title: Thermal Ablation versus Surgical Resection for the Treatment of Stage T1 Hepatocellular Carcinoma in the Surveillance, Epidemiology, and End Results Database Population.
abstract: OBJECTIVE
  To compare survival outcomes of small solitary hepatocellular carcinomas (HCCs) treated with thermal ablation vs resection in the Surveillance, Epidemiology, and End Results (SEER) cohort.
  
  
  METHODS
  SEER data (November 2014 submission) were searched for histologic diagnoses of HCC and stage T1 disease (≤ 5-cm solitary tumor without vascular invasion). Comparison was made between thermal ablation and resection as the primary treatment. Overall and disease-specific survival were compared by log-rank tests (stratified for presence of fibrosis) and Cox regression (with tumor size and presence of fibrosis covariates).
  
  
  RESULTS
  Of 264 patients with ≤ 2-cm HCCs, 185 underwent thermal ablation and 79 underwent resection. Patients undergoing ablation had higher Ishak scores (P = .0002). There was no difference in survival (observed P = .698, disease-specific P = .446). Of 544 patients with 2.1-4-cm HCCs, 335 underwent thermal ablation and 209 underwent resection. Patients undergoing ablation were more likely to have higher Ishak scores (P < .001), but had slightly smaller tumors (2.9 vs 3.1 cm; P < .001). There was no difference in survival (observed P = .174, disease-specific P = .609). Of 112 patients with 4.1-5-cm HCCs, 46 underwent thermal ablation and 66 underwent resection. Patients undergoing ablation had higher Ishak scores (P = .0002). Surgical resection was associated with improved survival (observed P = .009, disease-specific P = .046).
  
  
  CONCLUSIONS
  There was no difference in overall or disease-specific survival between surgical resection and thermal ablation for T1 HCCs ≤ 4 cm after adjusting for the presence of histologic fibrosis and tumor size in the SEER cohort. Significant benefit was observed with surgery for tumors measuring 4.1-5 cm.
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital and Mount Sinai Hospital, University of Toronto, NCSB 1C-568, 585 University Ave., Toronto, ON, Canada M5G 2N2.
authors.forename: Oleg
authors.initials: O
authors.lastname: Mironov
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital and Mount Sinai Hospital, University of Toronto, NCSB 1C-568, 585 University Ave., Toronto, ON, Canada M5G 2N2.
authors.forename: Arash
authors.initials: A
authors.lastname: Jaberi
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital and Mount Sinai Hospital, University of Toronto, NCSB 1C-568, 585 University Ave., Toronto, ON, Canada M5G 2N2. Electronic address: john.kachura@uhn.ca.
authors.forename: John R
authors.initials: JR
authors.lastname: Kachura
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000401:mortality; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014481:United States