title: Surgical resection versus ablation for hepatocellular carcinoma ≤ 3 cm: a population-based analysis.
abstract: BACKGROUND
  Ablation for ≤ 3-cm hepatocellular carcinoma (HCC) has been demonstrated to be an effective treatment strategy. The present study sought to examine the outcomes of patients with ≤3 cm HCC after ablation versus resection.
  
  
  METHODS
  Patients treated by ablation or surgical resection for ≤ 3 cm T1 HCC were identified from the National Cancer Database (2002-2011). Survival outcomes were analysed according to propensity score modelling.
  
  
  RESULTS
  A total of 2804 patients underwent ablation (n = 1984) or a resection (n = 820) for solitary HCC ≤ 3 cm. Patients treated with ablation as compared with a resection had a higher frequency in alpha-fetoprotein level (AFP) elevation (46.5% versus 39.1%, P < 0.01) and the presence of cirrhosis (22.2% versus 14.5%, P < 0.01). Unadjusted overall survival (OS) at 3 and 5 years was greater after a resection (67%, 55%) versus ablation (52%, 36%, P < 0.01). After propensity score matching, the improved overall survival (OS) was sustained among the resection cohort (5 year OS: 54% versus 37%, P < 0.001). In multivariable models, a resection was independently associated with an improved OS [hazard ratio (HR): 0.62, 95% confidence interval (CI): 0.48-0.81; P < 0.01].
  
  
  CONCLUSIONS
  Resection of HCC ≤ 3 cm results in better long-term survival as compared with ablation. Treatment strategies for small solitary HCC should emphasize a resection first approach, with ablation being reserved for patients precluded from surgery.
authors.affiliation: Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Miura
authors.affiliation: Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Fabian M
authors.initials: FM
authors.lastname: Johnston
authors.affiliation: Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Tsai
authors.affiliation: Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Eastwood
authors.affiliation: Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Anjishnu
authors.initials: A
authors.lastname: Banerjee
authors.affiliation: Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Christians
authors.affiliation: Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
authors.affiliation: Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance; D011379:Prognosis; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014922:Wisconsin / Q000453:epidemiology