Comparison of 2 curative treatment options for very early hepatocellular carcinoma

Abstract

Curative treatments for very early-stage hepatocellular carcinoma (HCC), defined as single HCC with a maximum diameter of <2 cm in patients with well-preserved liver function, consist of surgical resection or radiofrequency ablation (RFA). In this retrospective study, we compared the efficacy of both treatments in 154 patients with very early-stage HCCs who underwent resection or RFA as initial therapy and were followed up for a median of 56.8 months. Propensity score matching analysis was also conducted. Overall survival was comparable between treatment groups (median survival time of 143 vs 97 months for resection and RFA, respectively; P = .132). Resection group; however, demonstrated a significantly lower recurrence rate after initial therapy than RFA group (42.3% vs 65.7%; P = .006) with a longer median recurrence-free survival time (66.7 vs 33.8 months; P = .002), which was confirmed even after matching ( P = .04). In contrast, the recurrence pattern in advanced-stage (9.6% vs 1.0%; P = .01) or incurable recurrences (19% vs 13%; P = .04) was more frequent following resection than RFA. Recurrent lesions were comparatively more curable in RFA group than in resection group (80% vs 54.5%; P = .02). The recurrence of HCC was independently associated with lower serum albumin level ( P = .027), the presence of comorbid diabetes mellitus ( P = .010), and RFA ( P = .034). In conclusion, in patients with very early-stage HCC, surgical resection has achieved significantly better recurrence-free survival than RFA. A closer follow-up is required after resection.

Risk Models for Predicting the Recurrence and Survival in Patients With Hepatocellular Carcinoma Undergoing Radio-Frequency Ablation

“…However, it still has a high rate of recurrence and death after RFA. 12 - 14 It is unclear which risk factors affect patients undergoing RFA, and there are not enough reliable prognostic models available to provide clinical guidance. In this study, we constructed 2 nomograms on prognostic models for patients with HCC after RFA.…”

Clinical Outcomes of Ablation Compared with Resection for Single Hepatocellular Carcinoma Lesions, as a Primary Treatment or Bridging to Liver Transplantation: A Retrospective Comparative Study

“…Previous literature reporting favorable outcomes in surgical resection included predominantly younger non-Western patient populations, in which hepatitis B is the most common etiology for HCC [ 14 , 16 , 17 , 26 – 28 ]. Additionally, the OS of patients with HCC is determined by underlying liver function, with the general understanding that patients with good function are selected for surgical resection and those with poorer function undergo ablative therapies [ 6 ].…”

Improved Survival Outcomes with Surgical Resection Compared to Ablative Therapy in Early-Stage HCC: A Large, Real-World, Propensity-Matched, Multi-Centre, Australian Cohort Study

“…Nevertheless, over the last two decades, percutaneous ablation with thermal techniques such as radiofrequency ablation (RFA) and microwave ablation (MWA) has emerged as a suitable alternative treatment modality to surgical resection in those with limited dis-ease, particularly those with borderline liver function. Indeed, multiple studies [8][9][10][11][12] have failed to show a significant difference in overall survival between resection and ablation, and results of published meta-analyses comparing the two treatments in BCLC 0, 0/A and A disease have similarly had mixed results, potentially due to poor trial design in many of the primary studies [13][14][15][16][17][18][19][20][21][22][23][24].…”