Clin Mol Hepatol.
2022 Apr;28(2):207-218. 10.3350/cmh.2021.0294.
Surgery versus radiofrequency ablation in patients with Child- Pugh class-A/single small (≤3 cm) hepatocellular carcinoma
- Affiliations
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- 1Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
- 2Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- 3Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary’s Hospital, Incheon, Korea
- 4Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Korea
- 5Department of Biomedical Sciences, Inha University School of Medicine, Incheon, Korea
- 6Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
- KMID: 2528250
- DOI: http://doi.org/10.3350/cmh.2021.0294
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 (P=0.215), and even in patients with HCC of ≤2 cm (P=0.816) and without cirrhosis (P=0.195). The estimated RFS was better in the SR group than in the RFA groups (P=0.005), also in patients without cirrhosis (P<0.001), but not in those with HCC of ≤2 cm (P=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) (P=0.215) and 1.698 (1.777–2.448) (P=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.
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