Surgical resection versus radiofrequency ablation very early‐stage HCC (≤2 cm Single HCC): A propensity score analysis

Abstract

Background & aim: Hepatocellular carcinoma (HCC) is increasingly being detected at a very early-stage due to the wide implementation of the surveillance of at-risk patient populations combined with improved imaging technologies. Whether patients with HCC at a very early stage can be offered local ablation as a first-line treatment option still remains controversial. We retrospectively compared the effectiveness of surgical resection (SR) and radiofrequency ablation (RFA) for Barcelona Clinic Liver Cancer (BCLC) very early-stage HCC in patients with long-term follow-up.Methods: Propensity score analysis using inverse probability weighting (IPW) from a large-volume liver centre. We included adult patients who between 2000 and 2013 received a diagnosis of very early-stage HCC (BCLC stage 0; a single tumour ≤2 cm, Child-Pugh A class, eastern cooperative oncology group [ECOG] 0) and who were treated with SR or RFA as the first-line treatment. Results:We identified 1208 patients, 631 in the SR group and 577 in the RFA group.The median follow-up time was 86.2 months. After propensity score analysis using IPW, the 15-year overall survival rates were 60.4% and 51.6% in the SR and RFA group respectively. RFA group showed poorer overall survival than SR group (adjusted hazard ratio, 1.29; P = .0378). The 15-year recurrence-free survival rates were 37% and 23.6% in the SR and RFA group respectively (P < .001). Conclusion:For patients with very early-stage HCC, the SR group was associated with better overall and recurrence-free patient survival compared to the RFA group.Therefore, SR should be considered as the first-line treatment for these patients. K E Y W O R D Shepatocellular carcinoma, Barcelona Clinic Liver Cancer stage 0, surgical resection, radiofrequency ablation

Imaging Predictors of Survival in Patients with Single Small Hepatocellular Carcinoma Treated with Transarterial Chemoembolization

“…Thus, treatment options other than TACE, such as radioembolization, ablative therapy, or stereotactic body radiation, should be actively considered for this high-risk group. This study's limitations include its retrospective nature, which makes it vulnerable to a variety of potential biases (10). However, for the evaluation of survival outcomes in patients with a single small (≤ 3 cm, BCLC 0/A stage) HCC, it may be difficult to perform a prospective study, because it would probably require a prohibitively large sample size due to the longer survival time of these patients compared to those with other BCLC-stage (B, C, D) HCC (10).…”

“…This study's limitations include its retrospective nature, which makes it vulnerable to a variety of potential biases (10). However, for the evaluation of survival outcomes in patients with a single small (≤ 3 cm, BCLC 0/A stage) HCC, it may be difficult to perform a prospective study, because it would probably require a prohibitively large sample size due to the longer survival time of these patients compared to those with other BCLC-stage (B, C, D) HCC (10). Moreover, we believe that we have compensated for this limitation by applying our model, derived from the training cohort, to a separate validation cohort to increase its reliability (18).…”

“…Another limitation is that this is a single-center study, which may limit the generalizability of the results. Thus, it remains possible that our results may not be pertinent for patients with HCC in other countries, owing to differences in demographics and underlying causes of liver disease (10).…”

“…However, there are distinct scenarios in which surgical resection or radiofrequency ablation might not be feasible such as, in individuals with insufficient liver function or combined comorbidities, or a tumor location that is risky or not accessible for ablation (10). In such cases, where the three established treatment choices are contraindicated, transarterial chemoembolization (TACE) can be an alternative treatment against single small HCC (10).…”

“…However, there are distinct scenarios in which surgical resection or radiofrequency ablation might not be feasible such as, in individuals with insufficient liver function or combined comorbidities, or a tumor location that is risky or not accessible for ablation (10). In such cases, where the three established treatment choices are contraindicated, transarterial chemoembolization (TACE) can be an alternative treatment against single small HCC (10). A previous study reported that TACE is an effective and safe treatment for single small (≤ 3 cm) HCC, achieving long-term survival rates comparable to those of hepatic resection and radiofrequency ablation when the underlying liver dysfunction is similar (11).…”