Abstract

BACKGROUND: The first-line therapy for early-stage hepatocellular carcinoma (HCC) is unclear. This study was conducted to assess and compare survival after surgery vs. after radiofrequency ablation (RFA) for early-stage HCC.

MATERIAL AND METHODS: Data from HCC patients with a single tumor measuring 31–50 mm were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. Overall survival (OS) and cancer-specific survival (CSS) were assessed and compared between surgery and RFA treatment. Propensity score matching was performed. Multiple imputations were used to create 5 sets of complete data. Fine and Gray competing risk multivariate regression models were used to control biases.

RESULTS: This study included 839 patients: 339 (40.41%) received RFA and 500 (59.59%) underwent surgery. Surgery improved the 5-year OS (63.95% vs. 37.13%, p<0.01) and CSS (64.01% vs. 38.29%, p<0.01) compared with RFA after propensity score matching. The competing risk regression models revealed that, compared with RFA, surgery resulted in better survival in the unmatched cohort with an adjusted sub-distribution hazard ratio of 0.689 (95% confident interval [CI], 0.562–0.868; p=0.001) and in the propensity-matched cohort with an adjusted sub-distribution hazard ratio of 0.642 (95% CI, 0.514–0.801; p<0.001).

CONCLUSIONS: Surgery appears to be a better therapy choice than RFA for patients with early-stage HCC with a single tumor measuring 31–50 mm.

Keywords: Carcinoma, Hepatocellular, Catheter Ablation, general surgery, Aged, Aged, 80 and over, Cohort Studies, Databases, Factual, Liver Neoplasms, Middle Aged, Neoplasm Staging, propensity score, Proportional Hazards Models, radiofrequency ablation, Retrospective Studies, SEER Program, Treatment Outcome