title: When to Perform Surgical Resection or Radiofrequency Ablation for Early Hepatocellular Carcinoma?: A Nomogram-guided Treatment Strategy.
abstract: Radiofrequency ablation (RFA) is indicated for early-stage hepatocellular carcinoma (HCC), but the comparative efficacy between RFA and surgical resection (SR) is inconclusive. We aim to develop a prognostic nomogram for predicting recurrence-free survival (RFS) after RFA. We also evaluate the possibility of using nomogram in improving treatment algorithm.We retrospectively enrolled 836 patients with Barcelona Clínic Liver Cancer very-early/early-stage HCC receiving SR or RFA. A visually-orientated nomogram was constructed with Cox proportional hazards model, and number and size of tumor, platelet count, albumin level, and model for end-stage liver disease score were included. The concordance index of the nomogram was 0.69.Radiofrequency ablation patients were stratified into low and high-risk groups by the median of nomogram scores. The RFS and overall survival (OS) of 2 risk groups were compared with SR patients with propensity score matching analysis. SR provided better RFS and OS compared with high-risk (nomogram score ≥9.8) RFA patients in the propensity model. The 5-year RFS rates were 36% versus 11%, whereas the 5-year OS rates were 74% versus 60% for SR and high-risk RFA groups, respectively (both P < 0.05). However, SR was associated with better RFS (5-year RFS rates 41% vs 29%), but similar OS (5-year OS rates 80% vs 81%), compared with low-risk (nomogram score <9.8) RFA patients in the propensity model (P < 0.05 and P > 0.05, respectively).In conclusion, this user-friendly nomogram offers individualized recurrence risk estimation and stratification for early HCC patients receiving curative RFA. The nomogram can be integrated into current treatment algorithm. SR should be considered the first-line treatment for high-risk patients to achieve better long-term survival.
authors.affiliation: From the Department of Medicine (P-HL, Y-HL, Y-HH, C-WS, H-CL, T-IH); Department of Surgery (C-YH); Department of Radiology, Taipei Veterans General Hospital, Taiwan (Y-YC); Faculty of Medicine (P-HL, Chia-Yang Hsu, Y-HL, Cheng-Yuan Hsia, C-WS, Y-YC, H-CL, T-IH); Institute of Clinical Medicine (Y-HH); Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan (T-IH); and Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV (C-YH).
authors.forename: Po-Hong
authors.initials: PH
authors.lastname: Liu
authors.forename: Chia-Yang
authors.initials: CY
authors.lastname: Hsu
authors.forename: Yun-Hsuan
authors.initials: YH
authors.lastname: Lee
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Hsia
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Su
authors.forename: Yi-You
authors.initials: YY
authors.lastname: Chiou
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D049451:Nomograms; D057216:Propensity Score; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology