Radiofrequency ablation is superior to ethanol injection in early-stage hepatocellular carcinoma irrespective of tumor size.
BACKGROUND
Randomized trials suggest that radiofrequency ablation (RFA) may be more effective than percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC). However, the survival advantage of RFA needs confirmation in daily practice.


METHODS
We conducted a population-based cohort study using the Taiwan Cancer Registry, National Health Insurance claim database and National Death Registry data from 2004 through 2009. Patients receiving PEI or RFA as first-line treatment for newly-diagnosed stage I-II HCC were enrolled.


RESULTS
A total of 658 patients receiving RFA and 378 patients receiving PEI treatment were included for final analysis. The overall survival (OS) rates of patients in the RFA and PEI groups at 5-year were 55% and 42%, respectively (p < 0.01). Compared to patients that received PEI, those that received RFA had lower risks of overall mortality and first-line treatment failure (FTF), with adjusted hazard ratios (HRs) [95% confidence interval (CI)] of 0.60 (0.50-0.73) for OS and 0.54 (0.46-0.64) for FTF. The favorable outcomes for the RFA group were consistently significant for patients with tumors > 2 cm as well as for those with tumors < 2 cm. Consistent results were also observed in other subgroup analyses defined by gender, age, tumor stage, and co-morbidity status.


CONCLUSIONS
RFA provides better survival benefits than PEI for patients with unresectable stage I-II HCC, irrespective of tumors > 2 cm or ≤ 2 cm, in contemporary clinical practice.
Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan ; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Zhong-Zhe
ZZ
Lin
Wen-Yi
WY
Shau
Chiun
C
Hsu
Yu-Yun
YY
Shao
Yi-Chun
YC
Yeh
Raymond Nien-Chen
RN
Kuo
Chih-Hung
CH
Hsu
James Chih-Hsin
JC
Yang
Ann-Lii
AL
Cheng
Mei-Shu
MS
Lai
D000279:Administration, Cutaneous; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D015331:Cohort Studies; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D013624:Taiwan; D016896:Treatment Outcome
D000431:Ethanol