedback and immunosuppression.Journal for immunotherapy of cancer · 2026Article
- Personalised decision-making in hepatocellular carcinoma: conceptual evolution over two decades.BJS open · 2026Review
- Smartly Assembled near-Micron RF-Responsive Agents Bridge Transarterial Embolization and Immunothermal Potentiation.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- Identifying the Optimal Treatment for Patients with Hepatocellular Carcinoma and Clinically Significant Portal Hypertension: A Multicenter Propensity Score-Weighted Analysis.Annals of surgical oncology · 2026Article
- Perivascular versus nonperivascular hepatocellular carcinoma treated with liver resection: a retrospective propensity score matching comparison of long-term outcomes.Quantitative imaging in medicine and surgery · 2026Article
- Liver resection versus radiofrequency ablation or transarterial chemoembolization for early multinodular BCLC-A hepatocellular carcinoma: a systematic review and meta-analysis.Journal of liver cancer · 2026Article
- Comparisons of clinical patterns, short- and long-term prognostic outcomes in patients stratified by the severity of microvascular invasion after curative resection for hepatocellular carcinoma.World journal of surgical oncology · 2026Article
- From algorithms to adaptive frameworks: from square to circle in hepatocellular carcinoma management.Hepatobiliary surgery and nutrition · 2026Article
- Lipid nanoparticles and extracellular vesicles: emerging cell free therapeutic platforms for hepatobiliary cancers.Frontiers in cell and developmental biology · 2026Review
- Recombinant human type-5 adenovirus (H101) combined with radiofrequency ablation versus traditional radiofrequency ablation for hepatocellular carcinoma ≤ 3 cm: a phase III randomized controlled trial.International journal of surgery (London, England) · 2025Article
- Hepatocellular carcinoma: Epidemiology, diagnosis and treatment.JHEP reports : innovation in hepatology · 2025Review
- Surgery Without Scalpel: Histotripsy as a Non-Invasive and Non-Thermal Modality for Liver Tumor Ablation.Journal of clinical medicine · 2025Review
- Article
- Outcome of hepatic resection for HCC in ideal and non-ideal candidates.Hepatology communications · 2025Article
- Liver resection versus interventional treatments for hepatocellular carcinoma patients with hypohepatia: a multicenter study.Surgical endoscopy · 2025Article
- Outcomes and Cost of Major Liver Resection Using Combined LigaSure and Stapler: A Propensity Score Matching Study.Journal of clinical medicine · 2025Article
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Authors and funding
84 authors.
Alessandro VitaleDepartment of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Second General Surgical Unit, Padova Teaching Hospital, Padua, Italy.
Pierluigi RomanoDepartment of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Second General Surgical Unit, Padova Teaching Hospital, Padua, Italy.
Umberto CilloDepartment of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padova, Second General Surgical Unit, Padova Teaching Hospital, Padua, Italy.
Writing Group for the HE.RC.O.LE.S Collaborative Group
Writing Group for the ITA.LI.CA Collaborative Group
HE.RC.O.LE.S and ITA.LI.CA Collaborative Groups
Andrea LauterioDepartment of General and Transplant Surgery, Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
Angelo SangiovanniDepartment of Gastroenterologiy and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.
Giuseppe CabibboDepartment of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Section of Gastroenterology & Hepatology, University of Palermo, Palermo, Italy.
Gabriele MissaleDepartment of Medicine and Surgery, Infectious Diseases and Hepatology Unit, University of Parma and Azienda Ospedaliero-Universitaria of Parma, Parma, Italy.
Mariarosaria MarsegliaDivision of Internal Medicine, Hepatobiliary and Immunoallergic Disease, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Franco TrevisaniUnit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Francesco Giuseppe FoschiMedicina Interna Faenza, Dipartimento Emergenza, Medicina Interna e Cardiologia IRCCS-Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" Meldola, AUSL Romagna, Meldola, Italy.
Federica CiprianiHepatobiliary Surgery Division, "Vita e Salute" University, Ospedale San Raffaele IRCCS, Milan, Italy.
Simone FamularoDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Fabio MarraDepartment of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Florence, Italy.
Carlo SaittaDepartment of Clinical and Experimental Medicine, Division of Medicine and Hepatology, University of Messina, Messina, Italy.
