title: An explorative data-analysis to support the choice between hepatic resection and radiofrequency ablation in the treatment of hepatocellular carcinoma.
abstract: BACKGROUND
  Whether to prefer hepatic resection or radiofrequency ablation as first line therapy for hepatocellular carcinoma is a matter of debate.
  
  
  OBJECTIVE
  To compare outcomes of resection and ablation, in the treatment of early hepatocellular carcinoma, through a decision-making analysis.
  
  
  METHODS
  Data of 388 cirrhotic patients undergoing resection and of 207 undergoing radiofrequency ablation were reviewed. Two distinct regression models were devised and used to perform sensitivity and probabilistic analyses, to overcome biases of covariate distributions.
  
  
  RESULTS
  Actuarial survival curves showed no difference between resection and ablation (P=0.270) despite the fact that ablated patients were older, with worse liver function and smaller, unifocal tumours (P<0.05), suggesting a complex, non-linear relationship between clinical, tumoral variables and treatments. Sensitivity and probabilistic analyses suggested that the superiority of resection over ablation decreased at higher Model for-End stage Liver Disease scores, and that ablation provided better results for smaller tumours and higher Model for-End stage Liver Disease scores. In patients with 2-3 tumours up to 3 cm, the two treatments produced opposite comparative results in relation to the Model for-End stage Liver Disease score.
  
  
  CONCLUSIONS
  The superiority, or the equivalence, of resection and ablation depends on the non-linear relationship existing between treatment, tumour number, size and degree of liver dysfunction.
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola - Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy. Electronic address: aleqko@libero.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola - Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Piscaglia
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola - Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola - Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Serra
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola - Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colecchia
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola - Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Maroni
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola - Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Venerandi
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola - Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola - Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D058625:End Stage Liver Disease; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Hepatocellular carcinoma; Liver function; Monte Carlo simulation; Radiofrequency ablation; Surgical therapy; Survival