title: Survival rates are comparable after radiofrequency ablation or surgery in patients with small hepatocellular carcinomas.
abstract: OBJECTIVE
  Differences in efficacy of radiofrequency ablation (RFA) and surgical resection (SR) are not clear for patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  From 2002 to 2007, 419 patients with HCCs ≤5 cm were enrolled consecutively in the study. Among these patients, 190 and 229 patients received RFA and SR, respectively, as their first treatment. Factors were analyzed in terms of overall survival and recurrence by multivariate analysis and propensity score matching analysis.
  
  
  RESULTS
  The SR group had younger age, a higher male-to-female ratio, higher prevalence of hepatitis B virus, lower prevalence of hepatitis C virus, better liver function reserve, and larger tumor size than the RFA group. The cumulative 5-year overall survival rates were 79.3% in the SR group and 67.4% in the RFA group. During the follow-up period, tumors recurred in 244 patients in a median time of 14.5 ± 15.7 months. Before propensity-score matching, the RFA group had shorter overall survival time (P = .009) and higher tumor recurrence rate (P < .001) than the SR group. After matching, RFA was comparable to SR in overall survival time (P = .519), but the RFA group still had a greater incidence of tumor recurrence (P < .001). In patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 HCC, RFA was as effective as SR for overall survival time and recurrence.
  
  
  CONCLUSIONS
  Patients with small HCCs have a higher rate of tumor recurrence following RFA than surgery, but overall survival rates are comparable between therapies. RFA is as effective as surgery in patients with BCLC stage 0 HCC.
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Hung-Hsu
authors.initials: HH
authors.lastname: Hung
authors.forename: Yi-You
authors.initials: YY
authors.lastname: Chiou
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Hsia
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Su
authors.forename: Yi-Hong
authors.initials: YH
authors.lastname: Chou
authors.forename: Jen-Huey
authors.initials: JH
authors.lastname: Chiang
authors.forename: Wei-Yu
authors.initials: WY
authors.lastname: Kao
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Yu-Hui
authors.initials: YH
authors.lastname: Su
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
authors.forename: Jaw-Ching
authors.initials: JC
authors.lastname: Wu
mesh_terms: D055011:Ablation Techniques; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome