title: Radiofrequency ablation as an alternative to hepatic resection for single small hepatocellular carcinomas.
abstract: BACKGROUND
  This study aimed to investigate whether radiofrequency ablation (RFA) is an alternative to surgical resection for hepatocellular carcinoma (HCC) within the context of current guidelines.
  
  
  METHODS
  This retrospective study included patients with normal portal pressure and serum bilirubin level who initially underwent liver resection or RFA for a single HCC of maximum size 3 cm. Between-group differences in cumulative rates of survival and recurrence specific for HCC were analysed in the entire cohort and in a propensity score-matched cohort.
  
  
  RESULTS
  A total of 604 patients were enrolled, 273 in the liver resection group and 331 in the RFA group. The 5- and 10-year HCC-specific survival rates for the resection and RFA groups were 87·6 versus 82·1 per cent and 59·0 versus 61·2 per cent respectively (P = 0·214), whereas overall 5- and 10-year recurrence-free survival rates for the corresponding groups were 60·6 versus 39·4 per cent and 37·5 versus 25·1 per cent respectively (P < 0·001). In the propensity score-matched cohort (152 pairs), there were no differences in HCC-specific survival (hazard ratio (HR) 1·03 for RFA versus resection; P = 0·899), whereas recurrence-free survival again differed between the treatment groups (HR 1·75; P < 0·001). RFA was independently associated with poorer outcomes in terms of treatment-site recurrence-free survival (adjusted HR 1·66; P = 0·026), but not non-treatment-site recurrence-free survival (adjusted HR 1·15; P = 0·354).
  
  
  CONCLUSIONS
  Although RFA carries a higher risk of treatment-site recurrence than hepatic resection, it provides comparable overall survival in patients with a single small HCC without portal hypertension or a raised bilirubin level.
authors.affiliation: Departments of Gastroenterology, Asan Liver Centre, Seoul, Korea.|Health Screening and Promotion Centre, Seoul, Korea.
authors.forename: G-A
authors.initials: GA
authors.lastname: Kim
authors.affiliation: Departments of Gastroenterology, Asan Liver Centre, Seoul, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Shim
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Departments of Radiology, Asan Liver Centre, Seoul, Korea.
authors.forename: S Y
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Departments of Radiology, Asan Liver Centre, Seoul, Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Won
authors.affiliation: Departments of Radiology, Asan Liver Centre, Seoul, Korea.
authors.forename: Y M
authors.initials: YM
authors.lastname: Shin
authors.affiliation: Departments of Radiology, Asan Liver Centre, Seoul, Korea.
authors.forename: P N
authors.initials: PN
authors.lastname: Kim
authors.affiliation: Departments of Surgery, Asan Liver Centre, Seoul, Korea.
authors.forename: K-H
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Departments of Surgery, Asan Liver Centre, Seoul, Korea.
authors.forename: S-G
authors.initials: SG
authors.lastname: Lee
authors.affiliation: Departments of Gastroenterology, Asan Liver Centre, Seoul, Korea.
authors.forename: H C
authors.initials: HC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D057216:Propensity Score; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome