Radiofrequency ablation is better than surgical resection in patients with hepatocellular carcinoma within the Milan criteria and preserved liver function: a retrospective study using propensity score analyses.
OBJECTIVE
Radiofrequency ablation (RFA) and surgical resection (SR) are effective therapies for hepatocellular carcinoma (HCC) within the Milan criteria. We aimed to compare the treatment efficacy according to the liver functional reserve using propensity score analysis.


METHODS
There were 330 and 369 HCC patients within the Milan criteria undergoing SR and RFA, respectively. A total of 147 and 48 pairs of patients with Child-Turcotte-Pugh (CTP) scores=5 and >5, respectively, were matched for analyses.


RESULTS
Overall, the 3- and the 5-year survivals were 88% and 76% in the SR group and 80% and 66% in the RFA group, respectively (P=0.006). The SR group had significantly younger patients, a higher male-to-female ratio and hepatitis B infection rate, with a better liver functional reserve and performance status, and a larger tumor burden. In patients with a CTP score of 5, no survival difference was noted between the SR and the RFA groups (P=0.564). In patients with CTP score >5, the SR group had a better long-term survival than the RFA group (P=0.016). After propensity score analysis, the RFA group had a better long-term survival than the SR group in patients with CTP score=5 in the univariate (P=0.024) and the Cox proportional hazards models (hazard ratio: 0.47, P=0.031). Comparable survival results were noted between SR and RFA in patients with CTP score >5 (P=0.15).


CONCLUSIONS
RFA is a safe procedure with better treatment efficacy than SR in patients with small HCC and a CTP score of 5, and provides effects comparable to SR in patients with CTP score >5. The baseline liver functional reserve may enhance treatment selection for outcome prediction.
*Faculty of Medicine ¶Institute of Clinical Medicine **Institute of Pharmacology, National Yang-Ming University School of Medicine Departments of ‡Medicine ∥Surgery #Radiology, Taipei Veterans General Hospital †Department of Medicine, Yuanshan Branch of Taipei Veterans General Hospital, Taipei, Taiwan §Department of Biostatistics, UCLA, Los Angeles, CA.
Yun-Hsuan
YH
Lee
Chia-Yang
CY
Hsu
Chen-Wei
CW
Chu
Po-Hong
PH
Liu
Cheng-Yuan
CY
Hsia
Yi-Hsiang
YH
Huang
Chien-Wei
CW
Su
Yi-You
YY
Chiou
Han-Chieh
HC
Lin
Teh-Ia
TI
Huo
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006305:Health Status Indicators; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome