title: Small Hepatocellular Carcinoma: Radiofrequency Ablation versus Nonanatomic Resection--Propensity Score Analyses of Long-term Outcomes.
abstract: OBJECTIVE
  To compare radiofrequency (RF) ablation with nonanatomic resection (NAR) as first-line treatment in patients with a single Barcelona Clinic Liver Cancer (BCLC) stage 0 or A hepatocellular carcinoma (HCC) and to evaluate the long-term outcomes of both therapies.
  
  
  METHODS
  This retrospective study was approved by the institutional review board. The requirement for informed consent was waived. Data were reviewed from 580 patients with HCCs measuring 3 cm or smaller (BCLC stage 0 or A) who underwent ultrasonographically (US) guided percutaneous RF ablation (n = 438) or NAR (n = 142) as a first-line treatment. Local tumor progression, intrahepatic distant recurrence, disease-free survival, and overall survival rates were analyzed by using propensity score matching to compare therapeutic efficacy. In addition, major complications and length of postoperative hospital stay were compared.
  
  
  RESULTS
  Before propensity score matching (n = 580), the 5-year cumulative rates of local tumor progression for RF ablation and NAR (20.9% vs 12.7%, respectively; P = .093) and overall survival rates (85.5% vs 90.9%, respectively; P = .194) were comparable, while the 5-year cumulative intrahepatic distant recurrence rates (62.7% vs 36.6%, respectively; P < .001) and disease-free survival rates (31.7% vs 61.1%, respectively; P < .001) in the NAR group were significantly better than those in the RF ablation group. After matching (n = 198), there were no significant differences in therapeutic outcomes between the RF ablation and NAR groups, including 5-year cumulative intrahepatic distant recurrence (47.0% vs 40.2%, respectively; P = .240) and disease-free survival rates (48.9% vs 54.4%, respectively; P = .201). RF ablation was superior to NAR for major complication rates and length of postoperative hospital stay (P < .001).
  
  
  CONCLUSIONS
  In patients with one BCLC stage 0 or A (≤ 3 cm) HCC who received RF ablation or NAR as first-line treatment, there were no significant differences in long-term therapeutic outcomes; however, RF ablation was associated with fewer major complications and a shorter hospital stay after treatment.
authors: From the Department of Radiology and Center for Imaging Science (T.W.K., H.R., M.W.L., Y.S.K., H.K.L., D.C., K.D.S.), Department of Surgery (J.M.K., C.H.D.K., J.W.J.), Division of Hepatology, Department of Medicine (S.W.P., Y.H.P.), and Biostatics Unit, Samsung Biomedical Research Institute (J.H.A.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-gu, Seoul 135-710, Korea.
authors: Tae Wook
authors: TW
authors: Kang
authors: Jong Man
authors: JM
authors: Kim
authors: Hyunchul
authors: H
authors: Rhim
authors: Min Woo
authors: MW
authors: Lee
authors: Young-sun
authors: YS
authors: Kim
authors: Hyo Keun
authors: HK
authors: Lim
authors: Dongil
authors: D
authors: Choi
authors: Kyoung Doo
authors: KD
authors: Song
authors: Choon Hyuck David
authors: CH
authors: Kwon
authors: Jae-Won
authors: JW
authors: Joh
authors: Seung Woon
authors: SW
authors: Paik
authors: Yong Han
authors: YH
authors: Paik
authors: Joong Hyun
authors: JH
authors: Ahn
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D057216:Propensity Score; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome