Hepatic resection compared to percutaneous ethanol injection for small hepatocellular carcinoma using propensity score matching.
BACKGROUND
Several surgical and non-surgical therapeutic modalities have been used for the treatment of hepatocellular carcinoma (HCC). There have been several studies comparing hepatic resection (HR) and percutaneous ethanol injection (PEI) for the treatment of HCC. However, there is still disagreement about the best treatment modality.


METHODS
From 130 patients undergoing HR, 116 patients were individually matched to 116 controls from 249 patients undergoing PEI using propensity score matching to overcome possible biases in non-randomized study. Survival analyses were undertaken to compare these propensity score-matched groups.


RESULTS
After matching by propensity score, the major clinical outcomes in the HR (n = 116) and the PEI (n = 116) groups were found to be similar. The 1-, 3- and 5-year overall survival rates were higher in the HR group (94.8%, 76.5% and 65.6%) compared to the PEI group (95.7%, 73.5% and 49.3%) (P = 0.059). The cumulative 1-, 3- and 5-year disease-free survival rates showed the same trend (HR: 76.1%, 50.6% and 40.6%; PEI: 62.6%, 25.5% and 19.1%) (P < 0.001). However, when stratified by Child-Pugh classification, it was no longer the case in the Child B patients. Single intrahepatic recurrence was the most common pattern of tumor recurrence after both treatments.


CONCLUSIONS
Patients undergoing HR had a better survival profile than those undergoing PEI. However, when considering which technique to use for optimal HCC management, the individual patient's hepatic function must be considered.
Cho
Yong Beom
YB
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Lee
Kuhn Uk
KU
Suh
Kyung-Suk
KS
Kim
Yoon Jun
YJ
Yoon
Jung-Hwan
JH
Lee
Hyo-Suk
HS
Hahn
Seokyung
S
Park
Byung-Joo
BJ
D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000601:surgery*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D015552:Injections, Intralesional; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D016019:Survival Analysis; D016896:Treatment Outcome
D000431:Ethanol