J Liver Cancer.  2024 Mar;24(1):71-80. 10.17998/jlc.2023.09.11.

Treatment options for solitary hepatocellular carcinoma ≤5 cm: surgery vs. ablation: a multicenter retrospective study

• Kariyama K
• Nouso K
• Hiraoka A
• Toyoda H
• Tada T
• Tsuji K
• Ishikawa T
• Hatanaka T
• Itobayashi E
• Takaguchi K
• Tsutsui A
• Naganuma A
• Yasuda S
• Kakizaki S
• Wakuta A
• Shiota S
• Kudo M
• Kumada T

• KMID: 2553819
• DOI: http://doi.org/10.17998/jlc.2023.09.11

Abstract

Background
/Aim: The aim of this study was to compare the therapeutic efficacy of ablation and surgery in solitary hepatocellular carcinoma (HCC) measuring ≤5 cm with a large HCC cohort database.
Methods
The study included consecutive 2,067 patients with solitary HCC who were treated with either ablation (n=1,248) or surgery (n=819). Th e patients were divided into three groups based on the tumor size and compared the outcomes of the two therapies using propensity score matching.
Results
No significant difference in recurrence-free survival (RFS) or overall survival (OS) was found between surgery and ablation groups for tumors measuring ≤2 cm or >2 cm but ≤3 cm. For tumors measuring >3 cm but ≤5 cm, RFS was significantly better with surgery than with ablation (3.6 and 2.0 years, respectively, P=0.0297). However, no significant difference in OS was found between surgery and ablation in this group (6.7 and 6.0 years, respectively, P=0.668).
Conclusion
The study suggests that surgery and ablation can be equally used as a treatment for solitary HCC no more than 3 cm in diameter. For HCCs measuring 3-5 cm, the OS was not different between therapies; thus, ablation and less invasive therapy can be considered a treatment option; however, special caution should be taken to prevent recurrence.

Keyword

Radiofrequency; Ablation; Surgery; Hepatectomy; Hepatocellular carcinoma; Patient selection

Figure

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  Figure 1. OS and RFS before (a) and after PSM (b) in HCC ≤2 cm. For patients with solitary HCC measuring ≤2 cm, there was an initial significant difference in OS between surgery and ablation prior to matching. However, this difference became insignificant after matching (13.7 vs. 11.2; mean observation period, 5.1 years). There was no significant disparity in RFS between the two treatments, both before and after matching (5.9 vs. 6.0; mean observation period, 3.5 years). OS, overall survival; RFS, recurrence-free survival; PSM, propensity score matching; HCC, hepatocellular carcinoma.

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  Figure 2. OS and RFS before (a) and after PSM (b) in HCC >2 cm and ≤3 cm. For HCC cases measuring >2 cm but ≤3 cm, there was an initial significant difference in OS between surgery and ablation before matching. However, this difference disappeared after matching (11.0 vs. 7.2; mean observation period, 4.7 years). RFS remained similar between the treatments, both before and after matching (4.9 vs. 3.0; mean observation period, 2.9 years). OS, overall survival; RFS, recurrence-free survival; PSM, propensity score matching; HCC, hepatocellular carcinoma.

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  Figure 3. OS and RFS before (a) and after PSM (b) in HCC >3 cm and ≤5 cm. For solitary HCC cases measuring >3 cm but ≤5 cm, surgery and ablation initially exhibited significant disparities in both OS and RFS before matching. Post-matching, the OS difference vanished (6.7 vs. 6.0; mean observation period, 3.4 years), while the RFS difference remained significant (3.7 vs. 2.0; mean observation period, 2.5 years). OS, overall survival; RFS, recurrence-free survival; PSM, propensity score matching; HCC, hepatocellular carcinoma.

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Reference

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