Matteo SerenariHepatobiliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Gianpaolo VidiliDepartment of Medicine, Surgery and Pharmacy, AOU Sassari, Italy.
Filomena MoriscoDepartment of Clinical Medicine and Surgery, Departmental Program "Diseases of the Liver and Biliary System", University of Napoli "Federico II", Naples, Italy.
Eugenio CaturelliGastroenterology Unit, Belcolle Hospital, Viterbo, Italy.
Andrea MegaGastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy.
Filippo PelizzaroDepartment of Surgery, Oncology, and Gastroenterology, Gastroenterology Unit, University of Padova, Padua, Italy.
Daniele NicoliniHPB Surgery and Transplantation Unit, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Ancona, Italy.
Francesco ArditoHepatobiliary Surgery Unit, Fondazione Policlinico Universitario A Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
Mattia GaranciniSchool of medicine and surgery, University of Milano Bicocca, IRCCS Fondazione San Gerardo, Monza, Italy.
Alberto MasottoGastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy.
Gianluca Svegliati BaroniLiver Injury and Transplant Unit and Obesity Center, Polytechnic University of Marche, Ancona, Italy.
Francesco AzzaroliGastroenterology Unit, Department of Surgical and Medical Sciences, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy.
Edoardo GianniniGastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
Pasquale PerriDivision of Hepatobiliary pancreatic Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy.
Andrea ScarinciDivision of Hepatobiliary pancreatic Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy.
Andrea Pierluigi FontanaDepartment of General and Oncological Surgery, Mauriziano Hospital "Umberto I", Turin, Italy.
Maurizia Rossana BrunettoUO Epatologia, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
Maurizio IariaDepartment of Medicine and Surgery, University of Parma, Parma, Italy.
Maria Di MarcoMedicine Unit, Bolognini Hospital, Seriate, Italy.
Gerardo NardoneDepartment of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli "Federico II", Naples, Italy.
Tommaso DominioniUnit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy.
Quirino LaiGeneral Surgery and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy.
Cecilia FerrariHPB Surgical Unit, San Paolo Hospital, Savona, Italy.
Gian Ludovico RapacciniGastroenterology Unit, Fondazione Policlinico Universitario A Gemelli, IRCCS, Roma, Italy.
Sacco RodolfoGastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy.
Maurizio RomanoDepartment of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Hepatobiliary and Pancreatic Surgery Unit, Treviso Hospital, Treviso, Italy.
Simone ConciDivision of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
Marco ZoliDepartment of Medical and Surgical Sciences, Internal Medicine-Zoli Unit, Alma Mater Studiorum,Università di Bologna, Padova, Italy.
Maria ConticchioDepartment of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy.
Matteo ZanelloAlma Mater Studiorum, University of Bologna, AOU Sant'Orsola Malpighi, IRCCS at Maggiore Hospital, Bologna, Italy.
Giuseppe ZimmittiDepartment of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy.
Luca FumagalliDepartment of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy.
Albert TrociDepartment of Surgery, L Sacco Hospital, Milan, Italy.
Paola GermaniDivision of General Surgery, Department of Medical and Surgical Sciences, ASUGI, Trieste, Italy.
Antonio GasbarriniInternal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy.
Giuliano La BarbaGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Department of Medical and Surgical Sciences, University of Bologna Forlì, Forlì, Italy.
Michela De AngelisDepartment of General Surgery, Ospedale Carlo Poma, Mantua, Italy.
Stefan PataunerDepartment of General and Pediatric Surgery, Bolzano Central Hospital, Bolzano, Italy.
Sarah MolfinoDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Mauro ZagoDepartment of Surgery, Ponte San Pietro Hospital, Bergamo, Italy; Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy.
Enrico PinottiDepartment of Surgery, Ponte San Pietro Hospital, Bergamo, Italy; Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy.
Anna Chiara FrigoBiostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Gian Luca BaiocchiDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Antonio FrenaDepartment of General and Pediatric Surgery, Bolzano Central Hospital, Bolzano, Italy.
Luigi BocciaDepartment of General Surgery, Ospedale Carlo Poma, Mantua, Italy.
Giorgio ErcolaniGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Department of Medical and Surgical Sciences, University of Bologna Forlì, Forlì, Italy.
