title: Performance status enhances the selection of treatment for patients with hepatocellular carcinoma within the milan criteria.
abstract: BACKGROUND
  Performance status (PS) is closely linked with survival in patients with hepatocellular carcinoma (HCC). We investigated its impact on treatment strategy for small HCC(s).
  
  
  METHODS
  A total of 360 and 362 HCC patients within the Milan criteria undergoing surgical resection (SR) and radiofrequency ablation (RFA), respectively, were prospectively enrolled. Patients were classified into PS 0 (n = 558) and PS ≥1 (n = 164) groups. Propensity score analysis was performed, and 168 and 35 matched pairs were selected from patients with PS 0 and ≥1, respectively.
  
  
  RESULTS
  The SR group was younger and had a higher male-to-female ratio, higher prevalence of hepatitis B, lower prevalence of hepatitis C, better PS, better liver functional reserve, and larger tumor burden than the RFA group (all p < 0.05). Among patients with PS 0, the SR group was consistently younger, less cirrhotic, and had larger tumor burden (all p < 0.05). The long-term survival was comparable between SR and RFA group in patients with PS 0. After propensity score matching, SR provided significantly better long-term survival than RFA for patients within the Milan criteria classified as PS 0 (p = 0.016); the Cox proportional hazards model showed consistent results. There was no significant difference of overall survival between the SR and RFA group in patients with PS ≥1 before or after propensity score matching (both p > 0.05).
  
  
  CONCLUSIONS
  For HCC patients within the Milan criteria and classified as PS 0, SR provides a better long-term survival compared with RFA. Performance status may enhance treatment selection and stratify the risk of survival in these patients.
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Chia-Yang
authors.initials: CY
authors.lastname: Hsu
authors.forename: Yun-Hsuan
authors.initials: YH
authors.lastname: Lee
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Hsia
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Su
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Yi-You
authors.initials: YY
authors.lastname: Chiou
authors.forename: Fa-Yauh
authors.initials: FY
authors.lastname: Lee
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
mesh_terms: D055011:Ablation Techniques; D000367:Age Factors; D000368:Aged; D001201:Ascites / Q000150:complications; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006304:Health Status; D006498:Hepatectomy; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D047368:Tumor Burden
chemical_list: D012709:Serum Albumin