Surgery versus radiofrequency ablation in patients with Child- Pugh class-A/single small (≤3 cm) hepatocellular carcinoma

Abstract

Background/Aims: We compared the post-treatment overall survival (OS) and recurrence-free survival (RFS) between patients with Child-Turcotte-Pugh (CTP) class-A and single small (≤3 cm) hepatocellular carcinoma (HCC) treated by surgical resection (SR) and radiofrequency ablation (RFA).Methods: We retrospectively analyzed 391 HCC patients with CTP class-A who underwent SR (n=232) or RFA (n=159) as first-line therapy for single small (≤3 cm) HCC. Survival was compared according to the tumor size (≤2 cm/2–3 cm) and the presence of cirrhosis. Inverse probability of treatment weighting (IPW) method was used to estimate the average causal effect of treatment.Results: The median follow-up period was 64.8 months (interquartile range, 0.1–162.6). After IPW, the estimated OS was similar in the SR and RFA groups (<i>P</i>=0.215), and even in patients with HCC of ≤2 cm (<i>P</i>=0.816) and without cirrhosis (<i>P</i>=0.195). The estimated RFS was better in the SR group than in the RFA groups (<i>P</i>=0.005), also in patients without cirrhosis (<i>P</i><0.001), but not in those with HCC of ≤2 cm (<i>P</i>=0.234). The weighted Cox proportional hazards model with IPW provided adjusted hazard ratios (95% confidence interval) for OS, and the RFS after RFA versus SR were 0.698 (0.396–1.232) (<i>P</i>=0.215) and 1.698 (1.777–2.448) (<i>P</i>=0.005), respectively.Conclusions: SR was similar for OS compared to RFA, but was better for RFS in patients with CTP class-A and single small (≤3 cm) HCC. The RFS was determined by the presence or absence of cirrhosis. Hence, SR rather than RFA should be considered in patients without cirrhosis to prolong the RFS, although there is no OS difference.

Liver resection, radiofrequency ablation, and radiofrequency ablation combined with transcatheter arterial chemoembolization for very-early- and early-stage hepatocellular carcinoma: A systematic review and Bayesian network meta-analysis for comparison of efficacy

“…In recent years, regional therapies, including TACE (with or without chemotherapeutic) and RFA, have become key components of hepatocellular carcinoma treatment. Previous studies have shown no significant difference between RFA and LR regarding OS for single tumors smaller than 3 cm ( 10 – 12 ); however, LR may still result in better outcomes than RFA when it comes to RFS ( 39 ). Rapid advances in radiofrequency ablation equipment, improved electrodes, and the widespread use of high-resolution intraoperative ultrasound have increased the advantages of RFA.…”

Surgical therapy and survival in young patients with stage I–II hepatocellular carcinoma: a retrospective cohort study

“…However, few studies have elaborated on the relationship between surgical treatments and prognosis of HCC, especially in these patients with early-stage HCC (14). Currently, surgical treatment is the primary option for HCC treatment, and advances in surgery for HCC over several decades have expanded the range of surgical options (21). The results of the present study showed that surgery could offer better long-term survival than non-surgery for patients with HCC, which is consistent with several previous studies (21)(22)(23)(24)(25)(26).…”

“…Currently, surgical treatment is the primary option for HCC treatment, and advances in surgery for HCC over several decades have expanded the range of surgical options ( 21 ). The results of the present study showed that surgery could offer better long-term survival than non-surgery for patients with HCC, which is consistent with several previous studies ( 21 - 26 ). Yu et al reported that the main treatments for early HCC included liver resection, LT, and other operations such as LTD ( 24 , 27 ).…”

Laparoscopic anatomical versus non-anatomical liver resection for hepatocellular carcinoma in the posterosuperior segments: a propensity score matched analysis

“…Recent advances in minimally invasive surgery have gradually accelerated the adoption of laparoscopic liver resection (LLR), and its role in liver surgery is becoming increasingly important. Several studies have demonstrated that LLR could provide favorable short-and long-term outcomes compared with open liver resection (OLR) (8)(9)(10). However, these earlier studies included a limited number of patients who underwent laparoscopic anatomical resection (LAR), especially in the posterosuperior (PS) segments of the liver (segments 1, 7, 8, and the superior part of segment 4).…”