Paola TarchiDivision of General Surgery, Department of Medical and Surgical Sciences, ASUGI, Trieste, Italy.
Michele CrespiDepartment of Surgery, L Sacco Hospital, Milan, Italy.
Marco ChiarelliDepartment of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy.
Moh'd Abu HilalDepartment of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy.
Matteo CesconAlma Mater Studiorum, University of Bologna, AOU Sant'Orsola Malpighi, IRCCS at Maggiore Hospital, Bologna, Italy.
Riccardo MemeoDepartment of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy.
Andrea RuzzenenteDivision of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
Giacomo ZanusDepartment of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Hepatobiliary and Pancreatic Surgery Unit, Treviso Hospital, Treviso, Italy.
Guido GriseriHPB Surgical Unit, San Paolo Hospital, Savona, Italy.
Massimo RossiGeneral Surgery and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy.
Marcello MaestriUnit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy.
Raffaele Della ValleDepartment of Medicine and Surgery, University of Parma, Parma, Italy.
Alessandro FerreroDepartment of General and Oncological Surgery, Mauriziano Hospital "Umberto I", Turin, Italy.
Gian Luca GraziDivision of Hepatobiliary pancreatic Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy.
Fabrizio RomanoSchool of medicine and surgery, University of Milano Bicocca, IRCCS Fondazione San Gerardo, Monza, Italy.
Felice GiulianteHepatobiliary Surgery Unit, Fondazione Policlinico Universitario A Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
Marco VivarelliHPB Surgery and Transplantation Unit, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Ancona, Italy.
Elio JovineHepatobiliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Guido TorzilliDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Luca AldrighettiHepatobiliary Surgery Division, "Vita e Salute" University, Ospedale San Raffaele IRCCS, Milan, Italy.
Luciano De CarlisDepartment of General and Transplant Surgery, Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: The 2022 Barcelona Clinic Liver Cancer algorithm currently discourages liver resection (LR) for patients with multinodular hepatocellular carcinoma (HCC) presenting with 2 or 3 nodules that are each 3 cm or smaller. Objective: To compare the efficacy of liver resection (LR), percutaneous radiofrequency ablation (PRFA), and transarterial chemoembolization (TACE) in patients with multinodular HCC. Design, Setting, and Participants: This cohort study is a retrospective analysis conducted using data from the HE.RC.O.LE.S register (n = 5331) for LR patients and the ITA.LI.CA database (n = 7056) for PRFA and TACE patients. A matching-adjusted indirect comparison (MAIC) method was applied to balance data and potential confounding factors between the 3 groups. Included were patients from multiple centers from 2008 to 2020; data were analyzed from January to December 2023. Interventions: LR, PRFA, or TACE. Main Outcomes and Measures: Survival rates at 1, 3, and 5 years were calculated. Cox MAIC-weighted multivariable analysis and competing risk analysis were used to assess outcomes. Results: A total of 720 patients with early multinodular HCC were included, 543 males (75.4%), 177 females (24.6%), and 350 individuals older than 70 years (48.6%). There were 296 patients in the LR group, 240 who underwent PRFA, and 184 who underwent TACE. After MAIC, LR exhibited 1-, 3-, and 5-year survival rates of 89.11%, 70.98%, and 56.44%, respectively. PRFA showed rates of 94.01%, 65.20%, and 39.93%, while TACE displayed rates of 90.88%, 48.95%, and 29.24%. Multivariable Cox survival analysis in the weighted population showed a survival benefit over alternative treatments (PRFA vs LR: hazard ratio [HR], 1.41; 95% CI, 1.07-1.86; P = .01; TACE vs LR: HR, 1.86; 95% CI, 1.29-2.68; P = .001). Competing risk analysis confirmed a lower risk of cancer-related death in LR compared with PRFA and TACE. Conclusions and Relevance: For patients with early multinodular HCC who are ineligible for transplant, LR should be prioritized as the primary therapeutic option, followed by PRFA and TACE when LR is not feasible. These findings provide valuable insights for clinical decision-making in this patient population.
Indexed as
Carcinoma, HepatocellularChemoembolization, TherapeuticHepatectomyLiver NeoplasmsAgedFemaleHumansMaleMiddle AgedRadiofrequency AblationRetrospective StudiesSurvival RateTreatment Outcome
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